Testosterone replacement therapy (TRT) is a common treatment prescribed by doctors for men with clinically low testosterone levels. The decision to prescribe TRT depends on several factors:
Symptoms
- Do you have symptoms associated with low testosterone such as low sex drive, erectile dysfunction, decreased energy, mood changes, or loss of muscle mass? Your doctor will evaluate your symptoms to determine if they may be caused by low testosterone.
Blood Tests
- Your doctor will order blood tests to check your total testosterone, free testosterone, and other hormone levels. If both your symptoms and blood tests indicate low testosterone, TRT may be prescribed. The Endocrine Society defines low testosterone as total testosterone below 300 ng/dL and free testosterone below 5-9 pg/mL.
Medical History
- Your doctor will consider your overall health and medical history. TRT may not be advised if you have certain medical conditions that could be aggravated by testosterone therapy.
Age
- TRT is generally only prescribed for men over 30 years old. Peak testosterone levels are reached in the late teens to early 20s, then gradually decline with age.
Failure of Other Treatments
- Your doctor may first recommend lifestyle changes like weight loss, improved diet, exercise, and stress reduction. If symptoms persist despite such changes, TRT may then be considered.
Exam and Diagnostic Testing
- A full physical exam and diagnostic testing will be done to identify any underlying cause of low testosterone besides normal aging. If a condition is found, it will be treated first before considering TRT.
Risks vs. Benefits
- Your doctor will thoroughly discuss the potential risks and benefits of TRT to determine if it is appropriate for you. While TRT can effectively treat low testosterone symptoms, there are possible side effects like polycythemia, sleep apnea worsening, testicular atrophy, and fertility issues that your doctor must consider.
If TRT is prescribed, it is usually administered weekly by injection, transdermal gel, or patch. You will start at a low dose which is gradually adjusted based on follow up blood tests, symptom monitoring, and evaluation of any side effects. Close medical supervision is necessary throughout treatment.
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