What is Testosterone Replacement Therapy?

Testosterone Replacement TherapyTestosterone replacement therapy (TRT), also called androgen replacement therapy, is the treatment offered to men with low testosterone levels. When men age, our ability to produce the hormone known as testosterone decreases. The hormone testosterone determines our sex drive, energy levels, bone density, muscle mass and strength, and our ability to produce sperm, which interprets our fertility.  Testosterone is also responsible for male characteristics such as a deep voice, facial and body hair, and enlargement of sex organs.  Low levels of testosterone in boys can, therefore, lead to delayed puberty.

If this is your first time coming to my website, you’ll see that I tend to avoid talking about this topic, as I have found that food, natural supplements, such as TestoGen, and a lot of other “life hacks” have enabled me to keep my testosterone levels very optimal, even at my upper thirties.  However, I wouldn’t be doing people any good without educating them on the very popular, yet debated topic of testosterone replacement therapy, so I’ve decided to spend countless hours researching this topic from all angles to provide a factual diatribe about the pro’s, con’s, costs, and much more.  Please enjoy this try and comment below it if you have any opinions or experiences you’d like to share!  

Why Do People Need Testosterone Replacement Therapy?

TRT treats age-related hypogonadism, delayed puberty, and infertility. Hypogonadism is a condition in which sex gonads, of either men or women, fail to produce sufficient sex hormones. Other than hypogonadism, low levels of testosterone can be due to surgery of the sex organs, exposure to radiation during chemotherapy, genetics, and certain gonad infections.

As men age, our body’s natural ability to produce testosterone decreases by around 1% to 2% every year. Studies show that four in every ten men above the age of 45 years have low levels of testosterone. Testosterone replacement therapy helps men with low testosterone bring the hormone level back to normal. Our gonads, testicles to be precise, are responsible for producing testosterone when the levels of the hormone are low. A positive signal is relayed to our brains to increase the levels of testosterone. Positive feedback is a mechanism that aims at restoring levels of chemicals and hormones in our body to normal.

In a healthy body, low levels of testosterone trigger the hypothalamus to release gonadotropin-releasing hormone (GnRH). GnRH, in turn, triggers the release of luteinizing hormone from the pituitary gland that signals our gonads to produce more testosterone. In hypogonadism, the gonads do not respond to signals from the brain, meaning that the production of testosterone continues to remain low. Testosterone replacement therapy also has some off-label uses, especially by athletes, to enhance their performance, and bodybuilders to increase muscle mass. It also boosts sexual performance and weight gaining.

Symptoms like decreased libido, erectile dysfunction, weight gain or loss, loss of muscle mass, large breasts, irritability, and infertility are signs that our testosterone levels are low. When we experience these symptoms, we need to consult a physician who will do blood tests to check for our testosterone levels. Before the doctor can decide on placing the patient on testosterone replacement therapy, he or she carries out several blood tests. Multiple tests are needed because several factors affect the levels of our testosterone. Time of day, for example, can affect the test result, which is why most tests take place in the morning. Testosterone levels are highest in the morning and fluctuate during the day. Other factors like steroid medications, fitness levels, and our diets, can either lower or raise our testosterone levels.

Testosterone Injections

In many cases, you’ll hear the words “testosterone injections” when people are really talking about TRT.  Many people know the are widely available in injection form, and it seems to be the most popular way to get the test into the body.  Therefore, excuse me if you hear “testosterone injections” used interchangeably with TRT.

How is Testosterone Replacement Therapy Administered?

Once the doctor confirms that testosterone levels are indeed low, the type of medication and testosterone replacement therapy dosage of the patient depends on the levels of testosterone. Normal levels of testosterone range between 300 and 1000 ng/dl. For instance, if my test results show that my levels are at 100ng/dl, I will be placed on a higher testosterone replacement therapy dosage than a patient with levels at 180ng/dl. The type of medication and dosage also vary depending on the health condition of the patient.
Testosterone medications are associated with specific side effects that can exacerbate an existing condition in patients. For example, testosterone replacement therapy medications can increase the risk of a heart attack in patients with congestive heart disease. Additionally, the age of the patient will determine the dosage of the drug; adults usually receive higher dosages compared to pediatrics.

Administrations of TRT is through various routes. Intramuscular injections are common methods of administration. However, there are testosterone replacement therapy trans-dermal or buccal patches and topical gels that are available. Statistics in the United States show that most men use topical gel therapy. Transdermal patches are placed directly on the skin, and the hormone passes the skin to get into the bloodstream. Patches have a strength of 2.5-5 mg, and one can use one or two patches a day, depending on its strength. Patches need to be placed on clean, dry areas of the skin to ensure they adhere properly. Buccal testosterone replacement patches are placed every 12 hours on the gum directly above the incisors. Oral tablets are also available but not commonly used because they are associated with high toxicity on the liver. Patients need to take three to six tables every day for the levels of testosterone to rise.

