Hypogonadism (Low Testosterone) Treatment

Take-home points:

• The primary goal of hypogonadism treatment is to restore testosterone levels in the body.
• This is typically achieved through testosterone replacement therapy, which is available in various forms, including gels, tablets, and injections.
• Certain benefits may be observed from 6 months onwards, highlighting the importance of long-term compliance with treatment.

Testosterone treatment

If you have been diagnosed with hypogonadism you are typically prescribed testosterone replacement therapy (TRT) which aims to restore normal testosterone levels and relieve your symptoms of hypogonadism.¹

Learn more about diagnosing hypogonadism

‍The British Society of Sexual Medicine (BSSM) recognises several benefits of treating hypogonadal patients with TRT and these benefits and many others have been highlighted through clinical trials.¹

Benefits of TRT

Improved sexual function, erectile function and sexual desire  ‍

Hypogonadism impairs sexual function and desire, and can cause erectile dysfunction as well, a condition characterised by persistent difficulties in maintaining erections. One of the primary advantages of TRT is its ability to enhance sexual function and desire, while also improving the responsiveness to a first-line treatment option for erectile dysfunction known as PDE5 inhibitors.^1,2

Interested in learning more about erectile dysfunction treatment options?

‍Improved body composition

Hypogonadism can lead to a decrease in bone mass and density, a condition known as osteoporosis. Additionally, reduced muscle mass, strength, and weight gain are commonly observed changes in individuals with hypogonadism. For those experiencing decreased muscle and bone mass, TRT can help enhance overall muscle mass, muscle strength, and bone strength. However, it is important to note that these benefits may take up to 12 months to become noticeable with treatment.¹

‍Potential improvements in mood

TRT is linked to moderate improvements in mood.³ However, it is important to note that TRT is not an antidepressant and should not be used as a treatment for depression.² Some research suggests that TRT may enhance memory and cognitive function, but there is a scarcity of high-quality studies to validate these findings. Therefore, further research is necessary to provide more conclusive evidence.^2,3

TRT increases haemaglobin levels

‍Patients with anaemia have low red blood cell count which can increase the risk of fatigue. Patients may also experience symptoms such as chest pain, feeling cold, headaches and feeling dizzy. TRT can increase haemaglobin levels and may improve symptoms of anaemia in patients with anaemia.¹ ‍

Who is TRT for?

TRT is intended for patients diagnosed with hypogonadism. However, before prescribing TRT, doctors will take into account several other crucial factors. Men who have breast cancer, active prostate cancer (cancer that is currently progressing), heart failure, or those who are attempting to conceive should not be recommended TRT. ^1,2

Types of TRT

‍TRT comes in a variety of preparations which vary on their route of delivery. Examples include gels, tablets, injections, and nasal sprays. ‍

Gels 

• Testosterone gel is applied topically on the skin, allowing for absorption into the bloodstream. It typically has minimal side effects, with the most commonly reported being itchy and irritated skin in the area where the gel is applied.⁴ One safety concern with testosterone gel is the potential for unintentional transfer to another person before it has fully absorbed into the skin. While small amounts on a one-off occasion are not believed to be harmful, repeated exposure of testosterone to other household members, particularly women and children, could have adverse effects on their health.⁵ This risk can be minimised by ensuring adequate drying time before coming into contact with others.

Oral TRT

• TRT tablets are applied onto the gums in the mouth and provide a controlled and sustained release of testosterone directly into the bloodstream. This method bypasses the initial liver metabolism, allowing for increased absorption and utilisation of testosterone in the body. Another oral option involves small patches that can be placed on the gums, facilitating the absorption of testosterone into the bloodstream as well. The most frequently reported side effect associated with both patches and tablets is gum irritation.⁴

Injectable TRT 

• There are different types of injections to choose from that are typically injected into your arm or leg by a doctor or nurse. In some cases you can learn to self-administer and inject yourself at home. Side effects are minimul, with the most commonly reported being pain and swelling around the area of injection.⁴ 

Assessing progress

It is recommended that your healthcare professional overseeing your TRT reviews your treatment approximately three months after initiation. Subsequently, they should conduct additional assessments at the six-month and twelve-month marks to evaluate the effectiveness of the therapy in managing your condition.² It's crucial to maintain regular communication with your healthcare professional to ensure optimal care.

The TRTed Medication tracker

Here at TRTed, we have developed a medication tracker to help you keep on track of your treatments.

Join the conversation on the TRTed Community! 

References

1. Hackett G, et al. The journal of sexual medicine. 2017;14(12):1504-1523.
2. Salonia A, Bettocchi C, Carvalho J. Eur Urol. 2021.
3. Juny. World J Mens Health. 2016; 34(3): 194–199. 
4. Shoskes, et al. Transl Androl Urol. 2016; 5(6): 834–843.
5. Michael G, et al.Current Medical Research and Opinion 2012; 28(2): 267-269.