Man feeling tired

We’ve all heard those commercials about low testosterone or Low T on television and sports-talk radio, with former sports stars sharing their solution to feeling sluggish and less virile. If you’re not feeling like the man you used to be, there’s no reason to panic. But you probably have questions.

Dr. Evan Lacefield, MD, urologist at Memorial Hermann Medical Group (MHMG) Cypress Multi-Specialty shares what you need to know about testosterone and Low T.

What is testosterone?

Two small glands in the brain – the hypothalamus and the pituitary – release chemical messengers known as hormones, and these travel via the bloodstream to a male’s gonads, or testicles. There, they spur production and release of testosterone, the primary male sex hormone.

Females also have testosterone, but in smaller amounts, just as males also have low amounts of estrogen. Estradiol, its chief form, helps modulate libido, erectile function and sperm count.

When these hormonal triggers slow down, as they naturally do with age, men could experience low testosterone levels. As a result, they could have fatigue, poor sleep, mood swings, brain fog, hair loss, reduced muscle tone and low libido or sex drive—some of the same symptoms that women report post-menopause.

How do you detect Low T?

Beyond experiencing the symptoms listed above, how else would you know if you have Low T? Additional testing such as bloodwork may reveal anomalies, not just in your testosterone levels but also in other hormone levels as well.

Besides checking levels of testosterone, Dr. Lacefield also checks for follicle-stimulating hormones (FSH) and luteinizing hormones (LH). The last two brain chemicals travel via your blood to deliver messages to your testicles to produce testosterone and sperm.

Normal levels of testosterone in men are between 300 and 1,000 nanograms per deciliter (ng/dL). Anything below 250 to 320, depending on the lab, is low, he says.

How low is concerning?

“We try to not go strictly on numbers,” Dr. Lacefield says. “Your body won’t feel great at 301 and terrible at 299. So, we also ask whether you have any symptoms.”

One number can matter greatly, though. If your testosterone levels are below 100, then other tests may be needed to make sure that there aren’t more serious issues present, such a pituitary gland tumor.

How do you treat Low T?

You’ve probably heard about testosterone replacement therapy, or TRT, but it’s not the sole solution to addressing Low T. “If only it were that simple,” Dr. Lacefield says. “Treatment is actually multi-pronged.” 

As with so many health issues, lifestyle habits can be a major contributor to a problem. Also, your general health can affect your testosterone levels, especially if you are overweight, diabetic or taking certain medications.

Independently of TRT, eating more lean meat and getting more exercise and sleep can help raise your energy level.  

Your doctor also may prescribe a medicine that strengthens the signal from the hypothalamus to your testicles. “It can help the body produce more testosterone on its own, and you’ll remain fertile,” Dr. Lacefield says.

Testosterone can also be raised by applying certain patches, gels, creams or sticks. You may get the hormone via weekly injections—possibly at home.

Doctors don’t want to transform you into an energy junkie or bodybuilder. “Testosterone will not affect you as if you are consuming energy drinks,” Dr. Lacefield says. “That’s not our goal, but if you don’t feel like getting off the couch when you get home from work, then we can improve that.”

But be careful where you seek help. “Lots of places will sell you testosterone,” Dr. Lacefield says, “but you won’t get a thoughtful evaluation.” 

Given the complexity of resolving low T—and the small but dangerous risk of pituitary tumors—you should see your primary care health provider or urologist.

Can raising testosterone cause a heart attack or stroke?

Recent research shows that supplemental testosterone will not cause cardiovascular disease, Dr. Lacefield says. In fact, it may provide additional protection against disease.

Does TRT fix erectile dysfunction?

While TRT can help restore sex drive, testosterone levels are not the driving factor of erectile dysfunction. “Testosterone is not a treatment for erectile dysfunction,” Dr. Lacefield says. “There are four approved treatments for that.”

Types of treatments can include oral or injectable medications, vacuum devices or surgically implanted prostheses.

After TRT, are you done?

Not necessarily. Since some testosterone converts to estrogen, male patients may require an estrogen blocker to regulate their hormones. A patient’s red blood cell count will need to be monitored as an excess could raise their risk of blood clots. 

“Also, a fair number of men on testosterone therapy can develop infertility,” Dr. Lacefield says. “Your body may stop making sperm because the brain signals to the testicles that you’ve got testosterone.” 

Talk to your doctor if you’re concerned about your fertility. 

Other possible side effects of testosterone replacement include acne, excess red blood cells, an enlarged prostate, enlarged breasts, shrinking testicles and worsened sleep apnea.

“The way we prevent problems is to watch and see how men feel,” Dr. Lacefield says. “If they feel fantastic, then great. We’re done.” 

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