Testosterone cypionate is a common testosterone replacement therapy medication available in DEPO form. DEPO formulations are given intramuscularly and have a long duration of action. After injecting the body with the drug, it slowly goes into the bloodstream, and it might take a while before the levels of testosterone rise. Testosterone cypionate is administered once or twice a month and has lower dosages in the long term compared to daily injections. It is given as 50-400 mg every two to four weeks. Topical gels like Testim and AndroGel are also widely in use; the gel is applied once daily to the skin on the upper arm.

Other common medications used for testosterone replacement therapy include testosterone enanthate and testosterone undecanoate. 50-200 mg of testosterone cypionate and enanthate injections can treat premature puberty. The injections are administered every two to four weeks for no more than six months. Alternatively, the patient can use 150-450 mg Testopel pellets every three to six months. Testopel is a common pellet implant to adult men prescribed as 150-450 mg every three to six months for it to be effective. Smaller dosages range from 12.5 mg to 50 mg for pediatrics and young adults. Delatestryl (testosterone enanthate) is available as a 200 mg/ml intramuscular injection every two to four weeks. The exact dosage will depend on the weight of the patient. Aveed (testosterone undecanoate) is an intramuscular injection of 250 mg/ml every two to four weeks.

Testosterone Replacement Therapy Cost

The costs to incur on testosterone therapy will depend on the duration of treatment, location, and type of formulation of testosterone replacement medication. The price ranges from $20 to $1000 every month, with the factors, stated considered. Most health insurance companies cover part of the testosterone replacement therapy cost leaving the patient with a few expenses to cover.

The routes of administration of the medication can determine the testosterone replacement cost owing to the different frequency of administration for each route. With frequency as a factor, oral tablets are most expensive, followed by trans-dermal patches, buccal patches, topical gels, pellet implants, and injections as the least costly. Medications given through intramuscular injections are the least expensive because they are given less frequently (once or twice a month). Oral tablets are most expensive because they are taken three to six times a day, unlike patches that are only applied once or twice a day. Testosterone replacement therapy for age-related hypogonadism is a long-term treatment since the underlying issue is difficult to treat. Therefore, men should opt for routes of administration that are less costly, such as injectables, to reduce the costs to incur in the long term. Intramuscular injections are also more convenient since we are unlikely to miss our doses.

Testosterone Replacement Therapy Benefits

Testosterone Replacement

The benefits of having testosterone replacement therapy are plenty. Testosterone replacement therapy treats infertility for men battling with low sperm count and volume. Testosterone is responsible for the production of sperms, and therefore when the levels are low, sperm count is also low. For men having issues with sexual performance, testosterone replacement therapy benefits them by enhancing their sex drive and help them maintain an erection. The changes that we go through when we have low testosterone, such as enlargement of breasts, weight gain, and depression, can rob us of our self-esteem. Testosterone replacement helps us gain back our esteem and be comfortable with our bodies.

Low testosterone makes us susceptible to osteoporosis, a condition where our bones become brittle and fracture easily. With the help of testosterone replacement therapy, bone density and strength goes back to normal. Studies show that there is a link between testosterone and the ability to concentrate. Low levels of testosterone are associated with fatigue and poor concentration. Testosterone replacement therapy helps improve our attention and energy levels. Men on testosterone therapy having an overall improvement in cognitive function.

Since testosterone contributes to red blood cell production, low levels can lead to anemia. Testosterone replacement makes sure our blood levels are normal. However, when the levels rise above normal, red blood cell count also becomes higher than usual. Due to the benefits it offers, some young, healthy men tend to abuse testosterone medications to boost their energy levels and vitality. However, a study conducted showed that the risks of testosterone therapy outweigh the benefits in healthy young men.

Where to Get Testosterone Replacement Therapy Near You

Many of us wonder where we can get TRT if we have symptoms of low testosterone. Some areas, such as New York, have clinics that specifically offer testosterone replacement therapy. Any physician is capable of prescribing testosterone replacement therapy. There are also specialists in the male reproductive system, called urologists that provide testosterone replacement therapy. Clinics with a urologist are, therefore, a great answer to where to get testosterone replacement therapy near you.

Testosterone Replacement Therapy Reviews

Testosterone replacement therapy results vary from patient to patient, even among patients on the same medications. Factors such as diet, genes, and severity of the symptoms will determine how long it takes for us to respond to a certain drug.

Among patients placed on testosterone replacement therapy, patients on oral testosterone tablets complained of having little significant improvements in their symptoms. Oral tablets were associated with poor hormone levels among the formulations available. The pills are also associated with undesirable changes in the metabolism of the liver. Old-aged patients and people with busy schedules admitted to missing their doses on certain days. The patient takes three to six tablets daily, which is inconvenient for people with a busy schedule, while old-aged patients forget to take some doses. Oral tablets are, therefore, associated with the least adherence.

Implants, Testopel in particular, was associated with better results in patients on the drug for two for five years. Patients also find Testopel easy to use and were satisfied with the results. However, most patients complained of being on the drug for a long time without getting a dosage that is right for them. A particular patient using 12 implants in the first four months of treatment would experience symptoms of fatigue and low sex drive in the fourth month. The symptoms were a sign that there was a drop in his testosterone levels. It took a year for his doctors to discover that the condition improved with 12 pellets every three months.

