From the Guidelines
If your free testosterone is low and total testosterone is on the lower end of normal, you should not initiate testosterone replacement therapy without consulting a healthcare provider, as the long-term efficacy and safety of such therapy are unknown, especially in men without well-established medical conditions known to cause hypogonadism 1.
When evaluating your testosterone levels, it's essential to consider the distinction between free and total testosterone. Free testosterone is the biologically active form that's available to tissues, while total testosterone includes both free and protein-bound forms. Low free testosterone with normal total levels can indicate issues with sex hormone binding globulin (SHBG) levels, which affects how much testosterone is available for your body to use.
Some key points to consider:
- Testosterone treatment is approved by the U.S. Food and Drug Administration (FDA) for replacement therapy for men with primary or secondary hypogonadism caused by disorders of the hypothalamus, pituitary gland, or testes 1.
- The American College of Physicians suggests that testosterone therapy may provide small improvements in sexual functioning and quality of life but little to no benefit for other common symptoms of aging in older men with low testosterone levels without well-established medical conditions known to cause hypogonadism 1.
- Lifestyle changes, such as regular exercise, adequate sleep, stress reduction, and a balanced diet rich in zinc, vitamin D, and healthy fats, may be recommended before considering testosterone replacement therapy.
- Nutritional supplements like vitamin D, zinc, and magnesium may be beneficial if you're deficient, but it's crucial to consult with a healthcare provider before starting any supplements.
It's essential to consult with a healthcare provider for proper evaluation and potential treatment, as they can help determine the best course of action based on your individual needs and health status. A healthcare provider may recommend monitoring your testosterone levels and addressing any underlying health issues before considering testosterone replacement therapy 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Testosterone Levels and Treatment Options
- Free testosterone levels are a little low, while total testosterone levels are normal but on the low side of normal 2, 3.
- Testosterone replacement therapy (TRT) is a common treatment for low testosterone levels, but it may have adverse effects such as polycythemia and may not be suitable for men seeking to conceive 2, 4.
- Clomiphene citrate is an alternative treatment that stimulates gonadotropin secretion, leading to increased endogenous testosterone production, and may be a promising option for men with hypogonadism, particularly those desiring fertility preservation 3, 5.
Treatment Considerations
- The safety and efficacy of long-term TRT are still unknown, and clinicians must consider the unique characteristics of each patient and make necessary adjustments in the management of late-onset hypogonadism (LOH) 2, 4.
- Clomiphene citrate may be used as an off-label treatment for hypogonadism, and long-term data suggest that it is safe and effective with few side effects 5.
- The choice between TRT and clomiphene citrate depends on individual patient characteristics, such as fertility desires and overall health status 3, 6.
Potential Risks and Benefits
- TRT may increase cardiovascular morbidity and mortality risks, but the evidence is poor and varies across study populations 4.
- Clomiphene citrate may increase estradiol levels, but it has not been shown to increase the risk of prostate cancer or worsen lower urinary tract symptoms 3, 5.
- Both TRT and clomiphene citrate may have benefits such as improved libido, erectile function, and overall well-being, but the risks and benefits must be carefully weighed for each individual patient 2, 3, 6.