testosterone is also termed as hypogonadism or androgen deficiency syndrome. In
the United States, about 4 million men are affected by low levels of
testosterone. Usage of testosterone replacement therapy (TRT) in the elderly
men is quite common.
testosterone in a normal male is controlled by two parts of the brain - the
hypothalamus and the pituitary. The
hypothalamus in the brain releases GnRH, which in turn stimulates the release
of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the
anterior pituitary. Luteinizing hormone triggers the production of testosterone
from the testes.
When the testosterone
level reaches a certain specific concentration in the blood stream, it
restrains the GnRH from the hypothalamus and checks the release of luteinizing
hormone by the anterior pituitary.
There are types of
hypogonadism- primary hypogonadism is the commonest type; others are secondary
hypogonadism and mixed hypogonadism, which is the rarest type.
Primary hypogonadism is seen when the testes
fail to respond to FSH and LH. . Secondary hypogonadism is seen when FSH and LH
are produced in insufficient quantities.
Mixed hypogonadism is
seen when there are some defects in the testes, and hypothalamus or pituitary.
and symptoms of testosterone deficiency:
The diagnosis of
testosterone deficiency requires the assessment of testosterone level in the
serum. The average lower level of normal of testosterone in young men is
300ng/dL and symptoms of deficiency appear below this threshold. Testosterone deficiency results in -
incomplete sexual development
Reduced libido or
development of breast in men
Loss of body hair
especially from the armpits and pubis
Hot flashes and
Increased body fat
Loss of memory
A circadian rhythm is
depicted by the serum testosterone level with high values in the morning. The
testosterone values are therefore tested in the morning blood samples.
replacement therapy (TRT) is beneficial in treating deficiency of testosterone.
It can bring positive results in improving erectile dysfunction, libido,
cognition and mood, body strength and composition, and bone density. Benefits of testosterone replacement therapy
are listed below:
replacement therapy has a positive impact on the sexual thought, successful
intercourse, achievement of erections and motivation. TRT improves the overall
sexual performance in testosterone-deficient males.
Mood and Cognition:
Mixed results are
attained with testosterone replacement therapy with respect to mood and
Body Composition and Strength:
replacement therapy remarkably alters the body mass without bringing any change
in the overall weight of the body.
Bone Mass Density (BMD)
testosterone replacement therapy increases the bone mass density. Testosterone
plays an important role in promoting bone formation and prevents bone
Possible side effects
of testosterone replacement therapy (TRT) may vary from mild to serious and
even lethal. Acne eruption, gynecomastia, male pattern baldness and suppression
of spermatogenesis are the mild adverse effects while worsening sleep apnea,
benign prostatic hyperplasia (BPH), worsening of breast cancer, prostate cancer
and cardiovascular ailments are the serious effects associated with
testosterone replacement therapy.
replacement therapy (TRT) aims at restoring serum testosterone within the
normal range. Men receiving testosterone replacement therapy should be
regularly monitored and baseline testosterone concentrations should be recorded
at 3 to 6 months after the onset of the therapy.
Before starting the
treatment, digital rectal examination and prostate-specific antigen (PSA)
testing should be done to rule out prostate enlargement or cancer. Regular check
up for hematocrit should also be done to check the incidence of polycythemia.
TRT can cause lipid
and liver abnormalities so lipid profile and liver function test should be done
periodically during the therapy.
are available in various forms such as oral, parenteral (not oral), transdermal
(absorbed through skin), pellets (inserted just below the skin) and buccal.
No optimal delivery
method for testosterone has been established.
testosterone gels are Testim, Androgel and Fortesta. Axiron is available as a
solution of testosterone.
testosterone is used as intramuscular injections.
Finally, it can be said that testosterone
replacement therapy is beneficial in treating the deficiency of testosterone.
Proper counseling and medication therapy management are crucial for adequate
administration of TRT.