Testosterone is a hormone produced by the testicles and is responsible for the proper development of male sexual charTestosteroneacteristics. Testosterone is also important for maintaining muscle bulk, adequate levels of red blood cells, bone density, sense of well-being, and sexual and reproductive function

Testosterone production increases rapidly at the onset of puberty and decreases rapidly after age 50 (to 20–50% of peak level by age 80). Recent estimates show that approximately 13 million men in the United States experience testosterone deficiency and less than 10% receive treatment. Studies have shown that men with hypertension, diabetes, or obesity may be twice as likely to have low testosterone levels

Testosterone production declines naturally with age. This natural decline starts after age 30 and continues throughout life.  Low testosterone, or testosterone deficiency (TD), may result from:

  • injury or infection to the testicles
  • chemotherapy or radiation treatment for cancer
  • genetic abnormalities such as Klinefelter’s Syndrome (extra x chromosome)
  • hemochromatosis (too much iron in the body)
  • dysfunction of the pituitary gland (a gland in the brain that produces many important hormones)
  • medications, including hormone analogues used to treat prostate cancer and steroids
  • chronic illness
  • cirrhosis of the liver
  • chronic renal (kidney) failure
  • AIDS
  • inflammatory disease such as sarcoidosis (a condition that causes inflammation of the lungs and other organs)
  • stress
  • alcoholism
  • chronic opioid use

Symptoms of testosterone deficiency include the following:

  • decreased sex drive
  • decreased sense of well-being
  • depressed mood
  • difficulties with concentration and memory
  • erectile dysfunction

Changes that occur with testosterone deficiency include:

  • a decrease in muscle mass, with an increase in body fat
  • variable effects on cholesterol metabolism
  • a decrease in hemoglobin and possibly mild anemia
  • fragile bones (osteoporosis)
  • a decrease in body hair

The only accurate way to detect the condition is to have your doctor measure the amount of testosterone in your blood.  The highest levels of testosterone are generally in the morning. This is why doctors prefer, if possible, to obtain early morning levels of testosterone.

The options available for testosterone replacement are:

  • Intramuscular injections, generally every two or three weeks
  • Subcutaneous Pellet implantation. Pellet are place under the skin and supply testosterone for 3 – 6 months
  • Testosterone patches worn either on the body or on the scrotum (the sac that contains the testicles). These patches are used daily. The body patch application is rotated between the buttocks, arms, back or abdomen.
  • Testosterone gels and creams that are applied daily to the shoulders, upper arms, or abdomen.

Each has side effects and advantages and disadvantages:

  • Intramuscular injections produce wider swings in hormone concentration, with higher levels shortly after the injection and lower levels just before the next injection is due. They may also produce increases in blood cell count that are higher than normal.
  • The body patches may produce skin irritation in a significant number of men, requiring discontinuation of the patch.
  • The gels and creams require care in making sure that the hormone is not accidentally transferred to another person or partner.
  • Pellets provide the most stable serum level of all the options.  They are cost effective last 3 – 6 months but must be inserted by a doctor with local anesthetic.

The choice of hormone replacement therapy is best made with a thorough discussion between a patient and his physician.

In general, hormone replacement therapy is safe. It is associated with some side effects, including:

  • acne or oily skin
  • mild fluid retention
  • stimulation of prostate tissue, with perhaps some increased urination symptoms such as decreased stream or frequency
  • breast enlargement
  • worsening of sleep apnea (a sleep disorder that results in frequent night time awakenings and daytime sleepiness)
  • decreased testicular size


Many of these side effects are not common and are dose dependant.  Adjusting the level testosterone down will usually resolve most side effects.

Testosterone replacement therapy in Philadelphia may stimulate growth of the prostate. If early prostate cancer is present, testosterone may stimulate the cancer’s growth. Therefore, men who have prostate cancer should not take testosterone replacement therapy. It is important for all men considering testosterone replacement therapy to undergo

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