From the Guidelines
An endocrinologist is the primary specialist who deals with low testosterone, though urologists also commonly treat this condition. If you're experiencing symptoms of low testosterone such as fatigue, decreased libido, erectile dysfunction, reduced muscle mass, or mood changes, you should first consult your primary care physician who can order initial blood tests to check your testosterone levels. If levels are confirmed to be low, they may refer you to an endocrinologist who specializes in hormonal disorders. Treatment options typically include testosterone replacement therapy (TRT), which comes in several forms including injections (such as testosterone cypionate or enanthate, typically 50-200mg every 1-2 weeks), topical gels (like AndroGel or Testim applied daily), patches, or pellets implanted under the skin. The appropriate treatment and dosage depends on your specific situation, age, and health status. Endocrinologists are particularly well-suited to manage this condition because they can monitor not just testosterone levels but also related hormones and potential side effects of treatment, including effects on prostate health, red blood cell production, and fertility, as noted in the American College of Physicians guideline on testosterone treatment in adult men with age-related low testosterone 1.
Some key points to consider when dealing with low testosterone include:
- The U.S. Food and Drug Administration (FDA) requires the pharmaceutical industry to label all testosterone medications to clearly state that their products are approved for use only in persons with low testosterone levels due to known causes 1.
- The role of testosterone treatment in managing age-related low testosterone is controversial, with some studies suggesting small improvements in sexual functioning and quality of life but little to no benefit for other common symptoms of aging 1.
- Long-term efficacy and safety of testosterone treatment are unknown, and evidence about mortality is also inconclusive due to very serious imprecision, low event rates, and potential fragility of the results 1.
- The annual cost of testosterone replacement therapy can vary, with the transdermal formulation costing around $2135.32 per beneficiary and the intramuscular formulation costing around $156.24 per beneficiary in 2016 1.
Overall, when dealing with low testosterone, it's essential to consult with a specialist, such as an endocrinologist, who can provide personalized guidance and treatment options based on your specific situation and health status.
From the FDA Drug Label
1 INDICATIONS AND USAGE Testosterone gel 1. 62% is indicated for replacement therapy in adult males for conditions associated with a deficiency or absence of endogenous testosterone: • Primary hypogonadism (congenital or acquired): testicular failure due to conditions such as cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome, orchiectomy, Klinefelter's syndrome, chemotherapy, or toxic damage from alcohol or heavy metals • Hypogonadotropic hypogonadism (congenital or acquired): gonadotropin or luteinizing hormone-releasing hormone (LHRH) deficiency or pituitary-hypothalamic injury from tumors, trauma, or radiation
The specialist that deals with low testosterone is typically an Endocrinologist or a Urologist.
- Endocrinologists specialize in the diagnosis and treatment of hormone-related disorders, including hypogonadism.
- Urologists may also be involved in the treatment of low testosterone, particularly in cases where the condition is related to testicular or pituitary problems. 2
From the Research
Specialist for Low Testosterone
The specialist who deals with low testosterone is typically an:
- Endocrinologist: a doctor who specializes in the diagnosis and treatment of hormone-related disorders, including low testosterone 3
- Urologist: a doctor who specializes in the diagnosis and treatment of disorders related to the urinary tract and male reproductive system, including low testosterone 4, 5
- Primary care physician: a doctor who provides general medical care and may refer patients to a specialist if necessary 3
Treatment Options
Treatment options for low testosterone may include:
- Testosterone replacement therapy (TRT): a treatment that involves replacing testosterone in the body to relieve symptoms of low testosterone 4, 6, 7
- Human chorionic gonadotropin (hCG) therapy: a treatment that involves using hCG to stimulate the production of testosterone and sperm in the body 6, 5, 7
- Clomiphene citrate: a medication that can help increase testosterone production in the body 7
Considerations for Fertility
For men with low testosterone who wish to preserve fertility, considerations may include: