Low Testosterone: Evaluation and Treatment by Experienced Urology Specialists in NYC
We offer highest-quality urology care by board-certified urologists.
What is Testosterone?
Testosterone is a naturally occurring hormone that is present at very high levels in men and very low levels and women. Testosterone is responsible for sexual development in men during fetal life, in childhood, adolescence and adulthood. In women testosterone is present at much lower levels, typically less than 10% of what a typical male has. Testosterone in women is important in maintaining sexual drive among other functions.
Testosterone is produced primarily in testes in men. A small amount of testosterone is also produced in the adrenal glands.
What is the Role of Testosterone?
Testosterone is a very important hormone which affects many functions of the body including metabolism, reproduction, red blood cell maintenance, bone maintenance and muscle mass maintenance. Testosterone is considered to be an anabolic steroid which means that it stimulates body functions.
What is Low Testosterone?
Testosterone levels vary tremendously from one man to another. Testosterone levels also vary from day to day and during each day in any individual man. For example, testosterone levels are typically higher in the morning and lower in the evening especially in younger man.
As men age, this variation becomes less pronounced.
Typically testosterone levels less than 300-350 are considered borderline low. Because testosterone levels vary tremendously, a repeat testosterone level is necessary if the initial testosterone level comes back at less than 350. It is important to note that some men have no symptoms with low testosterone and some men have symptoms with higher levels of testosterone which suggests that 1 rule does not fit all.
What are the Symptoms of Low Testosterone?
Low testosterone is also called hypogonadism.
Common symptoms of low testosterone include decreased sex drive, worsening erection quality, obesity, decreased energy levels, sleepiness, falling asleep after meals. These symptoms are nonspecific and may be caused by many other medical issues other than low testosterone. It is important to have a thorough evaluation to avoid missing other causes of these symptoms.
What are the Causes of Low Testosterone?
Low testosterone can be caused by dysfunction of the pituitary gland which controls the release of the luteinizing hormone (LH) which in turn regulates testosterone production in the testes. Low testosterone can also be caused by the failure of the testes to produce adequate levels of testosterone. One of the causes of low testosterone in some men is a condition called varicocele. Varicoceles high enlarged scrotal veins which can decrease the amount of testosterone produced in the testes.
What are the Treatment Options for Hypogonadism or Low Testosterone?
Treatment options dependent on the underlying cause of testosterone deficiency. The underlying causes lack of luteinizing hormone, hormone replacement therapy with luteinizing hormone equivalent can often effectively treat low testosterone levels. If prolactinoma is present, treatment of prolactinoma is the initial target of treatment.
In men who desire fertility, testosterone replacement therapy may affect the fertility potential of the testes and a carefully planned approach is necessary to prevent infertility.
Most common treatment for low testosterone is testosterone replacement therapy. Testosterone can be replaced using testosterone gel (AndroGel, Testim, AndroDerm, Axiron, Fortesta, injections and longer lasting Depo injections (AVEED) or testosterone pellets (TestoPel). Oral and nasal preparations off testosterone are also available.
Dr. Alex Shteynshlyuger is an experienced urologist who treats men with symptoms of low testosterone.