From the Guidelines
Men with low free testosterone should be considered for testosterone replacement therapy (TRT) only if they have symptomatic hypogonadism, and the treatment should be initiated with intramuscular formulations to improve sexual function, as recommended by the American College of Physicians 1. When evaluating men with low free testosterone, it is essential to conduct a comprehensive medical evaluation, including morning blood tests on two separate occasions to confirm consistently low levels, typically below 300 ng/dL total testosterone 1.
Key Considerations
- A gradual, age-associated decline in serum total testosterone levels begins in men in their mid-30s and continues at an average rate of 1.6% per year 1.
- The incidence of low testosterone in the United States is reported to be approximately 20% in men older than 60,30% in those older than 70, and 50% in those older than 80 years 1.
- Testosterone replacement in men with symptomatic hypogonadism may have benefits, including improved sexual function, well-being, muscle mass and strength, and bone density 1.
Treatment Approach
- Intramuscular testosterone formulations are recommended over transdermal formulations due to their lower cost and similar clinical effectiveness and harms 1.
- Lifestyle modifications, such as regular exercise, maintaining a healthy weight, adequate sleep, stress reduction, and limiting alcohol consumption, can also help improve testosterone levels.
- Medications like clomiphene citrate or human chorionic gonadotropin (HCG) injections may be considered to stimulate natural testosterone production in some men.
Monitoring and Safety
- Regular monitoring for potential side effects of TRT, including polycythemia, sleep apnea, acne, and prostate issues, is necessary 1.
- Treatment aims to restore testosterone to normal physiological levels, which can improve energy, mood, sexual function, muscle mass, and bone density.
From the Research
Low Free Testosterone: Causes and Treatment
- Low free testosterone, also known as hypogonadism, is a condition where the testes do not produce enough testosterone, leading to a range of symptoms including fatigue, decreased libido, and erectile dysfunction 2.
- The prevalence of hypogonadism varies depending on age, comorbidities, and study group, with estimated prevalence rates ranging from 2-4% in the general population 3.
- Testosterone replacement therapy (TRT) is a common treatment for hypogonadism, with transdermal testosterone patches and gels being popular options 4, 5.
Diagnosis and Management
- Diagnosing low serum testosterone involves measuring testosterone levels, which can be done through blood tests 6.
- Managing low serum testosterone involves determining which patients may benefit from therapy, and initiating treatment with TRT 6.
- TRT has been shown to improve symptoms of hypogonadism, including sexual function, mood, and body composition 5.
Treatment Options
- Transdermal testosterone patches, such as Testopatch, have been shown to be safe and effective in treating hypogonadism, with minimal changes in prostate-specific antigen (PSA) concentrations and no significant prostate risks 3.
- Testosterone gels, such as Testim, have also been shown to be effective in normalizing androgen levels and improving body composition and sexual function in hypogonadal men 5.
- The choice of treatment option depends on individual patient needs and preferences, as well as the presence of any comorbidities or contraindications 2, 4.