Low Testosterone (Low T)

What is low testosterone (hypogonadism)?

Hypogonadism, or low testosterone, is a reduction in the amount of testosterone being produced by the body. Patients experiencing hypogonadism may report fatigue, erectile dysfunction, lack of motivation, diminished libido, loss of lean muscle mass, and decreased bone density.

What causes low testosterone?

Hypogonadism can be classified as either primary or secondary.  Primary hypogonadism results from a problem within the testicles causing a deficiency in testosterone. This is also considered classic hypogonadism and occurs more frequently in younger men who might be suffering from Klinefelter’s syndrome, or in men who have had one or both testicles removed (from prostate or testicular cancer). 

Secondary hypogonadism involves a breakdown in communication between the hypothalamus or pituitary gland and its communication with the testes.  This breakdown can be caused by, and is often associated with, obesity and its vascular comorbidities. Additional factors contributing to hypogonadism may include aging, obesity (specifically, visceral adiposity), sedentary lifestyle, pituitary disorders, diabetes, chronic pain and opiate use, hypertension, and men who live with HIV.

How do I get tested for low testosterone?

A blood test for bioavailable testosterone, follicle stimulating hormone, luteinizing hormone, and prolactin are drawn after a visit with one of our doctors. If two low testosterone values are present, the patient has the option to begin testosterone replacement therapy.

What treatment options are available for low testosterone?

The Men’s Health Center offers a number of treatment options for low testosterone. Topical gels, creams, or patches may be prescribed and applied daily by the patient. Some patients opt for testosterone cypionate injections, which are administered in office by the RN, usually every two weeks. For patients who are comfortable self-administering injections at home, an in-office teaching session with the RN would be scheduled. After completion of the teaching session, patients will self-administer injections either weekly or biweekly. Testopel, or testosterone pellets may also be implanted under the skin by way of a small incision. Testopel procedures are usually performed every three to four months. The latest addition to treatment options offered at the Men’s Health Center is AVEED (testosterone undecanoate). AVEED delivers long- acting testosterone therapy, which requires only five injections per year after the first month of therapy.

What are the advantages of AVEED over other medications?

AVEED is longer-acting testosterone therapy. The initial AVEED injection is administered on day one, with the next injection in four weeks, and then injections are administered every 10 weeks.  Patients begin to notice the effects after the first injection.  With AVEED, the patient does not have to worry about the daily application of a medication, transference of the medication to another person, or frequent injection appointments. With any testosterone replacement therapy, laboratory values, including bioavailable testosterone, hemoglobin and hematocrit, and psa values will be monitored regularly.