Treatment options

Treatment of low testosterone is straightforward. Once the decision has been made to treat testosterone deficiency, low testosterone can be increased by using one of a number of treatment options. All of these treatment options require a doctor’s prescription. An ideal form of testosterone treatment will increase testosterone levels to a point within the normal range that aim to result in disappearance of your bothersome symptoms.1-7 It will also offer a convenient dosing schedule and way of administration.

Because of inter-individual differences, for some men, elevating testosterone levels into the middle of the normal range is enough for symptoms to disappear, while other men may need a higher dose or administration frequency of testosterone therapy that elevates testosterone levels into the high end of the middle of the normal range before symptoms disappear.8

It is important to keep in mind that it may take 6-12 months of uninterrupted testosterone therapy for your symptoms to disappear.9 In fact, symptoms can continue to improve for 2 years, and erectile dysfunction can continue to improve for as long as 9 years with uninterrupted testosterone therapy.10

A reason for lack of response to testosterone therapy among men who report that “it didn’t work” is sub-optimal dosing resulting in failure to achieve a large enough elevation in testosterone levels (within the middle of the normal range), or that they stopped the treatment too soon. Regular monitoring of testosterone levels and changes in symptoms (or lack thereof) will tell if any dose-adjustments of given testosterone medication are needed.

Testosterone effects tool


Visualisation of the time course for onset of potential testosterone effects.

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Treatment options

Treatment of low testosterone is straightforward. Once the decision has been made to treat testosterone deficiency, low testosterone can be increased by using one of a number of treatment options. All of these treatment options require a doctor’s prescription. An ideal form of testosterone treatment will increase testosterone levels to a point within the normal range that aim to result in disappearance of your bothersome symptoms.1-7 It will also offer a convenient dosing schedule and way of administration.

Because of inter-individual differences, for some men, elevating testosterone levels into the middle of the normal range is enough for symptoms to disappear, while other men may need a higher dose or administration frequency of testosterone therapy that elevates testosterone levels into the high end of the middle of the normal range before symptoms disappear.8

It is important to keep in mind that it may take 6-12 months of uninterrupted testosterone therapy for your symptoms to disappear.9 In fact, symptoms can continue to improve for 2 years, and erectile dysfunction can continue to improve for as long as 9 years with uninterrupted testosterone therapy.10

A reason for lack of response to testosterone therapy among men who report that “it didn’t work” is sub-optimal dosing resulting in failure to achieve a large enough elevation in testosterone levels (within the middle of the normal range), or that they stopped the treatment too soon. Regular monitoring of testosterone levels and changes in symptoms (or lack thereof) will tell if any dose-adjustments of given testosterone medication are needed.

Treatment options

Treatment of low testosterone is quite straightforward. Once the decision has been made to increase testosterone levels, low testosterone can be replaced by using one of a number of treatment options. All of these treatment options require a doctor’s prescription. An ideal preparation of testosterone will bring testosterone levels back into the normal range to reverse the symptoms of low testosterone. It will also be safe and offer a convenient dosing schedule and means of administration.

Several months of treatment may be required before changes are apparent. The general recommendations are to raise the blood testosterone level only into the middle of the normal physiological range. As testosterone therapy is long term, it is important that it is convenient, safe and effective.

Testosterone effects tool


Visualisation of the time course for onset of the many beneficial testosterone effects.

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The benefits of testosterone replacement

The benefits of testosterone replacement on sexual function, fat and lean body mass and bone density in men with low testosterone are clear. The potential benefits of testosterone replacement in reducing the risk of cardiovascular disease, metabolic syndrome and diabetes are still being investigated.

The benefits of testosterone treatment on hypogonadal men

The benefits of testosterone treatment on sexual function, body fat loss, muscle (lean body mass) gain and increase in bone mineral density in men with low testosterone are well-documented.2,3,11 The potential benefits of testosterone treatment in reducing the risk of heart disease, metabolic syndrome and diabetes is an active area of scientific research.

