Low Testosterone: Experienced Specialists in NYC
We offer highest-quality urology care by board-certified urologists.
Testosterone Treatment: What You Need to Know
Experienced Specialists in Men’s Health and Low Testosterone
Board-certified urologists at New York Urology Specialists are experienced in the treatment of low testosterone using all available treatment options for testosterone replacement including surgery when necessary. As specialists in men’s health, we also treat other problems that often accompany low T such as erection problems, ejaculation problems, urinary problems, and infertility. For men with absent testicles due to trauma or orchiectomy for testicular cancer or testicular torsion, we are able to offer testicular implants.
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 men.
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 one 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. Most commonly, low testosterone is 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 a 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 depend on the underlying cause of testosterone deficiency. If the underlying cause is a deficiency of luteinizing hormone (LH), 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.
The 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.
Treatment of Hypogonadism or Low Testosterone in Men
Patients with symptoms of low testosterone may benefit from testosterone replacement therapy (TRT). Low testosterone or low-T is a common problem that is highly prevalent in men over 50 to 60 years of age but may also occur in younger men. In general, testosterone levels tend to decrease as the man grows older, resulting in age-related testosterone deficiency, or age-related hypogonadism. Some men develop a profound decrease in testosterone production as a result of using anabolic steroids for purposes of bodybuilding.
Benefits of Testosterone Replacement
There are numerous benefits of testosterone replacement therapy in patients with clinically low levels of this hormone. One challenge in treating low testosterone is that the levels of this hormone vary greatly from person to person and day to day in the same man. As a result, it is recommended that at least two blood tests are performed to reliably demonstrate low testosterone before treatment is initiated. Typically, a morning measurement before 11 o’clock is recommended and two measurements are required by insurance companies in the United States to cover the cost of testosterone replacement therapy. However, studies show that in most young men, testosterone levels obtained later in the day are fairly reliable.
Because testosterone is a hormone, each person reacts differently to varying levels. Some men are able to lead a normal life despite fairly low testosterone levels without ever experiencing any symptoms. It is possible that in these men the testosterone receptors have a high affinity for the hormone. Other men are more sensitive to even a slight decrease in hormone concentration and experience symptoms of low testosterone requiring treatment.
We know that some men are born with impaired testosterone sensitivity. In particular, some men have partial testosterone (androgen) receptor insensitivity. In these men, although high levels of the hormone are present, the cells in the body are unable to sense it. As a result, these men may present with symptoms consistent with low testosterone. Genetic variability complicates the evaluation and treatment of men with low testosterone.
While initially there was a concern that testosterone replacement therapy has the potential for cardiac complications, current understanding is that testosterone replacement appears to decrease the risks of cardiac events.
As with any treatment, there are some risks of testosterone replacement therapy in particular if abnormally high levels of testosterone are achieved. Close monitoring is necessary to avoid the side effects of testosterone replacement therapy.
Treatment of Low Testosterone Levels and Infertility in Men with History of Testosterone and Anabolic Steroid Abuse
Many men who have used anabolic steroids including testosterone for bodybuilding experience shrinking testicular volume and become dependent on anabolic steroids. We often see patients at New York Urology Specialists who come to us with infertility and lack of sperm production on semen analysis as a result of anabolic steroid use in the past, sometimes many years previously.
We have extensive experience in treating hypogonadism in men who have a history of anabolic drug abuse. Fortunately, most of the time we have good success in reversing infertility and sometimes reversing testicular shrinkage with treatments that include clomiphene and HCG.
What is the Best Treatment Option for Testosterone Replacement?
There is no single treatment option that is best for testosterone replacement therapy. All treatments are equally effective in most men. In some men, topical gels may not be as effective or they may require higher doses, which could become expensive. Side effects are similar among all the treatment options except for intranasal testosterone which has additional side effects related to the route of administration.
The question typically comes down to dosing. For testosterone to be effective, an adequate and correct dose of the hormone needs to be administered. Often, the dose needs to be adjusted over time to reach therapeutic levels. One of the most common reasons for the failure of testosterone replacement is due to suboptimal dosing.
At New York Urology Specialists, experienced urologists are skilled in raising testosterone to sufficiently high therapeutic levels while avoiding excessively high levels that can lead to undesired side effects.
We offer affordable, highest-quality urology care with or without insurance. Find out our office hours or directions to our office. We offer weekday, weekend and evening office hours.
Dr. Alex Shteynshlyuger is a board-certified urologist, who specializes in all aspects of care for sexual problems in men including ED, premature ejaculation and other sexual concerns. He has successfully treated hundreds of men with sexual problems including ED and poor libido.
by Joseph Waddy on Oct 24, 2018
I have been a patient of another Urologist for years, with no positive results. Then I learned about Dr. Alex Shteynshlyuger through a TV newscast. I immediately decided to have a consultation with him. Best decision I ever made!!! Dr. Alex performed the Rezum procedure and has literally changed my life. I highly recommend Dr. Alex and his staff to anyone who wants the most caring, capable and result oriented urological medical care. Thumbs up to Dr. Alex and staff!!!!!!!!!
by DAM BEN STANTON on Sep 24, 2018
From the very appointment to the last follow-up visit, I felt I was at the right place and with the right people around me. Dr. Alex Stheynshlyuger and his staff made it easy and confortable. I would recommend them to every man.
