low t, low testosterone, symptoms of low t, testosterone replacement therapy

Low T and Low Testosterone Replacement Therapy

What is Testosterone? 

Testosterone is a male hormone that is produced primarily in the testicles. It is helpful in sustaining a man’s: 

  •  Bone density
  • Fat distribution
  • Muscle strength and mass
  • Facial and body hair
  • Red blood cell production
  • Libido
  • Sperm production

Testosterone levels begin to peak around the ages of adolescence and early adulthood. Additionally, around the ages of 30 or 40 a man’s testosterone levels begin to decline at an average rate of one percent per year. 

Causes and Symptoms of Low T 

Low testosterone, commonly referred to as “low T,” may be caused by either primary or secondary hypogonadism. In men suffering from primary hypogonadism, the testicle fails to produce testosterone. Conversely, in men with secondary hypogonadism, their pituitary gland (a part of the brain) doesn’t send a signal to their testicle to produce testosterone.  

Some common symptoms of low T  include: 

  • Changes in sleeping patterns:decreased ability to fall or stay asleep
  • Changes in sexual functions:decreased libido and fewer erections 
  • Physical changes: decreased muscle mass, strength, and bone density. May experience weight gain.
  • Emotional changes:lack of motivation and low self-confidence. May experience feelings of sadness or depression.

Diagnosis of Low T 

There a few ways a doctor diagnoses low T, including:

  • A detailed history and physical examination focusing on the genitalia as well as recognizing the signs of delayed puberty.
  • Blood tests to evaluate the levels of free and total testosterone along with FSH/LH and estrogen and estradiol.
  • Other tests may include: prolactin levels, baseline semen analysis, cranial imaging, genetics like chromosome testing and biopsy of the testicle.

Treatment Options for Low T 

Treatment options offered to men by their doctors depend on the type of hypogonadism they suffer from as well as their desire to remain fertile.  

For men who would like to remain fertile and boost their testosterone level, they should consider Clomid or injections of human chorionic gonadotropin (HCG). For men who have no desire to be fertile or no longer wish to reproduce, they are good candidates for testosterone replacement therapy (TRT). 

Options for TRT include:

  • Intramuscular injection of either short or long-term testosterone (Aveed)
  • Quarterly implantation of testosterone pellets (Testopel)
  • Daily topical application of testosterone (Androgel/Testim/Fortesa/Axiron)
  • Daily application of testosterone patch (Testoderm)
  • Slowly dissolving gum/cheek formulation (Striant)

Monitoring Testosterone Therapy 

It’s important to note that while receiving testosterone therapy, men must be closely monitored by their doctor. This is due to the increased risk of stroke, coronary artery disease, prostate enlargement and the inadvertent possibly of uncovering the presence of prostate cancer that come with TRT. As a result, routine blood tests are often part of monitoring testosterone therapy. Patients should be advised of these increased risks prior to treatment. Treatment is typically safe if patients are closely monitored.

Bioidentical Testosterone Replacement Therapy as a Low T Solution 

Bioidentical testosterone replacement therapy is a treatment option for low T. Bioidentical testosterone replacement therapy is the male form of bioidentical hormone replacement therapy (BHRT), which replicates the male hormone testosterone in men. The testosterone used in bioidentical TRT is plant-based, compared to traditional TRT, which is often sourced from synthetic sources. As a result, bioidentical TRT is often viewed as a more “natural” approach to TRT.   


If you think you may have low T and feel you may benefit from testosteronetherapy, it’s important to have proper testing, diagnosis and treatment. Dr. Howard Tay, MD,board-certified urologist, has many years of experience in diagnosing low T and working with men on an individualized treatment plan that aligns with their goals. Call our office to schedule a consultation with Dr. Tay at (602) 337-8500.