I'm a 56 male and I have just gotten blood resuts back and my testosterone level is 350. The last year I got the main symptoms such as lack of libido, lower sex drive and weaker erections which is OK when using Viagra. I'm thinking I may need tesosterone replacement. My insurance has a very high deductable so I'm looking at the best way to pick the right doctor and not pay a lot for tests.I understand a may need to be on androderm for the rest of my life. Could anyone advise me about which kind of doctor I should go to and if I should get testosterone replacement?
I am in a similar position and chose not to take hormones. The possible side effects were not worth taking the hormones for me. Luckily, my partner is understanding and we are adjusting to a lack of sex.
Testosterone levels are important. There are side effects to low testosterone like osteroperosis, muscle loss, balance problems, depression and there is the possibility that low testosterone is related to prostate cancer.
Low testosterone is also associated with a higher mortality rate; one recent study showed 2.5x higher for those with the lowest levels. Normal testosterone levels are important for many body functions including immune function.
Here is a recent medical journal article's conclusion:
Circulation. 2007 Dec 4;116(23):2694-701. Epub 2007 Nov 26. "CONCLUSIONS: Low testosterone may be a predictive marker for those at high risk of cardiovascular disease."
It's important to find the reason for low testosterone before you start taking replacements. Blood tests for free T, SHBG, LH, FSH, thyroid, and prolactin will narrow it down. Your GP can do those tests and if they show abnormality you would want to visit an endocrinologist.
There are many ways to take testosterone including pills, gel, patches and shots. For full replacement I think injections are the most convenient but for just boosting your levels a patch works if you don't get skin reactions to it. The gel works but you have to do it after you shower and be sure your partner doesn't touch the area of application for a few hours.
If you have low testosterone, the side effects of not treating it are far greater than the possible side effects of using testosterone replacement. That is like saying that it is better to have high blood pressure and risk a possible stroke than risk the side effects of BP medications.
Thank-you for your responses. I was thinking I should go to urologist to treat me with testosterone replacement. Should I first make sure he has a lot of experience in the replacement field?
Making sure that he has experience in this is what the men on this board who have had experience with this suggest. There have been many cases where urologists or even endocrinologists have said that as long as you are in the lab normals that everything is fine. At least according to reports of men who have posted with this problem.
I don't know if a urologist or an endo would be your best bet. Perhaps those with more experience than me could help you with that. Sometimes a good internist is better than a specialist if he/she is experienced in hypogonadism. From what I have read on this board, it is sort of hit or miss unless you can know beforehand if the doctor has experience in treating this. A lot of endos specialize in things like reproductive issues.
Just have to add my own note of caution. My husband's journey with prostate cancer began with low testosterone levels. The PCM we had at the time decided that the quick solution would be to start loading him up with testosterone -- injections as well as patches -- without doing a complete workup, or referring him to a specialist, to identify WHY his testosterone level was low. We trusted this doctor and shouldn't have. We found out the hard way that the low testosterone was due to early stage prostate cancer. If it had been identified at that point (more than 3 years ago), his treatment and recovery would not have been nearly so complex.
Please consult with an endocrinologist and a urologist before making any treatment decision. My husband and I both wish that we had been more knowledgeable about this issue.
I just did some more reading and found the results of a study that was published in JAMA in 1996. It was done at the Beth Israel Deaconess Medical Center, which is a affiliate of the Harvard Medical School. The study was of 77 men with low T, who had normal PSA and a digital rectal exam that detected no problem. Fourteen percent of the men were found to have prostate cancer and of those over 60, the percentage was 29%.The researchers believed that low testosterone levels falsely lower PSA and shrink prostate cancers, so that these tumors are more difficult to detect. They recommend that a prostate biopsy be done prior to starting TRT for men in their 50s and older.
Now to contradict this, the preliminary research of another study suggests that testosterone replacement therapy for men with low testosterone levels appears to have little effect on the prostate gland, contrary to some reports that this therapy may be harmful, according to a study in the November 15, 2008 issue of JAMA. This was a 22 month study of 40 men. However, all of the men were given biopsies before and after the study, so none of these had any signs of prostate cancer before the TRT began. The men were age 44 to 78 and the percentage of them with prostate cancer was apparently zero.
The tests show my free testosterone is 59 and in the lower normal range just like the total testosterone at 323. I'm thinking that most doctors will not let me start testosterone replacement even though I have most of the low testosterone symptoms. What should I do now? Wait until my testosterone is under 250 or keep seeing specialists until one of them treats me? I appreciate all comments!!!!!
I know that men post saying that their internist, urologist and even endocrinologist say that everything is fine as long as they are in the lab normal range. However, we don't know how prevalent this is. Is this 10% of doctors or 70% of doctors? I have no idea. My internal medicine doctor, who is also a rheumatologist, recognized that my level of 304 was too low and that I should be at least 500. I do wish that he had tested me for more things, but he did start me on TRT as soon as the results came back this past May.
There are different opinions even among the doctors who are considered the experts in this field. I have read sites where various doctors who treat hypogonadism have different opinions on how to treat the same thing, so I have no idea who is correct. Some believe that primary and secondary should be treated the same, while others believe that they should be treated differently.
I guess your best bet is to find out if a doctor who you are thinking of seeing thinks that your level is low and in need of treatment and also find out what hormones he normally checks before putting you on HRT.
Thank-you for your reply. What type of TRT are you taking? Is it Androgel? What are your readings since you have been treated? Do you feel it helped? Treatment is expensive and I have to pay most out of pocket.
Before you begin any kind of therapy, it is highly advisable to have a
number of basic blood tests done. This provides a starting point
baseline from which when you begin TRT (if you do) you will be able
to clearly see what is working and what isn't and what needs to be
altered to provide optimum benefit. Also a PSA to verify you don't
have an enlarging prostate which could be benign or otherwise.
The basic tests can usually pinpoint the cause of your low T.
That being said, TRT using injections costs a fraction of what androgel
costs. Self administered injections are not expensive and I believe are your best option. I accidently doubled one of my weekly injections and a
test done shortly therafter showed my TT to be 1232. Usually I stay
in a range between 450 and 900 over the week. But it is easy to fine
tune if desired. Once I failed to inject on time and after a few days
without T my blood pressure shot way up which made me realize how
important it is to stay in a reasonable range.
Your numbers are way too low for good libido and maybe problematic
for other reasons as well.
Much luck to you in finding a competent medical practitioner as they
appear to be few and far between.
Once you get used to self injection you discover it is really painless
and for me makes me feel more self empowered.
Thanks for response but I'm not good with needles eventhough I'm sure you are right about beneficial cost. If I did do the injection: Does the doctor make the shots for you? How often do you get total testosterone blood tests? Where do you get the tests? How often do you see your doctor? What type of doctor would you go to? What do you consider low testosterone range to be? My PSA was 1.3 so I think I'm OK there. Thanks
I am now on 10 gm of Testim, which is 2 tubes per day. My latest PSA in May was 0.53. I did feel more frisky than I have recently felt this morning, so maybe the Testim is doing some good. I'll see in a couple of months. I asked my doctor to switch me to Testim because of the greater absorption. I posted about that here:
The Testim seems to absorb better than the Androgel did, but it stays sticky for about 3 hours. I understand that it has some oil in it, so that is probably why. I don't care about that if it works well. My copay for Testim or Androgel is $25 per month. You can also get a coupon for up to $40 off of Testim each month for 12 months, but it is only good until the end of June of 2009, so that is only 7 months now. I signed up and downloaded one a couple of days ago, so it will cover my copay for 7 months. If the Testim doesn't work then I will talk to my doctor about T cyp shots.