Many men with low testosterone report improved energy levels, sex drive, and mood after testosterone treatment. If testosterone is low, why not replace it?
Not so fast. A low testosterone level by itself doesn't need treatment. Testosterone replacement therapy can have side effects, and the long-term risks aren't known. Only men with symptoms of low testosterone and blood levels that confirm this as the cause of symptoms should consider testosterone replacement. Talking with your doctor is the only way to know if testosterone therapy is right for you.
What Is Testosterone Replacement Therapy?
Testosterone replacement therapy (TRT) is a shot, patch, or gel of the hormone testosterone to bring the level back to normal. Testosterone is produced in your testes (testicles), the sex organs in men, and is responsible for masculine traits.
The name for the condition where you don't produce enough testosterone is hypogonadism. Signs of hypogonadism in men and people with male anatomy include:
- Low sex drive
- Sparse facial and body hair
- Fewer spontaneous erections (such as while sleeping)
It's natural for testosterone to decline as you age and not necessarily a reason for TRT.
Testosterone replacement therapy for women
Women and people assigned female at birth do produce testosterone as well as estrogen, though the amounts of testosterone are much smaller than those produced by men. Most of the testosterone is produced in the ovaries. In women, testosterone plays a role in:
- Libido (sex drive)
- Bone health
- Energy and mood
- Fertility and the menstrual cycle
Testosterone does decline in women as they age, especially after testosterone for men is anywhere from 300 to 1,000 nanograms per deciliter (ng/dL). But not everyone has symptoms at the same testosterone levels. Some may notice changes around 250 ng/dL, for instance. Others may not have symptoms until their level is at 150 or even 100.
For females, the normal range is 15 to 70 ng/dL. A woman usually gets a testosterone test when the doctor suspects she has an abnormally high testosterone level (as opposed to a low level).
What is a low testosterone level?
The American Urology Association considers a low testosterone level in men to be anything below 300 ng/dL. Other professional organizations have higher or lower cutoffs, ranging from 350 ng/dL to 200 ng/dL.
Forms of Testosterone Supplements
Testosterone replacement therapy comes in several forms. All can improve testosterone levels:
Transdermal patch
This is a skin patch worn on the arm, upper body, or another place where you're not likely to sweat or apply pressure (like lie on it). The patch is applied once a day between 8 p.m. and midnight. You'll need to choose a different spot to apply it each time. Wait 7 days before going back to a spot you already used.
Testosterone gel
This may come in a foil packet or from a pump or twist-off bottle. Testosterone is absorbed directly through the skin when you apply the clear gel once a day. You usually rub this on your shoulders, upper arms, or thighs, depending on the instructions on the medication. Let the gel dry before you put clothes on top of it. Be careful about letting children or female loved ones touch the treated area or touch unwashed clothes that were in contact with the gel, as testosterone may get transferred to them.
One type of gel is applied to the inside of your nose via a dispenser pump. You usually apply this three times a day in each nostril, 6 to 8 hours apart. Don't blow your nose or sniff for 1 hour after using this nasal gel.
Testosterone mouth patch
This may look like a pill, but it sticks to your upper gums. Apply this patch by pushing it against your gums and to the left or right of your front teeth. Keep it in place by pushing on it from the outside of your mouth as well. The patch continuously releases testosterone into the blood through the oral tissues. Replace it after 12 hours, switching to the other side of your mouth.
Testosterone shots
A nurse or technician may give you testosterone as a shot directly into a muscle. You can also learn how to give the shot to yourself at home. You'll be shown which body parts you can use for the injection site, as they need to be rotated. The shot is usually given once a week.
Testosterone implants
A health care provider inserts these pellets under your skin (usually in the buttocks area) every 3 to 6 months. They do this by making a small cut in your skin and using a special tool to implant 10 pellets of testosterone. Your body slowly absorbs the testosterone into the bloodstream.
Oral testosterone
Why not a simple testosterone pill? Oral testosterone has been around since the 1980s but was not popular because it can cause problems for the liver. But there are now some new pills (Jatenzo, Tlando, and Kyzatrex) that bypass the liver and get testosterone into the blood directly, in the same way that skin patches, gels, and other treatments do. You usually take the pill twice a day with food.
One downside is that these pills are expensive and may not be covered by insurance, unless you've tried other methods of treatment and had no success or bad side effects.
Benefits of Testosterone Therapy
What can you expect from testosterone treatment? It's impossible to predict because every man is different. Many men report improvement in energy, sex drive, and quality of erections. Testosterone also increases bone density, muscle mass, and insulin sensitivity in some men.
Men also often report an improvement in mood from TRT. Whether these effects are barely noticeable or a major boost depends on the person.
Karen Herbst, MD, PhD, an deep vein thrombosis and pulmonary embolism, a potentially life-threatening clot in the lungs.
cholesterol and blood pressure
You can also get addicted to anabolic steroids, even though they don't produce any "high."
How to Get Testosterone Replacement Therapy
You need a prescription from your doctor to access testosterone. But even if your doctor finds out that your testosterone levels are low, they may want you to try other remedies first – for instance, losing weight or seeing a Testicular Disease
