TRT San Diego

Understanding Low Testosterone in Men

Decline of Testosterone with Age

Men usually reach their peak testosterone levels in their early thirties. After this, a gradual decline typically begins around the mid-thirties, decreasing at a rate of about 1-3% annually. It's a common misconception that low testosterone is just a standard aspect of aging. However, this decline can lead to hypogonadism, a condition distinct from normal aging. Hypogonadism can adversely affect life quality, increasing the risk of heart disease and cognitive issues.

Causes of Reduced Testosterone Production

As men age, the pituitary gland, which signals testosterone production, may function less effectively. Additionally, the testicular cells responsible for testosterone production might become less responsive. This leads to lower testosterone levels in the blood. Other factors contributing to low testosterone include:

• Poor diet and obesity, which can elevate levels of estradiol, leptin, and adipokines.
• Use of alcohol, opioids, or previous anabolic steroid use.
• Lack of sufficient sleep.
• Pituitary gland disorders, including Kallman’s syndrome.
• Testicular injuries or conditions like undescended testicles.
• Autoimmune disorders.
• Conditions such as HIV/AIDS.
• Exposure to chemotherapy and radiation.

Symptoms Indicative of Low Testosterone

Individuals with low testosterone may exhibit various symptoms, including:

• Reduced sexual desire and weaker erections.
• General fatigue and a drop in energy levels.
• Irritability and mood swings.
• Decreased muscle mass and increased abdominal fat.
• Symptoms of depression.
• Infertility issues.
• Concentration difficulties or mental cloudiness.
• Development of breast tissue (gynecomastia).
• Loss of bone density, leading to conditions like osteopenia or osteoporosis.

Diagnosing and Addressing Low Testosterone

The approach to diagnose low testosterone is symptom-driven. Men are typically evaluated for testosterone deficiency only if they exhibit certain symptoms. Blood testosterone levels alone aren't the sole factor in determining the need for testosterone supplementation. Tools like the Androgen Deficiency in Aging Males (ADAM) questionnaire help in assessing symptoms:

• Do you have a decreased libido?
• Have you experienced a lack of energy?
• Reduced physical strength or endurance?
• Have you noticed any height loss?
• Have you noticed a lower enjoyment of life?
• Feelings of sadness or irritability?
• Do you have weaker erections?
• Have you had a deterioration in sports performance?
• Do you have increased sleepiness after-eating dinner?
• Have you had a decline in work productivity?

Answering "yes" to question 1 or 7, or any three other questions, suggests the possibility of low testosterone. In such cases, hormone supplementation might be beneficial, and further laboratory tests may be considered for accurate assessment.

Challenges in Defining Low Testosterone

The primary issue with identifying low testosterone through laboratory reference ranges lies in their inaccuracy. Different labs establish their reference ranges based on a limited sample of patients, such as 20 random males of varying ages. When treating a patient showing low testosterone symptoms, doctors typically administer testosterone and reevaluate the patient after six weeks. Improvement in symptoms is an indicator of low testosterone, confirming the need for ongoing supplementation. However, it's crucial to avoid excessively high testosterone levels due to associated health risks. The treatment aim is to restore testosterone levels to what they were in the patient's twenties.

Natural Methods to Boost Testosterone

While natural methods can increase testosterone levels, they are generally insufficient for men diagnosed with hypogonadism or significant testosterone deficiency. These methods are more suited to men without severe symptoms who seek a modest increase in testosterone. They include:

• Regular exercise and weight lifting.
• Reducing stress and cortisol levels.
• Vitamin D supplementation for if you are deficient.
• Ensuring adequate sleep, as sleeping less than five hours can lower testosterone by 10-15%.
• Avoiding exposure to endocrine-disrupting chemicals like BPA, parabens, and certain plastics.
• Limiting alcohol intake to prevent testicular atrophy.

Understanding Bio-Identical Hormone Pellets

Bio-Identical Hormone pellets, tiny like a grain of rice, consist of natural testosterone, not synthetic hormones. They differ from injectable testosterone, which can cause allergic reactions due to additives and often leads to higher estrogen production. Unlike injections, which cause hormone level fluctuations, pellets offer a steady, controlled hormone release over several months. The hormone levels peak around six weeks post-implantation and gradually decrease over 4-5 months, providing a more predictable hormone level.

Advantages of Testosterone Supplementation for Men with Low Levels

Testosterone supplementation in men with low levels offers a range of benefits:

• Boosts libido and enhances sexual satisfaction.
• Alleviates erectile dysfunction symptoms.
• Increases energy levels and improves focus.
• Enhances lean muscle mass while reducing abdominal fat.
• Elevates mood and can improve sleep quality.
• Offers protection against depression and cognitive disorders like Alzheimer's.
• Strengthens bone density.
• Reduces triglycerides, LDL cholesterol, and overall cholesterol levels.
• Lowers the risk of cardiovascular incidents, such as heart attacks.

Side Effects and Management of Testosterone Supplementation with Bio-Identical Hormone Therapy

Bio-Identical Hormone pellets aim to restore testosterone to levels typical of a man's twenties, usually without long-term side effects. During the initial 3-4 weeks, some men may experience temporary irritability or aggressiveness. Follow-up checks at 14-16 weeks post-pellet placement help maintain optimal testosterone levels.

Testosterone can convert into estrogen in the body, leading to increased estrogen symptoms in some men. In such cases, Letrozole, an aromatase blocker taken twice monthly, is prescribed.

High testosterone levels can lead to various health issues, including increased blood pressure, cardiovascular risks, prostate enlargement, mood changes, insomnia, and excessive hair growth. However, these issues do not arise with Bio-Identical Hormone pellet supplementation, as it targets maintaining testosterone within normal healthy ranges. Many patients with low testosterone symptoms often have serum testosterone levels around 300-400 ng/dL, and the goal post-supplementation is to reach approximately 1000 ng/dL.

Testosterone Supplementation and Pregnancy Planning

Men planning a pregnancy within the next 6-12 months should generally avoid testosterone supplementation. Externally sourced testosterone can lower internal testosterone production, crucial for sperm development. Consequently, this can lead to a significant reduction in sperm count (azoospermia) in a majority of men within four months of starting treatment.

For men aiming to preserve fertility, medications like clomiphene and enclomiphene, which stimulate hormone production in the pituitary gland and thereby increase testosterone and sperm production, can be a viable alternative.

The Procedure for Hormone Supplementation

For those interested in hormone supplementation:

1. Contact the clinic for a consultation with a physician.
2. Complete necessary medical intake forms through the online portal.
3. Undergo a medical evaluation to discuss symptoms, health concerns, and treatment options.
4. The clinic utilizes the SottPelle dosing algorithm, considering symptoms and lab results to determine the optimal hormone dose.
5. Pellet placement, a quick office procedure, follows.
6. Benefits typically begin to manifest 3-4 weeks after pellet placement.
7. Follow-up labs are conducted six weeks post-implantation to ensure optimal hormone levels. If symptoms persist, additional pellets may be administered.
8. Pellets generally last 3-4 months, with repeat lab tests guiding future doses.