Sexual


  • Controls sexual function (sex drive, erectile function, orgasm)
  • Reduces lower urinary tract symptoms (LUTS)
Alt tag

Psychological


  • Improves mood, energy, wellbeing and quality of life

Physical symptoms


  • Increases muscle mass
  • Increases strength
  • Decreases overall body fat mass
  • Decreases belly (visceral) fat mass
  • Increases bone mineral density

Health and well-being – quality of life

Improvements in signs and symptoms of low testosterone, such as libido, sexual, physical and mental functioning and mood, can be expected over time and will show you that the treatment is working.12

Body composition

Testosterone replacement in men with low testosterone plus lifestyle interventions (e.g. diet) may lead to increased lean body mass and strength and decreased fat mass.13

Diabetes

Men with diabetes have been shown to have substantially lower testosterone levels than men in the general population, yet low testosterone in many remains undiagnosed and untreated. It is not yet fully known whether diabetes is a cause or a consequence of low testosterone.14

Bone

Low testosterone can lead to thinning of the bones (osteoporosis) and men with hip fractures tend to have low testosterone. Testosterone replacement may lead to increased bone density.3

If low testosterone occurs during adulthood, you can make some lifestyle and dietary changes to help prevent osteoporosis. Regular exercise and adequate amounts of calcium and vitamin D help to maintain bone strength and are important to reduce the risk of osteoporosis.

Just like any other medicine, there may be some adverse effects with the use of testosterone replacement therapy. These risks and the potential benefits will be evaluated by your doctor but it is important that you understand them. If you and your doctor agree to start testosterone therapy then please refer to that products patient information leaflet (PIL) to see a full list of potential adverse events.

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References

  • Salonia A, Bettocchi C, Carvalho J, et al. 2020 EAU Guidelines on Sexual and Reproductive Health. Return to content
  • Morgentaler A, Traish A, Hackett G, Jones TH, Ramasamy R. Diagnosis and Treatment of Testosterone Deficiency: Updated Recommendations From the Lisbon 2018 International Consultation for Sexual Medicine. Sex Med Rev. 2019;7(4):636-649. Return to content
  • Hackett G, Kirby M, Edwards D, et al. British Society for Sexual Medicine Guidelines on Adult Testosterone Deficiency, With Statements for UK Practice. The journal of sexual medicine. 2017;14(12):1504-1523. Return to content
  • Dean JD, McMahon CG, Guay AT, et al. The International Society for Sexual Medicine's Process of Care for the Assessment and Management of Testosterone Deficiency in Adult Men. The journal of sexual medicine. 2015;12(8):1660-1686. Return to content
  • Khera M, Adaikan G, Buvat J, et al. Diagnosis and Treatment of Testosterone Deficiency: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015). The journal of sexual medicine. 2016;13(12):1787-1804. Return to content
  • Morales A, Bebb RA, Manjoo P, et al. Diagnosis and management of testosterone deficiency syndrome in men: clinical practice guideline. CMAJ. 2015;187(18):1369-1377. Return to content
  • Lunenfeld B, Mskhalaya G, Zitzmann M, et al. Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men. The ageing male : the official journal of the International Society for the Study of the Ageing Male. 2015;18(1):5-15. Return to content
  • Morgentaler A, Traish AM, Khera M. A Critique of the AUA Guidelines on Testosterone Deficiency. The journal of sexual medicine. 2020;17(4):561-564. Return to content
  • Saad F, Aversa A, Isidori AM, Zafalon L, Zitzmann M, Gooren L. Onset of effects of testosterone treatment and time span until maximum effects are achieved. Eur J Endocrinol. 2011;165(5):675-685. Return to content
  • Saad F, Caliber M, Doros G, Haider KS, Haider A. Long-term treatment with testosterone undecanoate injections in men with hypogonadism alleviates erectile dysfunction and reduces risk of major adverse cardiovascular events, prostate cancer, and mortality. The ageing male : the official journal of the International Society for the Study of the Ageing Male. 2020;23(1):81-92. Return to content
  • Traish AM. Benefits and Health Implications of Testosterone Therapy in Men With Testosterone Deficiency. Sex Med Rev. 2018;6(1):86-105. Return to content
  • Morgentaler A, Miner MM, Caliber M, Guay AT, Khera M, Traish AM. Testosterone therapy and cardiovascular risk: advances and controversies. Mayo Clin Proc. 2015 Feb;90(2):224-51. doi: 10.1016/j.mayocp.2014.10.011. PMID: 25636998. Return to content
  • ISA, ISSAM, EAU, EAA and ASA recommendations: investigation, treatment and monitoring of late-onset hypogonadism in males. Wang C, Nieschlag E, Swerdloff RS, Behre H, Hellstrom WJ, Gooren LJ, Kaufman JM, Legros JJ, Lunenfeld B, Morales A, Morley JE, Schulman C, Thompson IM, Weidner W, Wu FC. Ageing Male. 2009 Mar;12 (1):5-12. Return to content
  • Morgentaler A, Miner MM, Caliber M, Guay AT, Khera M, Traish AM. Testosterone therapy and cardiovascular risk: advances and controversies. Mayo Clin Proc. 2015 Feb;90(2):224-51. doi: 10.1016/j.mayocp.2014.10.011. PMID: 25636998. Return to content