Low Testosterone (Low T)

As men age, it is common for many to experience low testosterone. Low testosterone is also referred to as low T, or clinically referred to as hypogonadism. Testosterone is the male sex hormone that circulates in the bloodstream. With age, levels of testosterone naturally decline. While this is normal, in certain circumstances it may cause related health issues.


The causes of low testosterone can be multifactorial. Testosterone naturally declines with age. Stress and temporary illness can cause temporary low testosterone. Testicular dysfunction can also be caused by varicocele, varicose veins of the testicle. Low testosterone is strongly associated with metabolic syndrome (hypertension, hyperlipidemia, obesity). Obesity is inversely correlated with obesity, the heavier a person is, the lower they’re testosterone will be. Oftentimes, we do not find a cause for low testosterone, and the causes unknown.


Decreased sex drive, energy, muscle mass, and exercise tolerance are all common with low testosterone. Other related symptoms can include erectile dysfunction, change in cognitive function, irritability, mood change, depression, iron deficiency, and osteoporosis. Most commonly men with low testosterone feel tired throughout the day.


A simple blood test will indicate whether or not an individual has low testosterone levels, and will also be able to point out any possible underlying conditions that are the root cause of low testosterone. Your doctor will also conduct a physical exam and medical history screening.


There are 2 ways to bring testosterone level up which include either testosterone replacement therapy or trying to increase one’s alone natural production of testosterone. Testosterone replacement therapy includes testosterone injections, testosterone transdermal gels, subcutaneous testosterone pellets, and a testosterone skin patch. While there are no diets or exercise regimen that can improve once and natural testosterone, natural production of testosterone can be increased by taking a fertility medication called Clomid.


 What are the options for testosterone replacement?
1. Testosterone injections: There are 2 types of injections, short-acting a long-acting injections. Testosterone cypionate, can be done at home every 1-2 weeks depending upon the regimen your doctor prescribes. The long-acting injections, Aveed (testosterone undecanoate), as administered in the office once every 10 weeks. Insurance usually covers both of these. Even if insurance does not cover the short-acting injections are generic and cheap over-the-counter, usually around $30 a month. Aveed, testosterone undecanoate, is the ten-week testosterone injection that is slow release every 10 weeks.
2. Testosterone patch: This is a daily patch of testosterone that is absorbed through the skin. Unfortunately usually causes a rash.
3. Testosterone gel: Daily application of a testosterone gel on either the shoulders size orbits depending on the type gel.
4. Subcutaneous testosterone pellets: 7-10 testosterone pellets can be placed underneath the skin in the upper buttock area. This office procedure is done every 3-4 months.

What are the medical options for increasing natural production of testosterone?
Clomid, or clomiphene citrate, is a fertility medication that tricks the body into thinking it does not produce any testosterone so the brain sends more signals to the testicles to make them produce more testosterone. Because it is a fertility medication, it is rarely covered by insurance. However, it is generic and should not cost more than $20-25 a month.

What are the side effects of testosterone replacement?

When someone receives testosterone, their body may interpret it that they’re making too much, so the testicles shut down. This can cause infertility as well as testicular shrinkage. the blood to become too concentrated as well as an asymptomatic elevation in liver enzymes. The side effects should be monitored by periodic labs. It is currently unknown if testosterone replacement increases, decreases, or has no effect on cardiovascular events. The FDA warnings that there may be an increased risk of cardiovascular events. Testosterone replacement does not increase your risk for prostate cancer however if you’re diagnosed with prostate cancer you will probably be told to stop your testosterone replacement since it can exacerbate prostate cancer.

What is considered low testosterone?

There is actually no standard definition of low testosterone. The American Endocrine Guidelines say to use the reference ranges as provided by the lab which can vary from lab to lab. In general, testosterone less than 300 or 350 is considered low.

Will any of these treatments allow me to produce testosterone without having to take any medications in the future?
No, you need to continue the treatment to keep your testosterone.

How does obesity affect one’s testosterone level?
Testosterone is metabolized by the fatty tissue. The heavier someone is and the higher the BMI, the lower their testosterone will be.

Is one treatment better than another?
There is no best treatment per se. The best regimen is based upon informed discussion between physician and patient and to using the option that is most acceptable to the patient. Insurance will cover most of the testosterone options.

Virginia Urology has several locations in Central Virginia, including Richmond, Petersburg, Emporia, Prince George, Mechanicsville, and Midlothian.  Call (804) 330-9105 today to schedule an appointment regarding your low T symptoms.