Testosterone therapy is intended to treat male hypogonadism (low T), a condition in which the body fails to make enough testosterone.
Testosterone replacement therapy, also called androgen replacement therapy, is approved to treat male hypogonadism (low testosterone or “Low T”), a condition in which the body fails to make enough hormones because of a problem with the testicles, pituitary gland, or brain. Men use testosterone products — such as patches, gels, pills, injections, or creams — to help with fatigue, erectile dysfunction, and loss of sex drive.
Testosterone therapy is intended to treat male hypogonadism (low testosterone or “Low T”), a condition in which the body fails to make enough hormones because of a problem with the testicles, pituitary gland, or brain. A number of prescription testosterone products are available to treat hypogonadism. Testosterone products come in different forms, including gels, injectable solutions, patches, pills, and pellets implanted under the skin.
Once a patient starts testosterone therapy, the patient usually undergoes lifelong treatment. Doctors will monitor the patient’s hormone levels every six months to a year. Depending on the patient, the checkups may be more frequent.
Fast Facts: Use of Testosterone Therapy Over the Years
- American men spend $2 billion on testosterone each year
- Four times as many men used testosterone products in 2014 than in 2000
- In 2013, 2.3 million Americans were being treated with testosterone therapy
- In 2011, nearly one in 25 men in their 60s were taking testosterone
- Prescription sales of testosterone increased from $18 million in 1988 to $1.6 billion in 2011
Types of Testosterone Products
Testosterone can be administered in a skin patch, skin gel, pill, or cream form — or as an injection, a solution applied to the armpit or a patch, or a buccal system applied to the upper gum or inner cheek.
While many testosterone products are available only with a prescription, some drug stores and health food stores sell them over the counter. A few of these products also claim to be all-natural.
Gels (Androgel and Testim)
Testosterone gel is a prescription medication applied directly to a man’s skin —on the shoulders and upper arms and/or abdomen, depending on the brand. Testosterone gel can inadvertently transfer from your body to others and can lead to serious health reactions. To avoid such contact, apply testosterone gel to clean, dry, intact skin that will be covered by clothing. Wash your hands right away with soap and water after applying. Once the gel has dried, cover the area with clothing and keep it covered until you have washed the area well or have showered.
First approved in 1979, Depo-testosterone is one of the older drugs of its kind on the market. It’s a liquid and is designed for injection deep into the gluteal muscle. The active ingredient, testosterone cypionate, is a white or creamy white powder mixed with other ingredients to make a solution. The drug is available in two strengths, 100 mg, and 200 mg.
Testosterone transdermal patches, including Androderm, come as patches to apply to the skin. Patches work best when applied around the same time each night and are left in place for 24 hours. Testosterone patches are meant to be worn at all times until replaced with new patches. Androderm patches should be changed every 24 hours. The old patch should be removed before applying the new one. You should apply the patches to different spots each night and wait at least seven days before re-using a spot.
Capsules (Methyltestosterone and Android)
The testosterone capsules Methyltestosterone and Android have been discontinued but have been used in men and boys to treat conditions caused by lack of the hormone, such as delayed puberty, and in women to treat breast cancer that has spread to other parts of the body. Methyltestosterone is a man-made form of testosterone. It can affect bone growth in boys who are treated for delayed puberty.
Manufacturers of testosterone boosters like Testofen have touted their products as means to increase muscle mass, strength, and sex drive in men. Among the most popular testosterone boosters are products that contain some combination of Tribulus Terrestris, DHEA, zinc, and d-aspartic acid. These ingredients have been associated with a number of side effects, including aggressiveness, breast enlargement, cholesterol changes, prostate problems, and an increased risk of cardiovascular disease.
Makers of testosterone products use two types of hormones:
Bioidentical Hormones AndroGel and a number of other products contain bioidentical hormones. Scientists create bioidentical hormones in a lab to chemically match the hormone naturally made by the body. In theory, this results in fewer side effects.
Synthetic Hormones Synthetic hormones are altered from the original chemical makeup, so they do not match those made by the body. These types of drugs typically have more side effects.
Why Men Use Testosterone Therapy
Unusually high or low levels of testosterone can significantly affect a man’s physical and mental health. Men typically use testosterone drugs to address a medical issue — like Low T or erectile dysfunction— or to enhance their physical performance
Treating Low T
Testosterone levels in men start to spike during puberty and drop on average by 1 percent every year after age 30. Lack of this key sex hormone in older men can cause health issues, including osteoporosis, loss of muscle mass and strength (sarcopenia), and psychological symptoms. Doctors prescribe testosterone drugs to treat these symptoms.
While declining testosterone levels tend to be part of normal aging in men, others experience the dip because of disorders of the testicles, pituitary gland, and brain that cause hypogonadism. Other factors — such as injury to the testicles, cancer treatments, chronic diseases, and stress — can also contribute to low testosterone production.
The FDA approved testosterone as replacement therapy only for men who have low testosterone levels due to disorders that cause hypogonadism. However, the agency has said testosterone is being widely used to try to relieve symptoms in men who have low testosterone for no apparent reason other than aging — a use for which the benefits and safety have not been established.
Declining Testosterone Levels by Age
Doctors analyze testosterone levels in two categories: total testosterone and free testosterone. Most testosterone is attached to a protein called sex hormone-binding globulin (SHGB). A small amount of testosterone is free, and a small amount regularly attaches and detaches itself from a protein called albumin. Any testosterone that is not attached to SHGB is considered free testosterone.
Remedying Erectile Dysfunction
Some men turn to testosterone to increase sex drive and treat erectile dysfunction (ED), which is the inability to get and keep erections. In fact, according to an article published by Harvard Health Publications, some doctors used it to treat ED before Pfizer released Viagra in 1998.
However, only about 5 percent of men experience ED solely from low testosterone. Low testosterone levels can be a contributing factor to ED but are more likely to reduce sexual desire than cause ED. Many doctors won’t consider prescribing testosterone to a patient unless he presents certain other symptoms, too.
Dr. Abraham Morgentaler is an advocate of using testosterone for treating men with sexual dysfunction, including ED.
Morgentaler does admit that some men may require testosterone and Viagra, however, in order to have adequate erections.
Enhancing Physical Performance
Because testosterone allows men to increase muscle mass and performance, athletes and bodybuilders use testosterone-boosting supplements and drugs to increase strength and improve recovery time. The practice of using these drugs is called “doping.” Athletes use both synthetic and bioidentical supplements. Bodybuilders in particular are known for their use of synthetic hormones to rapidly increase muscle mass.
Testosterone can help increase muscle mass in a much faster fashion. Athletes who use anabolic steroids may find that they’re able to increase their endurance and their strength by doing the same amount of training as they would otherwise.
However, using performance-enhancing drugs, testosterone included, is illegal in most sports. While the drug is helpful to men who are clinically diagnosed with Low T, men who abuse these drugs solely to boost performance face a number of possible side effects.
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