Testosterone is a most crucial hormone for men’s health. It is responsible for sex differentiation, fertility, and secondary sexual characteristics. It is equally important for maintaining bone and muscle density, providing an overall cardioprotective effect, haematopoiesis, and maintaining cognitive functions.

With age, as the testosterone levels decrease - 4–12% in men aged 50–59 years, 9–23% in men aged 60–69 years, and 28–49% in men over 70 years old. Some people experience symptoms like reduced sex drive, reduced bone and joint strength, fat deposits around the waist and stomach, cognitive impairment, and mood swings, which affect their daily lives.

Testosterone replacement therapy for men can be administered in different forms like gels, patches, injections, or oral formulations, which help the body replenish its testosterone reserves. The final mean level of testosterone in a man’s body should be between 300 ng/dL to 1000 ng/dL. It can also be done naturally, depending on a practitioner’s thorough assessment, a blood test and some scientifically validated self-assessment questionnaires, thus confirming the patient’s course of action.

What Is Testosterone?

Testosterone is the main male sex hormone produced by the male gonads – the testes. Testosterone for men’s health is the most crucial hormone responsible for sex differentiation, developing typical male characteristics, producing spermatozoa, and maintaining fertility. Testosterone synthesis starts from the seventh week of fetal development (during pregnancy) and its function remains relevant in male health till old age. (1)

Also Read: Impact of TRT on Fertility

Also Read: Benefits of TRT for Erectile Function

During the seventh week of pregnancy, a series of developments by the Sertoli cells and Leydig cells, two major somatic cells responsible for the structural and functional development of the testes in the fetus, lead to the formation of the male urogenital tract. Testosterone initially gets secreted by the Leydig cells and further helps form the prostate and the main genital organs. The testes in the fetal system descend through the inguinal canal near the pelvis) in the last 2 months of development. (2)

Why Is It Important To Report Low Testosterone Levels?

Testosterone is also important for several other crucial functions in the body apart from the obvious sexual traits. These include maintaining bone and muscle density, providing an overall cardioprotective effect, haematopoiesis (formation of blood and its components), and maintaining cognitive functions. Evidently, with age, as the testosterone levels decrease over time, these functions also get hampered. This results in men getting diagnosed with increased fat (especially abdominal fat), reduced muscle mass, osteoporosis, declining cognitive functions, mood swings, possible anaemia due to reduced erythropoiesis, and cardiovascular risks among others.(1) However, the changes might also not be so apparent and can be dealt with naturally as well.

Also Read: How TRT Can Help Treat Brain Fog

The prevalence of low testosterone (Low T) levels varies among patients as they age - 4–12% in men aged 50–59 years, 9–23% in men aged 60–69 years, and 28–49% in men over 70 years old. In Canada, about 25% of men between ages 40 and 62 are reported to test low for testosterone on blood work. (3) This condition is known as late-onset hypogonadism and is underreported in a lot of cases – only 5% of these men get diagnosed and treated. A lot of times, this happens because the symptoms can be passed off as the usual signs of getting older or even symptoms of other conditions unrelated to low T levels. It also stems from a lack of understanding of what low-T is and how it can affect you as a male.

Also Read: Symptoms and Causes of Low Testosterone

Misdiagnosis of low-T levels also remains a crucial issue. A study in Ontario revealed that 1 in 90 men over 65 years old was being prescribed testosterone replacement therapy, but only 6% of these patients had been actually diagnosed with hypogonadism.(4) Hence it is crucial for both the patients and the practitioners to be aware of the risks and benefits of testosterone replacement therapy, and if at all it is applicable to them.

How to Know If You Have Low Testosterone

Low Testosterone shows itself in many different forms and varies from person to person. For example, some men may experience more psychological symptoms of low -T such as decreased motivation and low self esteem while others may experience physical symptoms like erectile dysfunction and lack of energy or increased fatigue. Here are some more examples below:

Physical Symptoms of Low -T

• Erectile dysfunction
• Premature ejaculation
• Lack of energy, fatigue
• Decreased endurance
• Muscle weakness, loss of strength
• Aches, joint and muscle pains
• Deterioration in work performance, sports
• Weight gain, increased abdominal fat
• Increased hair loss

Psychological Symptoms of Low -T

• Low sex drive
• Decreased motivation
• Decreased enjoyment of life
• Low self-esteem
• Depression
• Anxiety
• Grumpy, irritability
• Mood swings
• Brain fog

If you’ve experienced any of the above symptoms and you’re over the age of thirty, it might be worth it to run some tests to see if you are experiencing low testosterone. The process of figuring it out is quite simple – all it takes is a blood test.

	Take our online test and check if you are eligible for our hormone therapy This allows our medical team to analyse your blood test and confirm if you’ve qualified for treatment

What is Testosterone Replacement Therapy?