Transdermal patches are associated with maintaining steady testosterone levels in most patients. Patients could see changes in their symptoms within a week of using the patches. However, red and itchy skin is evident in about 80% of the patients limiting the use of patches.

Testosterone replacement therapy reviews on topical gels are good. The gels raise testosterone levels higher than all other formulations. Patients, however, complained about having to go for clinic checkups frequently to ensure that their body adequately absorbs testosterone from the patches. A good level of absorption is 80-85%, levels lower than that require the patient to switch to a different medication.

Symptoms of low testosterone, in patients on testosterone cypionate and enanthate injections, slowly subside. The body absorbs the drugs slowly, explaining why time is needed before symptoms start subsiding. They also find injections convenient to use since they hardly miss their shots.

It is, therefore, safe to say that better testosterone replacement therapy results are likely to be seen in patients on intramuscular injections and topical gels.

Testosterone Replacement Therapy Side Effects

Side effects of testosterone therapy will vary depending on the type of formulation a patient is on. There are, however, some general testosterone replacement therapy side effects associated with all formulations. General side effects include:

1. Skin reactions like acne.
Our faces have the highest concentration of sebaceous glands which are responsible for producing sebum. High levels of testosterone cause these glands to overproduce sebum that blocks hair follicles, causing acne.

2. Elevated red blood cell count.
Increased red blood cell production increases the risk of getting pulmonary embolism. Pulmonary embolism is a condition in which one or more lung arteries get blocked by a substance traveling the bloodstream. High red blood cell count is associated with increased clot formation. The clot can go into the bloodstream to the lungs to cause pulmonary embolism that manifests as breathing difficulties.

3. Edema of the feet.
The risk of getting edema is higher for patients with existing liver, kidney, or heart conditions. Oral testosterone tablets are not safe for men with liver failure because they cause liver toxicity.

4. Increased prostate size
It also predisposes patients with existing prostate cancer to the disease.
Testosterone causes prostate cells to proliferate at a higher rate. Though the proliferation is non-cancerous, physicians usually do a prostate biopsy before prescribing testosterone replacement therapy to a patient as a precaution.

5. Testicles of some patients shrink.
Smaller testicles, in turn, limit sperm production.

6. Deep vein thrombosis.
Deep vein thrombosis also develops due to elevated red blood cells. A clot travels in the bloodstream to block a deep vein.

7. Sleep apnea.
8. Decreased cholesterol levels.
9. Sore and enlarged breasts.

Some rare side effects can occur, such as depression and sudden mood changes. There are more specific side effects for each testosterone replacement therapy formulation.

Transdermal patches:

Patches on the skin are usually associated with skin sensitivity that limits their use. 40% of men have redness, itchiness, and blisters on the area of the skin the patch is applied.

Oral Tablets:

Testosterone tablets are associated with a high risk of liver toxicity. Tablets of Halotestin (fluoxymesterone) and Testred (methyltestosterone) have the highest risk of liver toxicity. Liver toxicity manifests as yellow eyes, pain in the upper left quadrant of the chest, and dark-colored urine.

Buccal patches.
Side effects of buccal patches involve headaches, irritation to the mouth and gum, persistent bitter taste, and pain in the gums and mouth. Serious side effects, such as bleeding of the gums, can also occur.

Topical Testosterone Gels:

Testosterone gel on the skin can be potentially transferred to another person through skin-to-skin contact immediately after the application of the gel.

There are no symptoms specific to testosterone injections. Some men are allergic to testosterone replacement medications and present with breathing difficulties, a swollen tongue, face and throat, and hives. It is, therefore, essential that we consult our doctors on any noticeable allergy symptoms when starting testosterone replacement therapy. Since testosterone replacement therapy is long term, dependence on the drugs can occur. Patients who have stopped testosterone replacement therapy can experience withdrawal effects associated with the worsening of hypogonadism. Interrupted therapy leads to a significant drop in levels of testosterone, which in turn worsens the patient’s initial symptoms.

Sources Consulted for This Article:

Booth, Stephanie. n.d. Low Testosterone: How to Talk to Your Doctor. WebMD. https://www.webmd.com/men/features/low-testosterone-how-to-talk-to-your-doctor##1

Is Testosterone Replacement Therapy Right for You? n.d. WebMD. https://www.webmd.com/men/guide/testosterone-replacement-therapy-is-it-right-for-you#1

Jewell, Tim. 2019, January 28. TRT: Separating Fact from Fiction. Healthline. https://www.healthline.com/health/trt

Mayo Clinic Staff. 2020, April 04. Testosterone therapy: Potential benefits and risks as you age. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/sexual-health/in-depth/testosterone-therapy/art-20045728

Shiel, William. Low Testosterone (Low T) Treatments. 2016, August 18. RxList. https://www.rxlist.com/low_testosterone_slideshow_pictures/article.htm

User Reviews & Ratings: Testopel implant. n.d. WebMD. https://www.webmd.com/drugs/drugreview-9833-Testopel+implant.aspx?drugid=9833&drugname=Testopel+implant&pageIndex=1&sortby=3&conditionFilter=-500