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If you listen to sports radio, it seems as if every other ad is pushing a new low testosterone (low-T) treatment: More energy! Bigger muscles! Better sex! All with a simple pill, shot, or gel! When something sounds too good to be true, it usually is. Many men and a surprising number of providers don't realize that taking exogenous (synthetic) testosterone or over-the-counter supplements may have harmful side effects if not administered properly. Tinkering with your testosterone levels without direction from a qualified specialist can cause other health issues, such as testicular atrophy, infertility, and an increased risk of prostate cancer. An estimated 1 in 50 men have low-T and experience symptoms such as less energy, decreased libido (sex drive), erectile dysfunction, lack of concentration, or trouble sleeping. Around age 30, a man's testosterone levels may slowly begin to decline. Approximately 35% of men in their 70s have low-T, according to the American Urological Association. But we're beginning to see more men in their 20s with low-T at the UT Southwestern male urology clinic. Sometimes low-T is caused by medical conditions, such as genetic diseases or past chemotherapy or radiation therapy. More often, symptoms can be linked to sedentary lifestyle, poor diet, anxiety, or depression. Safe, successful low-T treatments start with personalized conversations. So, before you call that low-T clinic or click on an outlandish ad for testosterone-boosting supplements, find out what's at stake for your health. There are safer, more cost-effective options to restore youthful energy – and potentially reverse fertility loss from previous testosterone products.
What's a normal testosterone level?Testosterone is a natural hormone produced primarily in the testicles, and it helps men maintain everything from bone density and body hair to sex drive and sperm production. However, you don't have to hit a certain number or level to be "a real man," despite what the constant flow of ads may tell you. What matters is who you are and where you are in your life. On average, a testosterone level of 300–1,000 nanograms per deciliter (ng/dL) of blood is normal. Hypogonadism – reduced testicular function – generally occurs when the total testosterone is less than 300 ng/dL. However, a healthy level for you depends on your age, lifestyle, and bioavailable testosterone level – the unbound testosterone your body isn't using for daily functions. Unlike many low-T clinics, we calculate bioavailable testosterone by measuring levels of two proteins, sex hormone binding globulin and albumin, that typically bind to testosterone. It's possible to have a normal total testosterone level and experience low-T symptoms if this balance is off. Having a normal bioavailable testosterone level tells us your body is making plenty and you likely won't benefit from testosterone replacement therapy. If your bioavailable testosterone level is low, we can discuss options. Risks of off-the-shelf testosterone therapyAvoid supplements over the counter. None are regulated or approved by the U.S. Food and Drug Administration (FDA), which means you can't verify what they're made with or whether they're safe, even if they come with a celebrity endorsement. Some testosterone supplements have been shown to cause health conditions such as erectile dysfunction or kidney failure. Low-T clinics tend to overtreat, making blanket recommendations around the patient's total testosterone and not their individual health needs. Your best bet is to see a board-certified urologist with expertise in hypogonadism, or a fertility expert who is experienced in treating male patients. A personal approach can help you avoid a range of complications such as: Taking synthetic testosterone can reduce fertility. InfertilityIt is well known that exogenous testosterone can – and often will – cause infertility. Unfortunately, some doctors prescribe testosterone to treat infertility, and inadvertently make the problem worse. Natural testosterone and sperm production is fueled by two hormones created in the pituitary gland of the brain: luteinizing hormone (LH) and follicle-stimulating hormone (FSH). When a man takes synthetic testosterone, the brain detects the excess and slows or stops production of LH and FSH. That means the body quits producing intratesticular (natural) testosterone, and consequently, production of sperm due to the suppression of LH and FSH. This results in reduced fertility. Testicular atrophyLittle to no LH and FSH production, means no stimulation of the testicles. If the testicles aren't stimulated by these hormones, they may atrophy, or shrivel up. Testicular atrophy has been associated with long-term use of exogenous testosterone or over-the-counter