Low Testosterone (cont.)

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When should I seek medical care for low testosterone?

For infants, routine screening examination is useful in checking for normal placement of the testes within the scrotum.

As puberty approaches in males, it is important that parents and health care practitioners look for the development of secondary sex characteristics such as lowering of voice, development of characteristic hair growth, and increased muscle mass.

In adults, most males will seek help with erectile dysfunction and decreased libido.

In women, a loss of sexual desire and libido are often the presenting complaints.

How is low testosterone diagnosed?

Many of the symptoms that lead to the diagnosis of low testosterone are nonspecific, and the health care professional may want to take a history of symptoms and perform a physical examination prior to ordering blood tests to assess for low testosterone levels in the body.

The diagnosis also depends upon at what age the concern occurs. Many times the diagnosis in the pediatric age group occurs because the parent and health care professional to observed abnormalities or delays in physical development.

If the diagnosis of low testosterone or hypogonadism is considered, blood tests to measure testosterone levels may be ordered. The level of testosterone varies depending upon the time of day, and most often, early morning testosterone levels are measured.

Based upon the clinical situation, further tests may be considered to determine whether the low testosterone is due to primary or secondary hypogonadism.

What is the treatment for low testosterone?

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The initial consideration for treating low testosterone is to find the underlying cause and address that issue.

While the testosterone levels fall with aging, there is no evidence that this is an abnormal condition requiring treatment.  However, research results are inconclusive, and studies measuring the effect of testosterone in men age 60 to 80 found no benefit in mental or physical function.

Treatment of low testosterone in men

In men, low testosterone levels in the body can be supplemented by hormone replacement with testosterone. Testosterone replacement therapy can be prescribed as an intramuscular injection usually given on a biweekly basis, as a patch or gel placed on the skin, or as putty that is applied to the gums of the mouth. Each of the treatments has its risks and benefits. The decision as to which form of testosterone to use depends upon the clinical situation. Discussions between the patient and health care practitioner often helps decide which medication to use.

Treatment of low testosterone in women

In women, in the United States there are currently no preparations that are FDA approved for testosterone replacement. Esterified estrogens and methyltestosterone (Estratest), manufactured by Solvay Pharmaceuticals, a combination of estrogen and methyltestosterone that was formerly available, was discontinued by the manufacturer in the spring of 2009.

Some doctors will advise women to cut the patches for men into smaller sizes, or to use the gel in smaller doses; however, the accuracy of these methods is questionable, as is the safety.


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