Thanks to new evidence that testosterone replacement therapy (TRT) does not increase prostate cancer risk, many PCa patients with low testosterone are breathing sighs of relief. Testosterone levels tend to decrease as men age, by about 1% per year after age 30. Low testosterone – also called low T or hypogonadism – affects approximately 13 million men. Symptoms can include lack of sex drive (libido), erectile dysfunction affecting quality or quantity of erections, low energy and depression, lack of muscle tone or increased body fat, and anemia (low iron).
If you are experiencing any of these issues, do not try to diagnose the problem by yourself. I have written previously on the importance of getting a medical evaluation and blood work-up to find out if your testosterone has taken a dip. Why see a doctor? Because other physical, mental or emotional conditions can mimic low T, so it’s important to know what the actual culprit is. A blood level of total testosterone less than 300 ng/dL is considered evidence of low T, and the simplest solution is to boost levels with TRT as prescribed by a doctor. TRT helps by reversing physical conditions such as loss of muscle tone, and by improving symptoms such as low energy.
TRT can be administered in various formulations with different delivery systems.
The most common are injections into muscle where the testosterone is absorbed, topical gels or creams that are rubbed into the skin or patches worn on the skin (absorbed through the skin), buccal tablets (absorbed through the upper gums above your front teeth, not swallowed), sublingual tablets (absorbed under the tongue, not swallowed) and implantable pellets. All of these methods are safe when used as directed, appear to have no effect on PSA or raise unhealthy cholesterol levels, and will increase T levels into the low-to-mid normal range. However, one delivery system may be preferable over another.
- Injections are given at intervals (two initial injections 6 weeks apart, and then every 12 weeks thereafter, a total of 4 annual injections once started) to maintain the same level in the blood
- Topical gels or creams are applied daily
- A patch applied to the skin, changed daily
- Daily use of buccal or sublingual tablets that slowly dissolve and are absorbed through the moist membranes in the mouth, not swallowed
- Pellets implanted by the doctor under the skin near the hip and slowly release testosterone into the blood. Implantation is usually done every 4 months
Testosterone replacement therapy has been in use for decades. Some of the earlier formulations had problems such as a roller-coaster effect (high levels when first administered followed by drop-off back to symptomatic levels) or fluid retention. Today, however, most problems have been corrected for. Comparison studies have not demonstrated that one formulation is clearly superior to another, or has significantly worse side effects. Some men using a transdermal product may experience slight skin irritation at the site, so switching to a different formulation may be the answer.
If you have been diagnosed with prostate cancer and are on active surveillance, or you have been treated for PCa, and worry that low testosterone is affecting your health or lifestyle, don’t hesitate to talk about this with your primary care physician or urologist. He or she can evaluate if low T is a problem, and work with you to find the right solution, without increasing PCa risk.
Copyright by Dan Sperling, MD. Reprint permission courtesy of Sperling Prostate Center (New York, Florida), the leading U.S. center for multiparametric detection, diagnosis and image-guided focal treatment of prostate cancer.
Read more in our Low T Health Center.