steroids. Development of male breastsIn some men, estrogen levels will increase as testosterone levels increase. Men naturally need some estrogen, one of the main sex hormones that women have, in the body for bone health and other body functions. But too much estrogen can cause conditions such as gynecomastia (male breast tissue). Excess estrogen can also cause sleep apnea, edema (swelling), and acne. Inflated testosterone levels can increase risks to your prostate. Increased risk of prostate cancerI've had patients come to us from low-T clinics with testosterone levels as high as 3,000. That's unnecessary, and so much chemical modification increases the risk of enlarged prostate or increase the risk of prostate cancer. Even safe and moderate testosterone therapy bears a slightly increased risk. Missed physical diagnosesLow-T clinics typically don't screen for serious health conditions that can affect testosterone production. For example, patients may need bloodwork to measure prolactin, a hormone made by the pituitary gland that, in high levels, can be a sign of a pituitary tumor. To follow a patient on testosterone replacement therapy, the provider should check your prostate-specific antigen (PSA), a natural protein that, in high levels, is associated with prostate cancer risk. You'll also need regular measurements of your hemoglobin (a blood protein) and hematocrit (red blood cells), which help carry oxygen through the body. An imbalance can indicate a serious medical issue, such as cancer, anemia, or kidney disease. Untreated mental health issuesOften, we find that anxiety or depression – not hormonal imbalances – are the root cause of low-T-like symptoms. Suppressing your emotions can interfere with normal functions, such as focusing at work or maintaining an erection. If you truly have low-T, underlying stressors can make symptoms worse. Everyone can benefit from an unbiased, listening ear now and then. I've referred many patients to see a therapist whose concerns resolve without testosterone therapy. When testosterone therapy might helpMen who are no longer interested in conceiving may benefit from safe, monitored testosterone replacement therapy. Some patients with genetic issues that cause subfertility, such as Klinefelter's syndrome, may also benefit. Losing weight through exercise and eating a healthy diet can help naturally improve testosterone levels. Natural options
Medication options
Recovering fertility after testosterone therapyRegaining fertility is not guaranteed, but it is possible for some patients depending on their age and duration of testosterone use. The first step is to end any testosterone therapy and get baseline lab tests to know where your levels truly are. Often, we find that the patient's LH production has been suppressed. In those cases, the next task is to increase it. Most patients start with Clomid. If that isn't sufficient, we may consider hCG injections. In rare cases when neither therapy works, we can consider increasing the FSH level as well with injections of the FSH substitute hMG. This drug is more expensive, and success is not guaranteed. If you are concerned about low-T symptoms, or if you've tried therapies that didn't work, talk with your primary care doctor or urologist. Feeling better starts with a conversation about your needs, goals, and lifestyle. Personalized care from a board-certified urologist or male fertility expert is the healthiest way to get there. To visit with a men's reproductive health specialist, call 214-645-8300 or request an appointment online.
What are the symptoms of low testosterone in a male?What are the symptoms of low testosterone?. Reduced sex drive.. Erectile dysfunction.. Loss of armpit and pubic hair.. Shrinking testicles.. Hot flashes.. Low or zero sperm count (azoospermia), which causes male infertility.. What happens if low testosterone goes untreated?Living with a testosterone deficiency long-term will increase your likelihood of developing age-related diseases, including osteoporosis and heart disease, among others.
How do you fix low testosterone?The best way to improve testosterone levels is by adopting some lifestyle habits that can improve overall health and well-being.. Getting enough sleep. ... . Maintain a balanced diet. ... . Lose weight. ... . Stay active. ... . Stress reduction. ... . Vitamins and supplements. ... . Review medications. ... . Avoid drugs and alcohol abuse.. What happens if man's testosterone is low?If a male has low testosterone, symptoms can include erectile dysfunction, and males and females may have reduced bone mass and sex drive. The hormone has many important functions, including: the development of the bones and muscles. the deepening of the voice, hair growth, and other factors related to appearance.
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