Understanding Low Testosterone
Testosterone is the primary male sex hormone, playing crucial roles in muscle mass, bone density, libido, mood, energy, and cognitive function. Low testosterone (hypogonadism) affects an estimated 20-40% of men over 45.
Source: Wikimedia Commons
Signs and Symptoms of Low Testosterone
Physical Symptoms
- Decreased muscle mass and strength
- Increased body fat (especially abdominal)
- Fatigue and low energy
- Hair loss
Sexual Symptoms
- Reduced libido
- Erectile dysfunction
- Decreased frequency of morning erections
Mental/Emotional Symptoms
- Depression or low mood
- Brain fog
- Poor sleep quality
Diagnosing Low Testosterone
The American Urological Association defines low testosterone as total testosterone below 300 ng/dL measured on two morning blood tests.
| Test | Purpose | |------|---------| | Total Testosterone | Primary diagnostic marker | | Free Testosterone | Bioavailable fraction | | LH/FSH | Distinguish primary vs. secondary | | PSA | Prostate screening baseline |
TRT Treatment Options
1. Testosterone Injections (Most Common)
- Testosterone cypionate or enanthate
- Injected weekly or bi-weekly
- Most cost-effective option
2. Topical Gels/Creams
- Applied daily to skin
- Convenient but risk of transfer
3. Testosterone Pellets
- Implanted under skin every 3-6 months
4. Nasal Gel (Natesto)
- Applied inside nostrils 3x daily
Benefits of TRT
When testosterone levels are properly optimized:
- Increased muscle mass (+3-5 kg lean mass over 12 months)
- Reduced body fat
- Improved libido and sexual function
- Better mood and reduced depression
- Enhanced cognitive function
- Improved bone density
Risks and Monitoring
Potential Risks:
- Erythrocytosis (increased red blood cells)
- Fertility suppression
- Sleep apnea may worsen
Required Monitoring:
- 3 months: Testosterone levels, CBC, PSA
- 6 months: Repeat + lipid panel
- 12 months: Comprehensive panel
- Annually thereafter
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Frequently Asked Questions
At what age should men consider TRT?
It depends on symptoms and lab results. Testosterone naturally declines about 1% per year after age 30. Men experiencing symptoms should get tested regardless of age.
Does TRT cause hair loss?
TRT can accelerate hair loss in men genetically predisposed to male pattern baldness. Discuss options like finasteride with your doctor.
Can you stop TRT once you start?
Yes, but natural testosterone production may take 3-6 months to recover. Some men need post-cycle therapy.