Testosterone Replacement Therapy

The Interplay between Testosterone and Estrogen

While estrogen is the primary female sex hormone and testosterone is the primary male sex hormone, both men and women require both hormones to maintain proper function and optimal balance between estrogen and testosterone.

Testosterone is necessary for regulating sperm production and the development of male sex characteristics, including facial and body hair, increased muscle and bone mass, and a deeper voice. Estrogen also plays an important role in men’s sexual development and overall health. It contributes to maintaining healthy function in nearly all systems of the body, including the neurological, cardiovascular, musculoskeletal, and immune systems. Estrogen in men is formed through the breakdown of testosterone using the enzyme aromatase, which is found in adipose tissue, adrenal glands, the brain, and the testicles.

Both testosterone and estrogen play a role in regulating sexual functions and reproduction. Their effects also depend on interactions with other hormones that regulate bodily functions such as metabolism, digestion, growth, mood, cognitive development, and temperature regulation. When a single hormone is imbalanced, it can affect other hormones and influence many aspects of one’s overall well-being. Thus, your hormones constitute a complex interplay where multiple hormones affect each other. If you are considering starting Testosterone Replacement Therapy (TRT), it is therefore relevant to measure all your hormone levels.

Testosterone Deficiency

Testosterone deficiency can occur due to a condition called hypogonadism, where the body fails to produce a sufficient amount of testosterone. This can lead to hormonal imbalance in men, affecting both the production and levels of estrogen and other hormones. Additionally, certain lifestyle factors can lower testosterone levels, including excessive exercise, improper nutrition, stress, obesity, medications (such as antibiotics or antipsychotics), or serious illness.

Maintaining a healthy lifestyle with regular exercise and a proper diet rich in essential nutrients is important to sustaining normal testosterone levels. Testosterone deficiency can have significant consequences for men’s health and quality of life.

Common symptoms of testosterone deficiency include:

• Reduced muscle mass and strength
• Hair loss
• Development of breast tissue (gynecomastia)
• Decreased libido (sex drive), erectile dysfunction, infertility
• Decreased energy, motivation, and initiative
• Sleep disturbances

In addition to physical symptoms, it can impact mental well-being and contribute to depression and anxiety, as well as decreased concentration and memory.

A blood test can determine if one has lower testosterone levels than what is considered normal for their age. If the test confirms testosterone deficiency, TRT (testosterone replacement therapy) can help restore normal testosterone levels and alleviate symptoms of testosterone deficiency provided one maintains a healthy lifestyle.

TRT Treatment

Many men suffering from low testosterone face challenges in their daily lives, especially when it comes to physical activity. Even those who dedicate time to regular exercise may feel fatigue and experience a significant reduction in muscle strength. One of the intentions of correcting testosterone levels is to provide the body with the capacity to handle intense physical exertion and improve post-exercise recovery. In addition to physical benefits, initiating hormone therapy can also have positive effects on mental aspects. It can lead to improved energy, increased muscle mass, enhanced libido, and an overall improvement in quality of life.

There are various forms of TRT, and the choice of treatment method depends on individual factors, patient preferences, and the doctor’s assessment. Here are some common forms of TRT:

• Injections: Testosterone can be administered through intramuscular or subcutaneous injections. Intramuscular injections provide a long-lasting release of the hormone and are often administered in large muscles such as the buttocks or thigh. Subcutaneous injections allow for quicker absorption into the bloodstream and are often done in the abdominal skin or thigh.

• Gel: Testosterone in gel form can be applied to the skin, from where it is absorbed into the bloodstream. This provides a more constant release of the hormone. The gel is typically applied to the shoulders, arms, or abdomen.

The timeframe for when one will start to experience the effects of TRT can vary significantly from individual to individual. Several factors influence how quickly TRT impacts symptoms of testosterone deficiency, including the administration type, individual factors, dosage, and the onset of symptoms. Generally, some individuals may begin to experience improvements within the first few weeks, while it may take several months for others.

Blood Tests

Before starting treatment, it’s relevant to measure your hormone levels as well as albumin, hematocrit, PSA (>40 years), and liver function tests to confirm testosterone deficiency and exclude other diseases. Testosterone therapy can lead to negative side effects, especially if there’s an underlying, undetected disease such as prostate cancer. Prostate-specific antigen (PSA) is a protein produced in the prostate gland. Low PSA levels are considered normal, while elevated levels may indicate various conditions, including prostate cancer. Elevated PSA levels alone are not necessarily an indication of prostate cancer, as they can be caused by other factors such as prostate infection, inflammation, or an enlarged prostate.