Testosterone Therapy for Hypogonadism Guideline Resources

Testosterone Replacement Therapy TRT

That translates to roughly 8.4 million men, many of whom are frustrated and leading lives that feel inadequate. As for Medicaid coverage, guidelines vary by state.”Most states offer some level of coverage for trt stack under their prescription drug benefit,” Dr. Shusterman says. Patients should always consult their healthcare provider for professional medical advice and ensure they know about available coverage and policy details.

If you have signs and symptoms of low testosterone, a healthcare provider will perform a physical exam. They’ll also ask questions about your medical history, medications you take or have taken, smoking history and any symptoms you currently have. Late-onset hypogonadism (LOH) is a type of secondary male hypogonadism that results from normal aging. As males age they have a deterioration of hypothalamic-pituitary function and Leydig cell function that decrease testosterone and/or sperm production.

Others may not have symptoms until their level is at 150 or even 100. This will include a blood test taken in the morning between 7 and 9 a.m., during which your testosterone levels are typically the highest, along with a complete hormone lab workup if needed, he says. “There is also a growing body of evidence that demonstrates testosterone is safe to administer in men with prostate cancer or previously treated prostate cancer,” Dr. Muthigi adds. “However, this must be managed and monitored by an andrology specialist.” Due to the baby boom that occurred after World War II, the percentage of population in the older age group in developed countries is increasing. Testosterone deficiency is a common disorder in middle-aged and older men but it is underdiagnosed and often untreated. Clinicians tend to overlook it, and the complaints of androgen-deficient men are merely considered part of aging.

This has resulted in men who would benefit from replacement seeking medical care. Testosterone replacement therapy is most commonly given as a topical gel or an injection. The Department of Urology at the University of North Carolina provides superb clinical care, dynamic medical education, and conducts practice-changing research to better serve the people of North Carolina, the Southeast, and beyond. Testosterone is important to a man’s health, says UNC Health urologist Marc J. Rogers, MD. Here’s the real deal about why, and what to do if you’re concerned about low testosterone. However, scientists caution there isn’t enough information to determine the safety of regular testosterone supplementation. If your child isn’t showing signs of puberty by the age of 14, talk to their pediatrician.

As you age, your testosterone level gradually declines — typically about 1% a year after age 30 or 40. For older men, it’s important to determine if a low testosterone level is due to normal aging or if it is due to a disease (hypogonadism). For many patients, we can provide low testosterone therapy in the form of testosterone replacement therapy (TRT) through our self-inject testosterone replacement therapy program.

Others, such as a deeper voice, a larger clitoris, scalp hair loss, and more body and facial hair, cannot be reversed. The testosterone that’s used for masculinizing hormone therapy is identical to the hormone that the testicles and ovaries make naturally. Don’t use synthetic androgens, such as oral methyl testosterone or anabolic steroids. It’s unclear whether masculinizing hormone therapy raises the risk of ovarian and uterine cancer.

Testosterone administration reduces whole-body and visceral fat mass. Some trials have reported greater improvement in measures of insulin resistance with testosterone treatment of men with T2DM or metabolic syndrome than placebo (7), but testosterone treatment has not consistently improved glycemic control. “There’s no signal that testosterone therapy increases the risk of prostate cancer,” says Anawalt. Testosterone therapy can help reverse the effects of hypogonadism, however, it is unclear whether testosterone therapy would benefit older men who are otherwise healthy. Although some men believe they feel younger and more vigorous if they take testosterone medications, there is little evidence to support the use of testosterone in otherwise healthy men.

Well-established reference ranges constitute the essential basis for identifying whether the circulating levels of a particular analyte, testosterone in this case, are normal or low. Due to the challenges in testosterone methodology, there is considerable variability in testosterone reference ranges.13  The specific reference ranges used to diagnose testosterone deficiency are discussed in more depth later in this document. However, practicing clinicians who review testosterone lab results will commonly face the dilemma of whether to use the reference ranges published by their specific lab or the absolute measure itself. As an example, a total testosterone value of 250 ng/dL may be considered low based on the current guideline but be marked within the normal range by the laboratory. This situation commonly occurs as reference laboratories often define a normal value as ranging within the 5th (or 2.5th) and 95th (or 97.5th) percentiles of a sampled population. However, as the testosterone literature uses absolute values to define low testosterone, the absolute value is ultimately the most important factor to determine whether patients may expect to achieve benefits with testosterone therapy.

Testosterone replacement therapy (TRT) is a reasonable treatment option often discussed for men with low testosterone levels and symptoms of hypogonadism. When replaced, many of the positive effects of testosterone are regained.[4] These positive results have led to a drastic increase in the use of testosterone replacement for men with symptomatic hypogonadism, though long-term data is lacking on the safety. Testosterone levels should be monitored 3 months after initiation of testosterone therapy.

The Panel recognizes that not all laboratories use LCMS technology, and immunoassays may be the only measurement tool available to clinicians. Some authorities have advocated that free testosterone should be the primary measure used to define testosterone deficiency. This is based on the concept that the free testosterone fraction is believed to be the most biologically active component.