Testosterone Therapy (TRT)

TRT is used to treat low testosterone (T) levels which can occur with age or as a result of a medical condition.

In the last 100 years, life expectancy for men has increased by 65%, according to the Centers for Disease Control and Prevention (CDC). In 1900, men lived until about age 46. By 2014, that age jumped to 76. There’s no question that men are redefining what it means to be 50, 60, and 70 years old or older.

As men age, their testosterone levels naturally decrease in a process sometimes called andropause or male menopause. This can lead to clinical symptoms of testosterone deficiency and/or low blood testosterone levels. Let’s define what testosterone is and why it is so important to maintain its proper levels.

What is testosterone?

Testosterone is the hormone responsible for the development of male external genitalia and secondary sexual characteristics. It’s produced by Leydig cells in the testicles in response to luteinizing hormone from the pituitary gland. Testosterone is essential for the development and maintenance of organs and physiological functions in males including:

• muscle bulk;
• bone density;
• red blood cells;
• sexual and reproductive function;
• vitality and well-being.

As men age, their bodies gradually produce less testosterone. This natural decline starts around age 30 and continues throughout the rest of a man’s life.

Why does T-hormone decrease with age?

Your body naturally produces less T as you age. According to an article in American Family Physician, the average male’s T production goes down by about 1 to 2 percent each year.

This is all part of a completely natural process that starts in your late 20s or early 30s:

1. As you age, your testicles produce less T.
2. Lowered testicular T causes your hypothalamus to produce less gonadotropin-releasing hormone (GnRH).
3. Lowered GnRH causes your pituitary gland to make less luteinizing hormone (LH).
4. Lowered LH results in lowered overall T production.

This gradual decrease in T often doesn’t cause any noticeable symptoms. But a significant drop in T levels may cause:

• low sex drive;
• fewer spontaneous erections;
• erectile dysfunction;
• lowered sperm count or volume;
• trouble sleeping;
• unusual loss of muscle and bone density;
• unexplained weight gain.

Many men experience changes as they age similar to the symptoms of hypogonadism. But their symptoms may not be related to any disease or injury. Some are considered a normal part of aging:

• changes in sleep patterns and sexual function;
• increased body fat;
• reduced muscle;
• decreased motivation or self-confidence.

What is hypogonadism?

Hypogonadism occurs when your sex glands produce little or no sex hormones. The sex glands, also called gonads, are primarily the testes in men and the ovaries in women. Sex hormones help control secondary sex characteristics, such as breast development in women, testicular development in men, and pubic hair growth. Sex hormones also play a role in the menstrual cycle and sperm production.

Hypogonadism may also be known as gonad deficiency. It may be called low serum testosterone or andropause when it happens in males.

Most cases of this condition respond well to appropriate medical treatment.

What are the types of hypogonadism?

There are two types of hypogonadism: primary and central.

Primary hypogonadism

Primary hypogonadism means that you don’t have enough sex hormones in your body due to a problem in your gonads. Your gonads are still receiving the message to produce hormones from your brain, but they aren’t able to produce them.

Central (secondary) hypogonadism

In central hypogonadism, the problem lies in your brain. Your hypothalamus and pituitary gland, which control your gonads, aren’t working properly.

What are the causes of hypogonadism?

The causes of primary hypogonadism include:

• autoimmune disorders, such as Addison’s disease and hypoparathyroidism;
• genetic disorders, such as Turner syndrome and Klinefelter syndrome;
• severe infections, especially mumps involving your testicles;
• liver and kidney diseases;
• undescended testes;
• hemochromatosis, which happens when your body absorbs too much iron;
• radiation exposure;
• surgery on your sexual organs.

Central hypogonadism may be due to:

• genetic disorders, such as Kallmann syndrome (abnormal hypothalamic development);
• infections, including HIV;
• pituitary disorders;
• inflammatory diseases, including sarcoidosis, tuberculosis, and histiocytosis;
• obesity;
• rapid weight loss;
• nutritional deficiencies;
• use of steroids or opioids;
• brain surgery;
• radiation exposure;
• injury to your pituitary gland or hypothalamus;
• a tumor in or near your pituitary gland.

What is Testosterone Replacement Therapy (TRT)?

TRT is an acronym for testosterone replacement therapy, sometimes called androgen replacement therapy. It’s primarily used to treat low testosterone (T) levels, which can occur with age or as a result of a medical condition.

It’s currently becoming increasingly popular for non-medical uses, including:

• enhancing sexual performance;
• achieving higher energy levels;
• building muscle mass for bodybuilding.

Some research suggests that TRT may in fact help you achieve some of these goals. But there are some caveats. It can also restore your sex drive and you may notice a drop in body fat and a buildup of muscle mass after TRT.

How is TRT used medically?

TRT is traditionally used to treat hypogonadism, which occurs when your testes (also called gonads) don’t produce enough testosterone. TRT works to make up for T that isn’t being produced by your testes.

If you have true hypogonadism, TRT can:

• improve your sexual function;
• boost your sperm count and volume;
• increase levels of other hormones that interact with T, including prolactin.

TRT can also help to balance unusual T levels caused by:

• autoimmune conditions;
• genetic disorders;
• infections that damage your sex organs;
• undescended testicles;
• radiation therapy for cancer;
• sex organ surgeries.

What are the non-medical uses of TRT?

Many countries, including the United States, don’t allow people to legally purchase T supplements for TRT without a prescription.

Still, people seek out TRT for a range of non-medical reasons, such as:

• losing weight;
• increasing energy levels;
• boosting sexual drive or performance;
• raising endurance for athletic activities;
• gaining extra muscle mass for bodybuilding.

Using TRT to gain a competitive edge in a sport is considered “doping” by many professional organizations, and most consider it grounds for termination from the sport.

TRT has few proven benefits for people, especially younger males, with normal or high T levels. And the risks may outweigh the benefits.

If you’re interested in more information concerning TRT and testosterone levels testing, please get in touch!