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Testosterone Therapy

Is Testosterone Therapy Right For You?

Is Testosterone Therapy Right For You?

Medically reviewed by Dr. Larry Lipshultz M.D

Despite what you are told by the barrage of advertisements paid for by pharmaceutical companies that make testosterone replacement therapy, this approach isn’t for every man who has low T or its symptoms. In fact, it’s appropriate for only a low percentage of men. Are you one of the minority of men who fit the definition of hypogonadism and therefore truly a candidate for prescription testosterone replacement therapy?

Is Testosterone Therapy Right For You?

Testosterone replacement therapy (TRT) is usually the right choice for men who have been accurately diagnosed with hypogonadism. This disorder is characterized by extremely low T levels associated with a medical condition plus symptoms that interfere with a man’s professional and personal life.

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Hypogonadism can be either primary (associated with a problem in the testicles, where T is produced) or secondary (associated with a problem in the pituitary gland or hypothalamus, both of which have a direct impact on T production). Among the medical conditions that can cause hypogonadism are the following:

  • Pituitary tumor or abnormalities, which can interfere with the release of pituitary hormones
  • Chronic kidney or liver disease, in which testosterone deficiency affects approximately 26 to 66 percent of patients with chronic kidney disease and low T has been reported in up to 90 percent of men with chronic liver disease
  • Alcoholism, which lowers testosterone and sperm count and raises estrogen
  • Inflammatory diseases such as histiocytosis, sarcoidosis, and tuberculosis, all of which affect the pituitary gland and hypothalamus
  • Sickle cell anemia, which has low T has a disease characteristic
  • HIV/AIDS, which can affect the hypothalamus, pituitary, and testes
  • Hemacromatosis (excessive levels of iron in the blood), which can cause testicular failure or dysfunction of the pituitary gland, impacting T production
  • Injury to the testicles, although damage to only testicle may not affect testosterone production
  • Chemotherapy and/or radiation therapy, which may cause only temporary reductions in T levels
  • Hormonal disorders, such as high levels of the hormone prolactin, a pituitary hormone that reduces T levels
  • Klinefelter syndrome, a congenital abnormality of the sex chromosomes that results in abnormal testicle development and under production of testosterone
  • Mumps orchitis, which can cause long-term damage to the testicles if the disease develops during adolescence or adulthood
  • Kallmann syndrome, which is abnormal development of the brain region (hypothalamus) that controls secretion of pituitary hormones
  • Obesity, which may be linked to hypogonadism

If you have a legitimate medical reason for embarking on testosterone replacement therapy, be sure you talk to your healthcare provider about all of the consequences of treatment. Keep all of your frequent checkup appointments to monitor your T levels and report any unusual symptoms or problems, even if you’re not sure they are associated with therapy.

References

Iglesias P et al. Gonadal dysfunction in men with chronic kidney disease: clinical features, prognostic implications and therapeutic options. Journal of Nephrology 2012 Jan-Feb; 25(1): 31-42

Sinclair M et al. Muscle mass and mortality in chronic liver disease: the impact of testosterone. Liver Transplantation 2014; 20:504-5

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