The use of testosterone therapy is increasingly common in the United States, with more than two million men receiving the therapy. While the popularity is growing in older males, with the expectation that it will improve libido, the success of the treatments is questionable for men, and even more so in women. (1)

What Is Hypogonadism, or Low Testosterone?

“In men who truly have low testosterone, a medical condition known as hypogonadism, they can be suffering from a variety of very significant ailments, like low strength and endurance, bone loss, and heart trouble, and for those guys, going on testosterone is important,” says Aaron Spitz, MD, a urologist in Laguna Hills, California, chairman of the American Urological Association’s Telehealth Task Force, and author of The Penis Book. “But for guys whose testosterone levels are normal, taking extra does not give them the same benefits.” (2)

It isn’t well understood which men will benefit the most from taking testosterone. And there’s also some controversy surrounding low T syndrome, because many men who have symptoms consistent with low testosterone actually have normal levels once tested. Some men may experience low testosterone levels caused by conditions such as thyroid problems, diabetes, depression, and medication side effects. Treating these underlying problems may effectively increase testosterone levels in the body. (2)

Who Can Be Helped By Testosterone Replacement Therapy?

Testosterone replacement therapy has been shown to help men with hypogonadism, a condition in which the body is not able to produce normal amounts of the hormone. Hypogonadism can reduce quality of life, testosterone can impact metabolism, brain function, and bone and body composition. Common causes of primary hypogonadism include: (3,4)

• Klinefelter Sydrome This is a congenital abnormality of the sex chromosomes, X and Y. A male normally has one X and one Y sex chromosome. In Klinefelter syndrome, a male is born with a second X sex chromosome in addition to one Y chromosome.
• Undescended Testicles Sometimes, one or both of the testicles may not descend from the abdominal cavity into the scrotum at birth. This condition often corrects itself within the first few years of life on its own, but if not addressed in early childhood, it may cause low testosterone production.
• Mumps Orchitis A mumps infection during adolescence or adulthood can cause testicular damage and reduce testosterone production.
• Hemochromatosis Too much iron in the blood can cause problems with both the testicles and/or pituitary gland, impacting testosterone production.
• Testicular Injury Damage to normally developed testicles can cause hypogonadism, but damage to only one may not have an impact on testosterone production.
• Cancer Treatment Chemotherapy and radiation can interfere with testosterone and sperm production. Often the effects are temporary, but permanent infertility can occur.
• Normal Aging Testosterone levels naturally drop as a man gets older, but testosterone therapy does not produce results in everyone.

What Do Testosterone Therapy Treatments Involve?

Currently, the only use of testosterone therapy approved by the Food and Drug Administration (FDA) is in men diagnosed with hypogonadism. (5) If you have symptoms of low testosterone, talk to your doctor about taking a blood test, or consult with an endocrinologist or urologist.

How Is Testosterone Therapy Prescribed and Delivered?

According to the American Urological Association, there are five different ways to take testosterone. No method is considered better than another, and while you are taking the therapy, your doctor will test your blood to measure your testosterone levels. The five methods are: (7)

• Transdermal (Topical) These come in the form of gels, creams, liquids and patches, and the effects last for about four days. Apply to dry skin without cuts or scratches, don’t wash the area until it’s time to apply another dose, and wash your hands after application. Other people, including women and children, should not touch the medicine.
• Injections Both short-acting and long-acting forms of testosterone injections exist. The short-acting medicine may be given under the skin or injected into muscle tissue. The long-acting one is usually given in the muscle. Injections are usually given either weekly, biweekly, or monthly.
• Oral The dose is a patch that’s placed above your canine tooth, and it should not be swallowed, since pill forms of testosterone can have harmful effects on the liver. The patch may cause headaches or gum irritation.
• Intranasal This form of testosterone is a gel that is sprayed into the nostrils, typically taken three times a day.
• Pellets Pellets are placed under the skin of your upper hip or buttocks by a healthcare professional. A shot of local anesthesia is used to numb the skin, and a small cut is made to place the pellets inside the fatty tissues under your skin. They dissolve slowly and are released over the course of three to six months

Your doctor and insurance coverage can help you choose which method is right for you.

Testosterone Replacement Therapy: What Are the Side Effects?

The likelihood of adverse effects of long-term testosterone replacement therapy is still unclear, but there is some scientific evidence to suggest it may have an impact on cardiovascular health, increased risk for prostate cancer, breast cancer, and sleep apnea. (8) In those who may have underlying prostate cancer, testosterone replacement therapy may exacerbate or worsen its growth.

According to the FDA, people taking testosterone should seek medical attention immediately if symptoms of a heart attack or stroke are present, such as: (5)

• Chest pain
• Shortness of breath or trouble breathing
• Weakness in one part or one side of the body
• Slurred speech

When men who do not have low levels of testosterone proceed with therapy, it can have an adverse effect on their own testosterone production, according to Dr. Spitz. “When a man uses shots, gels or pellets, his own natural production of testosterone shuts down. It returns in the vast majority of men once therapy is discontinued, but it can take many months to recharge.”

What About Over-the-Counter (OTC) Testosterone Replacement Products?

“When you see over-the-counter supplements from a vitamin store or online, they almost never boost your production of testosterone,” says Spitz. “When you are spending money to boost testosterone with OTC supplements, it is usually a waste of money.” He also cautions that oral doses are damaging to the liver. “For a pill to get into your system, it must be processed through the liver. Transmitting it through the skin or through injections does not need to be processed through the liver.” (2)