Introduction
Hi, I’m Dr. Caplan from Helios Telemedicine for Men.
Our topic today is, “Treatment of Testosterone Deficiency, a Quick Overview.” OK, so you have been diagnosed with symptomatic testosterone deficiency, AKA symptomatic male hypogonadism or symptomatic Low-T.
What can we do about it?
Overview
- First, we have to know is it primary, secondary, or mixed and how severe is it?
- Second, it took years to get here so it will take months to recover. Be patient.
- Third, regardless of the treatment, some recommend stopping after 6 months to see if your system has reset itself for a permanent “cure”, but in most men, treatment will be lifelong.
Secondary Testosterone Deficiency
In secondary hypogonadism the hypothalamus or pituitary gland fail to stimulate the testes enough resulting low testosterone levels.
Most strategies for treating uncomplicated secondary hypogonadism revolve around stimulating the hypothalamus to release more gonadotropin releasing factor to stimulate the pituitary gland to release more LH and FSH to stimulate the testes to make and release more testosterone.
This effort may include medications such as Clomid to block the estrogen receptors in the hypothalamus, medications like Anastrozole to prevent conversion of testosterone into the estradiol by the fat cells, use of various vitamins, herbs, and supplements, or some combination of them.
Primary Testosterone Deficiency
In primary testosterone deficiency, it is the testes which are failing.
It may be that they are trying but need is a higher level of stimulation than they are getting to get over the hump, so if the LH is not particularly elevated, we can try to treat primary hypogonadism I stimulating pituitary activity.
Many refer to start with this method as it stimulates the control axis, preserving fertility and avoiding some of the risks of testosterone replacement therapy. If this method does not work, or if after consultation with the clinician and patient agree to go with testosterone replacement therapy. Testosterone may be delivered in a variety of media including tablets that are swallowed, tablets or troches that dissolve in her mouth, creams, gels or patches that are applied to the skin, injections into the muscles or into the fat under this skin, or pellets that are inserted into the fat under the skin.
Regardless of the method of delivery, testosterone replacement therapy usually needs adjustments to get the right dosage and always needs careful follow-up to monitor for complication such as increase in blood count which may cause an increased risk for blood clots, shrinkage of the testes because the testosterone we give shutdown the stimulation from the pituitary gland, potential issues with fertility, and potential issues with rising estradiol levels.
Symptomatic Testosterone Deficiency
There are also special cases of symptomatic testosterone deficiency which do not fit into the convenience primary and secondary categories.
The most common of which is likely to be elevated SHBG, which could be treated by lifestyle changes to try to bring the SHBG levels down.
Other cases may be due to prior or ongoing use of anabolic steroids, the use of certain medications, chronic disease, or genetic factors.
What’s Next?
We will go into more in depth discussions of many of these therapeutic techniques over the next few weeks.
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