Testosterone replacement therapy is often a controversial subject matter. We will attempt to cipher through all of the information that is available to the public in an attempt to provide our readers with the knowledge to make an educated decision if this therapy is right for them. It is important for us to add that Oblique Magazine is not endorsing or negating the practice of this therapy. Our goal is to help inform.
Let’s begin by asking you to provide us with a little background on yourself.
I am Dr. Travis Love, a South Carolina native and Chief Medical Officer of Lowcountry Male and AquaVitae, two specialized centers devoted to highly personalized integrative care. My primary interests are in Anti-Aging, Regenerative, Metabolic and Cosmetic Medicine. I am a Diplomat of the American Academy of Anti-Aging & Regenerative Medicine, I hold a Certification in Aesthetic Medicine, and I serve as a National Physician Trainer for Galderma. I received my Doctorate from the Virginia College of Osteopathic Medicine, completed my internship training in Emergency Medicine at the Charleston Area Medical Center and finished residency training in Internal Medicine at Camden Clark Medical Center. My postgraduate medical education includes fellowship training in: Advanced Cosmetic, Stem Cell, Anti-Aging, Regenerative & Metabolic Medicine, certified through the University of South Florida.
What kind of symptoms would an individual experience if they have low T levels?
Everyone thinks of testosterone as simply the male sex hormone. However, both men and women can experience the symptoms of low testosterone. Few people realize that testosterone is the most abundant sex hormone in younger women, and it is the first hormone that begins to decline in females, as early as age 27.
Testosterone receptors are abundant in all organ systems including the central nervous system. The earliest manifestations of declining testosterone levels are often foggy thinking, poor short-term memory and decreasing visual acuity. Later symptoms in both men and women can include: irritability, low-level depression, increasing anxiety, poor sleep quality, night sweats, decreasing libido, feeling unusually fatigued, loss of muscle mass, gains in fat mass and loss of bone mineral density. Symptoms specific to men are: a decrease in beard growth, infrequent or absent morning erections and eventually erectile dysfunction.
What tests are performed to determine the actual “T” levels of a patient?
When evaluating for hormonal imbalances, one should always begin with obtaining a complete medical history, physical exam and lab-work. At our office we prefer to obtain a comprehensive sex hormone panel, a comprehensive thyroid panel, complete blood count, vitamin and mineral levels, lipid profile, inflammatory markers, and a PSA in men.
If tests do show low levels of Testosterone, are there lifestyle and diet changes that a patient can make in helping to increase these levels?
Absolutely! Lifestyle changes that may help with increasing testosterone production include improving stress coping strategies and getting at least 6 to 8 hours of restorative sleep each evening. Getting 45 minutes of physical activity at least three to six days per week, will also help to elevate testosterone levels. Finally, limit exposure to hormone disrupting chemicals, such as phthalates which are found in plastics. When possible, purchase foods that are not stored in plastic, do not drink from plastic bottles and do not reheat food in plastic containers.
If a doctor suggests therapy, what would this entail for the patient?
Testosterone replacement therapy can be tailored to the patient’s lifestyle and preferences. Oral testosterone replacement is never recommended because it is toxic to the liver. Transdermal delivery is an option with either creams or patches. However, creams can be messy, and the testosterone can be transferred from one individual to another by skin to skin contact. Patches present less of an issue for transference but can be irritating to the skin. Unfortunately, not all people absorb testosterone well through the skin. The two forms of testosterone replacement most often used in our office are injections and pellets. Injections are very convenient. They are typically administered once or twice weekly in individualized dosages and can be injected at home or in the office, based on patient preference. For individuals who are apprehensive of injections, pellets are an excellent alternative. Pellets provide a slow sustained release of bio identical testosterone. Pellets are typically placed in the fatty tissue of the hip during an in-office procedure. The duration of affect for pellets in women is typically 3 to 4 months and 4 to 6 months in men. Pellets are made from hundred percent testosterone with a starch binder and are totally absorbed over several months.
What benefits should a patient expect from TRT?
Almost all men and women who have suboptimal testosterone levels can expect the following benefits once testosterone has been replenished: improved mental clarity, and elevation in mood, a decrease in anxiety, improvements in body mass composition, increased strength and endurance, increased libido and an improvement in sexual function. Overall, optimized testosterone levels can help to slow age-related decline, improve overall satisfaction with one’s quality of life and help restore or maintain bone mineral density!
How long can a patient stay on TRT?
Individuals who elect to start testosterone replacement therapy can remain on TRT indefinitely.
As with any type of therapy or medication, it is important for the patient to be aware of risks and side affects. What do you feel a patient needs to be aware of if taking part in this TRT?
The only significant concern with testosterone replacement therapy in men and women is the overproduction of red blood cells if testosterone levels are not kept within normal ranges. Should a patient have a gradual increase in red cell production, testosterone levels can be titrated downward to prevent this in the future. With careful three-month monitoring and judicious prescribing practices, the risk for excessive red blood cell production can be eliminated.
In closing, what do you feel is the biggest reason many people may shy away from TRT?
Testosterone, until recently, was never taken into consideration as a part of women’s health. Therefore, women typically would never have considered testosterone replacement therapy. Conversations in healthcare settings and the media regarding the benefits of testosterone are just now beginning to take place with women. Most women don’t even realize that they have testosterone.
Conversely, there is a negative stereotype associated with testosterone replacement therapy for men. Some men are afraid of testosterone due to the massive amount of media exposure devoted to athletes from the 1980s and 90s who abused steroids, resulting in heart attacks and strokes. Still other men, who realize that there are health benefits to testosterone replacement therapy, are hesitant to admit to themselves that their testosterone levels may be diminishing. In my experience, many men see “Low-T” as a loss of their masculinity and carry feelings of guilt or embarrassment regarding TRT. This places a roadblock between them and the providers who can help restore their vitality!