What is testosterone?
Testosterone is a hormone produced by the testicles in men. The production of testosterone is controlled by other hormones (called gonadotrophins), which are themselves released from a part of the brain called the pituitary gland.
Low levels of testosterone can lead to you feeling symptoms such as the following:
loss of sex drive,
difficultly achieving or maintaining an erection,
loss of muscle mass,
reduced exercise tolerance
In some men, a low level of testosterone can contribute to thinning of the bones (osteoporosis) making fractures more likely.
Why are my testosterone levels low?
Testosterone levels in men fall gradually from the age of 40 years (however more and more men are presenting even younger). However, testosterone levels can fall to very low levels if there has been damage to the testicles (due for example to infection or treatment for cancer) or surgical removal of the testicles. Damage to the pituitary gland can cause low levels of gonadotropins and in turn that will result in a lack of testosterone. Low testosterone has also been recorded in some athletes due to in part constant cyclical weight reduction.
What are the different types of TRT (Testosterone Replacement Therapy)? And how is it given?
If we find your testosterone levels are low via way of hormonal assessment and/or you are symptomatic of testosterone deficiency then we can offer TRT (Testosterone Replacement Therapy)
In general, we can divide therapy into those who desire to maintain fertility and those who do not. With those who wish to maintain fertility, we use treatments which help boost or optimise one’s own testosterone and these can be issued in either injection form which would be subcutaneous (like diabetics using insulin pens in the skin of the lower abdomen) or oral forms which are taken daily.
For those who do not desire fertility, we offer TRT as either an injection or as a gel. The injection into a muscle in the buttock is usually given by a healthcare professional. To begin with, you receive injections at regular intervals followed by a blood test to determine the frequency of usage. You may feel some tenderness for a few days at the site of the injection. However, if you are concerned about the injection site you would need to seek medical advice, preferably from ourselves.
The gel comes in a container with a pump dispenser and is absorbed through the skin (it is important to ensure that the gel is applied to a hair-free region of the body). It is applied once per day usually in the morning to the skin of the chest, back or upper arm. It is important to let the gel dry completely. It is especially important not to have skin to skin contact with other’s prior to the gel drying; this will prevent the transfer of the gel.
Occasionally the gel can cause skin irritation. The dose of the gel may need to be adjusted depending on your symptoms and blood test results.
Like any medical treatment, TRT has both potential benefits and potential risks.
What are the benefits of taking testosterone replacement therapy?
TRT can be helpful for some men. It can increase sex drive and improve erectile function. TRT can also improve energy levels and, in theory, reduce the risk of fractures in men with osteoporosis. Some men have also reported a reduction in mental fatigue and in one’s mindfulness.
What are the risks of testosterone replacement therapy?
TRT can increase the production of red blood cells, which carry oxygen around the body. This can make the blood sticky and, in theory, increase the risk of heart attack and stroke. If you are taking TRT, you should have a regular blood test to check the number of red blood cells in your body. If this number goes too high your doctor will have a discussion with you about reducing or stopping your TRT. For this reason we anyone with a history of heart disease, we need a thorough discussion about the risks and benefits, before prescribing TRT.
Many men already develop an enlarged prostate gland as they get older and this can cause symptoms in passing urine such as a weak stream of urine. TRT can, therefore, sometimes make such symptoms worse. Hence why we offer prostate review with patient consent prior to starting therapy
There is no evidence that TRT causes cancer of the prostate. To help detect early growth of prostate cancer, you should have a blood sample to check your PSA levels prior to starting TRT and every year you are on it. If your PSA starts to rise, you will be referred to a specialist (urologist) and your TRT will be stopped. You may require further investigations by a scan or a prostate biopsy. We would not start TRT in someone who has untreated prostate cancer. However, it is important to note that PSA is not a perfect test for prostate cancer; it can be normal in some men with prostate cancer, while many men with a raised PSA do not have prostate cancer. Finally, TRT can reduce the size of your testicles and lower your sperm count.
If you have any further questions about testosterone replacement therapy, please book a complimentary consultation: Book Now