by Winston on Sep 15, 2018
I am very please and satisfied with everything that has been offorded to me by New York Urology Specialist Office.....Dr Alex
by Wyts on Sep 15, 2018
Wyts Wyts recommends New York Urology Specialists via Facebook. September 15, 2018 · Friendly , courteous, effiecient and professional staff members. This office i highly recommend for any and all Urology matters. Dr Alex Shteynshlyuger is very professional and knowledgable easy to communicate with. Thanks Dr Alex
by Lee St. James on Sep 01, 2018
Dr Alex and his staff are through professionals in every sense of the word. From initial diagnosis to a period of evaluating and ruling out options, we decided upon a surgical solution, which appears for the most part to have corrected the issue. Thanks to Ana, and the staff, especially Dr. Alex for treating me so well. Best regards, Lee
by Christopher cato on Aug 16, 2018
by Andrei on Aug 15, 2018
Dr. Alex Shteynshlyugerand is careful, patient, experienced. Uses innovative approaches, that actually yield results. He is indeed a good doctor, in every sense
by juanito creque on Apr 11, 2018
I am very satisfied with the treatment I received at new york urology specialist and would recommend them to other patients.they are the very best.
by JD on Jan 15, 2018
Well I put it to use last night and man, good job. My wife was elated. u made it much better somehow, so thank u for fixing my penis
by Jacob on Dec 05, 2017
"Cannot express how thankful I am I found Dr. Shtetnshlyuger. After undergoing surgery to correct a penile torsion I couldn't be happier with the results. A great doctor who is clearly good at what he does. With something as important as your private area, It's nice to be able to rest easy and know you are in good hands.." via HealthGrades.com 12/5/2017
by Bob Brown on Nov 19, 2017
I am writing to thank dr. Alex. He is thorough, professional, knowledgeable, helpful and friendly. I have seen him for ED and prostate issues, and he has explained all my options clearly, and found solutions that have been a great help. thank you! I highly recommend both Dr. Alex and his staff, which I find to be helpful, friendly, knowledgeable and very professional. They are a pleasure to deal with and all have been a great help.
by Clarence Brown on Sep 14, 2017
I am very much thankful for meeting Dr Alex .I had a very serious medical problem I visited many doctors but none could not help me it was very difficult for me until I visited Dr Alex after a couple visits my medical problem is no more I feel very great also I felt almost 20 years younger Dr Alex is second to none fantastic doctor. Thanks again Dr Alex from my family.
by Scott Cameron on Aug 18, 2017
Received circumcision from Dr. Shteynshlyuger. Dr. Shteynshlyuger is a very good specialist who cares for his patients. He was always concerned with my physical and mental comfort prior, during and post-operation. Dr. Alex is very thorough in his work to assess any problems and provide the necessary solution. Being that he has recently moved to a new location, this may afford for speedier appointments and easier flow of patients in and out. In addition, more personal space for waiting patients. If there was any con, it would be, the lack of space at his prior office and being able to see his patients at the appointed time, but a necessary sacrifice for good, careful work. I would recommend him as a very good doctor.
by Patient on Jun 04, 2017
" He found my source of testicular pain that was missed by a Urologist from my insurance provider. Although I paid to go out of network- any price is less than testicular pain. He is generous with his time and will not short change anyone for care." via Vitals.com Posted on June 4th, 2017
by Michael on Jul 03, 2014
I am feeling better now after visiting clinic New York urology specialists. Excellent staff and appointment on time.
by Charles M on May 23, 2013
Dear Dr. Alex – Since starting the [treatment], my cramps and burning have mostly gone. The biggest benefit is my leaking has been reduced to the lowest amount in almost 10 years. Charles M. Date: 2013
by George & Sally R on Jan 07, 2013
Dear Dr. Alex: We want to thank you for the excellent care you provided for George during his emergency operation and the follow up treatment. Your quiet, confident manner was reassuring to us during a very scary time for us. We will never forget you. George Sally R. Date: 2013
by Joanne R. on Sep 17, 2012
Dear Dr. Alex – I just wanted to write you a note to thank you for all of the care you have gave to my father during his illness. We appreciate all that you did to help my dad through his illness. We wanted to be sure to let you know how much it meant to us. Sincerely Joanne R.
by Joyce T on Feb 16, 2012
Dr. Alex Shteynshlyuger and Staff – Thank you so much for taking care of my husband Bob. Dr. Alex: I thank God everyday for you. You were an answer to prayer.
Low T is Treatable in Nearly Every Man
At New York Urology Specialists, our urologists are specially trained in the evaluation and treatment of erectile dysfunction and low testosterone levels. We understand the challenges that ED creates for our patients, their relationships and their self-esteem. We help you find a treatment for erectile dysfunction that fits your needs, your lifestyle and your preferences.
Urologists are doctors specializing in the treatment of men with erectile dysfunction. By the virtue of our experience and skill, we are able to offer an effective treatment option for nearly every man who desires an effective treatment for ED. We offer medical and surgical treatment for erectile dysfunction.
We Treat Some of the Most Complex Health Problems in Men Including:
- erectile dysfunction in men (ED)
- Premature Ejaculation
- Prostate Cancer.
- Infertility and low sperm count
- Peyronie’s Disease
- Erectile dysfunction in men for whom Viagra and Cialis do not work.
- No-scalpel vasectomy
- Erection problems in men with low testosterone.
Schedule an Appointment with Dr. Shteynshlyuger:
Dr. Alex Shteynshlyuger is a fellowship trained board-certified urologist with expertise in evaluation and treatment of urological problems in men using modern effective and proven treatment methods. He is highly recommended by top primary care physicians in the New York area. If you or someone you know has been experiencing urological symptoms, make an appointment to take advantage of Dr. Shteynshlyuger’s expert advice. Please feel free to contact us with any questions.