Testosterone is the most
important male hormone and is produced
mainly in the testicles in men. Its
production in the testicles is
controlled by the hypothalamus and
pituitary gland in the brain, which
release hormones that activate the
testicles to produce testosterone.
Testosterone is carried
in the blood bound to protein, and this
bound protein cannot have any effect on
the body. Only “unbound” or free
testosterone can enter other cells of
the body and have their effect. As a
result, anything that affects the amount
of testosterone that is bound can also
influence the effect testosterone can
have in the body.
Testosterone is
responsible for helping the body create
male characteristics during puberty, but
it also has important roles to play in
the adult male. It is important in
maintaining healthy sexual function,
energy levels, mood, strength and levels
of muscle and fat in the body.
In certain
circumstances, the body is unable to
produce and sustain sufficient
levels of testosterone.
As a result, the man
can experience unwanted effects,
including a lack of sex drive and
reduced sexual performance. Low
testosterone is also associated with
a feeling of irritability,
depression, low motivation and
energy levels. Men with this issue
may also notice a loss of muscle
mass and strength and an increase in
fat levels, especially around the
waist. Over a longer period of time,
there can also be a reduction in
bone density - increasing the risk
of osteoporosis.
Typical examples
of things that could be associated
with low testosterone are regularly
falling to sleep in the early
evening when you should not be
especially tired, poor performance
at work due to constant tiredness,
and feeling that you have lost your
joy of living, so much so that
things that you used to enjoy now
feel like a nuisance or too much
hassle. You may also notice fewer or
no morning erections and less hard
erections, reduced physical stamina
or strength and weight gain.
It may be tempting
to put these things down to the fact
that you are getting older, and it’s
true that we all slow down with age,
but the real problem could be low
testosterone and the good news is
that if that is the case, effective
and safe treatment is available.
Introduction to Low Testosterone
It is true that
testosterone levels fall as men
age, and this decline is steady
– about 1–2% a year from around
the age of 40. This is normal
but as the levels fall, it may
not be desirable - especially if
levels were not high in the
first place.
Low testosterone
can be caused by direct problems
with the testicles that disrupt
the production of testosterone.
Such problems include physical
damage to the testicles, the
mumps virus and cancer therapy.
Testosterone
levels can also be reduced as a
result of changes in the parts
of the brain that stimulate the
production of testosterone in
the testicles. Brain tumours can
cause this. Certain infections
such as tuberculosis and HIV can
also affect the pituitary gland.
Direct trauma can damage the
brain and anabolic steroid abuse
can temporarily reduce
testosterone levels.
Obesity is
also known to reduce
testosterone levels as fat cells
can convert testosterone to
oestrogen. This is a normal
bodily process, but excessive
fat cells mean that it happens
more than is normal.
It can be
difficult to determine if you
have clinical effects of low
testosterone because a lot of
the symptoms discussed above can
result from other causes. It can
also be difficult to determine
as the normal level of
testosterone varies according to
the individual, as well as the
time of day, age and which
laboratory conducts the analysis
to measure the levels. A fairly
wide level of total testosterone
in males is considered normal
(9-32 mmol/l which is equivalent
to about 270-1,000 ng/dl), but
many men do complain of symptoms
of low testosterone at the low
end of this normal range. For
example, a 45-year-old man with
10 mmol/l total testosterone may
be unhappy at that level.
Despite these
difficulties, if your overall
experience of changes and
problems matches the likely
symptoms of low testosterone and
you are concerned about how you
are feeling then it’s worth
exploring the matter further.
The treatments
offered by the Pharmacy2U Online
Doctor service are
testosterone-containing gels that
are applied to the skin. The
testosterone is absorbed through the
skin and builds up in the body over
time to restore levels. The gels
offer a safe way of administering
without the need for injections, and
the dose can be tailored easily. The
treatments offered are
Testim,
Testogel and
Tostran. Please click on each
treatment name for further
information.
Other treatments not
available from the Pharmacy2U Online
Doctor service include tablets that
are taken every day, buccal patches
that stick to the gum, intramuscular
injections every few weeks and an
implant that can last between four
and five months.
After review of
your consultation to see if you
are likely to benefit from
testosterone replacement
therapy, our UK-registered GP
will require you to undergo some
blood tests to determine if
treatment is safe for you. These
low testosterone blood tests and
prostate tests can be conducted
without any embarrassment, from
the convenience of your own
home, but they will be needed
before treatment is initiated.
Each blood test is provided at a
cost of £25, but you will be
able to decide whether or not to
proceed at each step of the way.
After review of
the results of the initial blood
tests, if the doctor decides
that it’s safe and appropriate
to start testosterone
replacement therapy, a
prescription for one month’s
testosterone replacement therapy
will be authorised. A further
blood test will be needed after
three weeks to see how you are
responding to treatment. All
being well, a further five
months of treatment will be
authorised before another blood
test is needed to check your
testosterone levels
again.Finally, a year after
treatment is initiated, and each
year after that, further blood
tests will then be needed to
ensure that the ideal level of
testosterone in your body is
maintained and that your
continued use of testosterone
replacement therapy remains
safe. We will be checking for
indications of prostate or blood
problems that can occur.
If you’re
concerned about your
testosterone levels, we offer
confidential consultations with
UK registered GPs through our
Online Doctor service.
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