Testosterone and TRT (Testosterone Replacement Therapy)

Testosterone is the primary sex hormone in males and plays a crucial role in the development and maintenance of secondary sex characteristics as well as mental health and cognitive, metabolic, hematologic, and other bodily functions. Testosterone levels naturally decline with age leading to unwanted symptoms like decreased libido, reduced muscle mass, weight gain, fatigue, mood changes, and decreased bone density, among others. The current guidelines recommend testosterone replacement therapy (TRT) for primary and secondary hypogonadism. Unfortunately, the vast majority of men fall into a different category known as adult-onset hypogonadism. This is also referred to as andropause or male menopause. There is no formal criteria or definition of andropause but rather a collection of symptoms associated with the natural decreases in testosterone levels with age. TRT can help men return to some prior level of functioning when testosterone levels were naturally higher. TRT is not used to achieve supra-physiologic levels but rather to restore what would have been normative in earlier years. There are many factors to consider when thinking about TRT and adjunctive therapies. When evaluating a man for low testosterone the provider must look not only at the testosterone level but also at other hormone levels within the body. Determining the correct source of the testosterone deficiency (if present) is vital to proper treatment. For example, if a patient presents with low testosterone levels because it is being converted into estrogen at higher-than-normal rates giving that man testosterone alone will not necessarily fix the underlying problem. This is especially common in overweight and obese men. Testosterone could improve symptoms but considering an adjunctive medication in addition to TRT may be necessary. Additionally, sometimes men present with low testosterone solely because of low internal production. In this case, stimulating endogenous production may work as a stand-alone treatment. As you can see evaluating a man with a hormone deficiency can become complex so, it is important to find a provider that looks at the picture holistically. Beware of cookie-cutter clinics that do bare minimum assessments as that approach can overlook the root cause of the issue. Also, beware of providers willing to target supra-physiologic dosing as this can cause issues with the pituitary gland as well as significantly increase the chance of adverse events.