Testosterone Deficiency Treatments

Testosterone is a naturally occurring hormone, a deficiency of which in men is marked by a number of physiological and psychological symptoms. After a diagnosis, a physician can prescribe testosterone therapy to restore natural levels via a number of delivery methods.

Identification

• Testosterone is a steroid hormone produced naturally in male testicles and in smaller amounts by the adrenal glands (women produce small amounts in the ovaries and adrenals as well). In men, testosterone increases skeletal muscle mass, improves bone density, and is responsible for male characteristics (deep voice, face and body hair) and sperm production. An estimated 13 million men in the United States suffer the effects of low levels of blood serum testosterone.

  Low testosterone can result from many acquired and congenital diseases, behavioral causes (such as alcoholism), chemotherapy and glandular injury, and as a side effect of the aging process. Men with low testosterone levels might experience a number of symptoms, including decreased muscle mass, loss of bone density, erectile dysfunction, lower libido, fatigue and depression.

Diagnosis

• Doctors must perform a medical exam, take a full medical and medication history, and test blood-serum levels of testosterone. Kallman syndrome is treated by injecting human chorionic gonadotropin, which is a precursor to testosterone production.

  After ruling out other conditions (such as pituitary dysfunction), a doctor can treat other causes by prescribing exogenous (non-naturally produced) testosterone. When doctors administer testosterone as a way to alleviate the effects of the aging process, this regimen is referred to as hormone replacement therapy.

Dosage

• The dosage given will attempt to mimic the testosterone levels that a man would have produced naturally before experiencing a deficiency. Normal adult males, on average, produce between 4 and 7mg of testosterone each day, mostly in the morning.

  However, the methods used to deliver testosterone (injection, oral, trans-dermal) make it difficult to accurately reproduce the circadian pattern of natural production, so doctors instead look for the desired physiological and psychological changes.

Oral Delivery

• According to Dr. Wayne J.G. Hellstrom of the Tulane University Medical Center, about 1/3 of U.S. men receiving testosterone therapy take oral testosterone. Doctors can prescribe pills or tablets (such as Andriol, Proviron and fluoxymesterone), or patients can attach an adhesive strip (Striant) to the gum and allow the testosterone to be absorbed in the mouth via the gum walls.

  Some oral forms of testosterone are modified by a process called 17-alpha alkalization (the attachment of an alkyl group), so that they are not broken down quickly by the liver and their effects last longer in the body (requiring less frequent dosages). This type of modification increases the hepatotoxicity of these pills (the likelihood that they will damage the liver).

Intra-Muscular Injection

• According to Dr. Hellstrom, doctors can provide a safe means of testosterone delivery by injecting the drug into the intra-muscular tissue. Oil-based versions of testosterone (such as testosterone enanthate) are usually modified by the attachment of an ester group to prolong their activity, allowing for less frequent administration. Some pharmaceutical companies also manufacture an aqueous version (testosterone suspended in water), which requires more frequent injections to achieve the desired effects.

  Men usually receive dosages between 50 and 400mg, administered once every two or three weeks. In addition to the inconvenience of receiving shots, some men taking oil-based injectable testosterone have also reported fluctuations in sexual desire, mood and energy levels.

Trans-dermal Delivery

• Men can also apply creams, sprays or patches containing testosterone directly to their skin or scrotum (for example, Androgel, Androderm and Testoderm). These products deliver testosterone effectively, but can result in skin irritation or rashes, and the patches applied to the scrotum can produce high levels of dihydrotestosterone (DHT), which may accelerate or lead to male pattern baldness.