Tinkering with your testosterone levels without direction from a qualified specialist can cause other health issues, such as testicular atrophy, infertility, and an increased risk of prostate cancer.

An estimated 1 in 50 men has low T and experience symptoms such as less energy, decreased libido (sex drive), erectile dysfunction, lack of concentration, or trouble sleeping. Around age 30, a man’s testosterone levels may slowly begin to decline. Approximately 35% of men in their 70s have low T, according to the American Urological Association.

But we’re beginning to see more men in their 20s with low T at the UT Southwestern male urology clinic. Sometimes low T is caused by medical conditions, such as genetic diseases or past chemotherapy or radiation therapy. More often, symptoms can be linked to a sedentary lifestyle, poor diet, anxiety, or depression.

Safe, successful low T treatments start with personalized conversations.

What’s a normal testosterone level?

Testosterone is a natural hormone produced primarily in the testicles, and it helps men maintain everything from bone density and body hair to sex drive and sperm production. However, you don’t have to hit a certain number or level to be “a real man,” despite what the constant flow of ads may tell you. What matters is who you are and where you are in your life.

On average, a testosterone level of 300–1,000 nanograms per deciliter (ng/dL) of blood is normal. Hypogonadism – reduced testicular function – generally occurs when the total testosterone is less than 300 ng/dL. However, a healthy level for you depends on your age, lifestyle, and bioavailable testosterone level – the unbound testosterone your body isn’t using for daily functions.

Unlike many low T clinics, we calculate bioavailable testosterone by measuring levels of two proteins, sex hormone-binding globulin, and albumin, that typically bind to testosterone. It’s possible to have a normal total testosterone level and experience low T symptoms if this balance is off.

Having a normal bioavailable testosterone level tells us your body is making plenty and you likely won’t benefit from testosterone replacement therapy. If your bioavailable testosterone level is low, we can discuss options.

When testosterone therapy might help

Men who are no longer interested in conceiving may benefit from safe, monitored testosterone replacement therapy. Some patients with genetic issues that cause subfertility, such as Klinefelter’s syndrome, may also benefit.

Losing weight through exercise and eating a healthy diet can help naturally improve testosterone levels.

What results can you expect from testosterone replacement therapy?

Over time, TRT restores your body’s testosterone levels and most men will begin to experience some symptom relief in as little as one month. Symptoms will continue to improve over time with the proper course of treatment.

For many men, the results of testosterone replacement therapy can be truly life-changing:

• increased energy and stamina;
• restored sex drive;
• the vast improvement of erectile dysfunction (ED);
• increased muscle mass and overall bone density;
• better moods and diminished feelings of depression.

Natural options

• Lose a few pounds: Approximately 30% of obese men have low T. Since muscle burns more calories than fat, the more muscle you have, the less likely your body is to store excess calories as fat. However, some research suggests that low T contributes to weight gain – it’s a vicious cycle. Start by cutting belly fat, which is good for your heart health and general wellness.
• Eat a healthy diet: For full-body health and hormone balance, consider the Mediterranean diet, which focuses on lean proteins, healthy fats, and plant-based foods. Also enjoy foods that are high in vitamin D, which supports testosterone production, strong bones, and mood. Some of these include eggs, salmon, and mushrooms.
• Rethink online viewing habits: Pornography is readily available online and it can perpetuate skewed expectations for what masculinity and sexual virility should feel like. Your body was not designed to perform sexually for hours on end – what you’re seeing on the screen is cinematography, not reality.

Medication options

Clomiphene citrate pills: The drug Clomid binds to estrogen receptors in the brain that cause negative feedback on testosterone production. The result is an increase in LH and FSH production. My mentor gave a great analogy for this process. It’s like putting an ice pack on a thermostat to trick it into cranking out more heat. Clomid encourages the brain to make more LH and FSH, and therefore make more natural testosterone.

Injections: The hormone hCG can substitute for LH. Patients typically manage these short- or long-term therapies at home. We typically prefer not to prescribe testosterone injections for men in their late 20s and 30s, as these treatments are more likely to cause infertility. Exceptions would be individuals with a genetic problem that interferes with fertility or men who do not want to conceive.

Aromatase inhibitor: The drug Anastrozole, more commonly used in breast cancer treatment, blocks the conversion of testosterone to estrogen. We typically prescribe this medication when there is a pertinent need because it can drive the estrogen level too low, resulting in fragile bones.

Gels: This option offers varying degrees of absorption, and you must allow the gel to dry before getting dressed. Women should not make contact with the gel to avoid increasing their own testosterone level, which can cause side effects such as unwanted body hair.

Nasal spray: A new drug, Natesto, allows for at-home dosing of testosterone with less risk of fertility loss. The testosterone absorbs through the lining of the nose, and the application takes about 10 seconds per dose, three times a day.

Patches: Similar to a nicotine patch, this option trickles testosterone into the system through the skin. Patches last about 24 hours and must be placed on an area of the body that is free of hair, oil, or irritation. It also can’t go over a bone or joint that will be disturbed by sitting, sleeping, or moving. You should not “reuse” a spot for at least seven days. Patches are not approved for age-related hypogonadism.

Testosterone pellets: We can implant testosterone pellets into the fatty tissue above the buttock area. The pellets hold crystalized testosterone, which releases into the body over four to six months.

Note:

Risks of testosterone therapy may include blood clots in the case of improper dosage and misuse of testosterone or testicular shrinkage in case testosterone is used without human chorionic gonadotropin which is prescribed to store fertility and normal sperm production. If the therapy is prescribed by a qualified professional and based on preliminary diagnostics and lab tests as well as if it is regularly monitored by a doctor during the cycle, then no risks are possible.

For any additional questions, apply for a free consultation here.