Testosterone replacement therapy (TRT) refers to replenishing declining levels of testosterone in men due to hypogonadism or other medical conditions. The normal mean testosterone in males lies between 300 ng/dL to 1000 ng/dL, with variations between the younger men and the elderly.(5) Studies have shown that the levels vary between 409-558 ng/dL (in 20-24 years old men), 413-575 ng/dL (in 25-29 years old men), 359-498 ng/dL (in 30-34 years old men), 352-478 ng/dL (in 35-39 years old men), and 350-473 ng/dL (in 40-44 years old men).(6)

Testosterone treatment for men is done predominantly through delivery systems like gels, skin patches and injections, while other less popular delivery methods include buccal, oral, and nasal formulations. While scrotal gels and patches are the easiest to apply and adhere to, most people run the risk of transferring them to their partners, spouses, or children, owing to household activities or during intimate encounters. Hence, testosterone injections (subcutaneous and intramuscular) find higher applications in TRT for men. Testosterone injections are administered as oil-soluble ester-based formulations. An ester is an organic compound where the hydrogen in the compound’s carboxyl group is replaced with a hydrocarbon group. Longer hydrocarbon chains and polar solutions ensure the compound retains its structure and can release the required doses of testosterone at a sustained pace.

The most common forms of TRT injections include Testosterone Enanthate and Testosterone Cypionate – two most prevalent ester-based formulations used in the present day to treat low-T conditions.​(7) Other esters are Undeconate, Propionate, Sustenol, and Nebido. (8) (9)

Also Read: Testosterone Enanthate vs Cypionate

The primary determinants to a successful TRT for low T levels are a higher half-life, less-frequent injections (or other dosing), regular monitoring and adherence to prescribed norms. Self-medication is injudicious.

Below is a common guide to TRT dosing:(10)

• For Injections: 75 to 100 mg of testoster­one enanthate or cypionate administered weekly, or 150 to 200 mg ad­ministered every other week
For Transdermal Patches: One or two 5 mg testosterone patches applied nightly on the skin of the back, thigh, or upper arm—away from pressure areas For Gels: 5 to 10 g of testosterone gel applied daily For Oral Tablets: 80 mg of testosterone undecanoate taken orally twice a day with meals

How to Know Whether One Need TRT or Not?

The first step towards understanding if a person needs TRT or not is to check if any of the testosterone deficiency symptoms are taking a serious toll on daily life activities. Visiting a licensed practitioner and taking a blood test (and/or a saliva test, depending on the severity of symptoms and the patient’s age) are the first steps to understanding the levels of testosterone. There are multiple online assessment tools which can also help a person self-assess their health, before reaching out to a practitioner as well. However, everyone is advised to execute a due-diligence before resorting completely to online tests. It is important to understand the relevant quality checks and confidentiality clauses before taking any online questionnaire.

Once the patient visits the doctor, the doctor will analyze the patient’s family and medical history, any previous cases of cardiovascular complications, history of breast and prostate cancer in the family and any other contraindications from previous medical conditions. Depending on these and the results from the blood/saliva tests, the patient will be prescribed an appropriate TRT regimen, if needed.

It is also important to note that not everyone will need TRT to get over low T levels. Natural ways to boost testosterone levels include following a healthy, nutrition rich diet, maintaining physical activity throughout the week (with strength training at least two days a week), and ensuring adequate sleep.

What are the benefits and risks of TRT?

TRT can improve low T levels in the human body between 12-20 weeks minimum, whereas it can also take longer to show effects among others depending on their overall health, the specific health aspect being investigated upon (eg. Effect on muscle health vs. glycemic control vs. sexual health) and adherence to the prescribed therapy.(11) The prima facie TRT benefits include:

• An improved sex drive and stronger erections and ejaculation, especially among younger men with low T levels
• Improved energy levels
• Better sleep
• More confidence, reduced anxiety, and irritability
• Hair growth
• Improved bone and joint health, with reduced adiposity and improved lean muscle mass
• Improved cognitive functions
• Better glycemic control and metabolism

Also Read: How TRT Can Help Treat Low Libido

However, there are a few risk factors that need to be considered before prescribing TRT to patients. These include,

• Aromatized estrogen accumulation because of more frequent testosterone injections
• Patients with existing risks of cardiovascular diseases, thromboembolism, and prostate cancer are advised to seek strict guidance on the course of TRT if prescribed
• Transferring topically applied testosterone gels to spouses, partners, or children in proximity
• Gynecomastia (male breasts) formed due to excess testosterone
• Acne

Benefits of Online Testosterone Therapy

It can be tricky to understand if one needs TRT or not. Most men with low testosterone levels in their body can have non-specific symptoms if at all. However, there are online tools available for assessment of the same. Getting a scientifically validated assessment tool (please insert applicable hyperlink for Science & Humans here) can solve multiple hassles for patients. The ADAM (Androgen Deficiency in Ageing Males) questionnaire and the Ageing Males Symptom (AMS) score are popular tools to help detect hypogonadism in males. (12) (13)There are test kits available to self-assess blood levels for testosterone. Coupled with the online questionnaires, the patient can understand where they stand in terms of testosterone levels. However, it is always advised to visit a doctor (or a licensed specialist) in case of any abnormalities. A validated online assessment tool from reliable resources can well augment the decision-making process, but not define the population who needs TRT. (12)

Next Steps

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