What is testosterone?
Testosterone is a key hormone in the male (and also female) body. It is the hormone responsible for secondary sex characteristics and is commonly directly related to libido (sex drive), overall performance and strength of erections
How common is low testosterone (hypogonadism)?
It is estimated that it affects 13 million men, but this number is likely low, as MANY men never get screened. The male body loses approximately 1-3% of its testosterone every year, after the age of 30. So, by the age of 55, it is VERY likely that you are low on testosterone.
How is low testosterone diagnosed?
A simple in office lab draw can determine if you have low testosterone. Results are usually ready the following day.
What levels are considered to be within normal range?
Depending on the lab, 350 ng/DL – 1100 ng/DL. However, since this number will diminish over time, a 65 year old male with a testosterone of 400 ng/DL might still be considered low, as they were likely >500 ng/DL a few years prior.
What are the benefits of being treated?
The most common benefits are:
- Increased libido (sex drive)
- Harder erections (if the erectile dysfunction is related to the low T, as it commonly is)
- Increased energy
- Increased strength and ability to gain muscle
- Increased concentration and ability to focus
- Decreased body fat (when combined with any reasonable diet/exercise regimen)
- Better sleep
How is it replaced?
There are several options available, and you and your Prestige Physician can determine which suits you best. There are some topical creams/gels available, but the results are traditionally less than satisfactory so we do not usually utilize them. Our two main methods are intramuscular injections and subcutaneous pellet therapy.
- Intramuscular Injections: Given weekly, these shots provide a tremendous boost in testosterone, which lasts 5-7 days. Unfortunately, their is not a reliable longer acting injection at this time.
- Pellet Therapy: Pellet therapy is chosen by many as is has a very reliable, consistent and sustained release of testosterone, that usually peaks in a few weeks and lasts between 3-6 MONTHS, depending on your bodies metabolic patterns and needs. It usually consists of 800-1200mg of time released testosterone stored in pellets, about the size of a small pill. They are inserted with a small device that is about the width of an ink pen, under local anesthetic (lidocaine) in the office.
How much does it cost?
We pride ourselves on charging significantly less than the competition by being an extremely efficient, completely digital office. For testosterone injection therapy, we charge $80 per month (and $60 for labs every 3 months), and for pellet therapy we charge $500, which typically lasts 3-4 months. Injections are given weekly and the pellets are given every 3-4 months, depending on your bodies metabolic patterns.
How long do the office visits take?
Your initial appointment will consist of a consult with a physician, and usually takes about 15 minutes + a lab draw, ~5 minutes. Subsequent visits for injections usually take less than 6 minutes (arrival to departure), and pellets take about 15 minutes (arrival to departure). If labs are being drawn, add ~5 minutes or so to the visit.
How often do I need to get my levels checked? What about PSA (prostate specific antigen) levels?
Your testosterone and PSA will be drawn before therapy, to determine your baseline levels.
Upon initiation of injection therapy, we will likely draw testosterone labs a few days after the first shot, and then again after about 3 weeks of therapy to determine if you are in the appropriate range. After that, we usually draw both testosterone and PSA every 3 months.
Upon initiation of pellet therapy, we will draw testosterone labs 1 month after placement to determine maximum efficacy, and then again 3 months after placement to determine when you would benefit from the next pellet placement. We will also draw PSA every 3 months with this therapy as well.
In addition to the above mentioned labs, we will frequently check your estradiol levels (some testosterone can get converted to estrogen), and a hemoglobin and hematocrit to ensure that the viscosity of your blood does not increase, as this is a rare but possible side effect.
What are the risks associated with treatment?
The most commonly seen side effects are increased size of the prostate (which can cause difficulty urinating), increased red blood cells (which can increase the viscosity/thickness of your blood) and possibly breast pain or enlargement, as some testosterone might get converted to estrogen. Luckily, these side effects are usually easy to manage with other medications to negate their effects. Testosterone supplementation also down regulates your bodies sperm production, so you should not take it if you are trying to impregnate.
Who should not receive testosterone replacement?
Patients with prostate cancer, unexplained elevation of PSA (prostate specific antigen), polycythemia/erytrhocytosis (thickened blood), a history of negative effects after using testosterone, patient with severe heart failure and patients with severe lower urinary tract symptoms associated with enlarged prostate should refrain from testosterone replacement therapy.