Why Men Choose Testosterone Shots
Testosterone injections are one of the most common methods of testosterone replacement therapy . As the name implies, these injections are administered to compensate for naturally low levels of testosterone by replacing it with exogenous testosterone.
Low testosterone is a common medical condition amongst men, particularly as they ageand it can happen long before you think of yourself as old. The body reaches peak testosterone levels in the late teenage years, but they dont subsequently drop off a cliff. Rather, they typically drop gradually as you age, although theres no hard and fast rule. For some men, this decline never results in abnormally low testosterone. For others, however, testosterone levels diminish to unhealthy levels.
There is rarely a sudden my testosterone is low moment. Instead, symptoms of low testosterone often emerge little by little over time. One of the most common of these symptoms is low libido. Other symptoms include fatigue, irritability, lack of concentration, depression, changing body composition, sleep disturbances. Some men experience a wide range of symptoms, some experience only a fewand the degree of severity can vary widely. But any of these effects can significantly impact your daily life and spur you to seek treatment.
A 2019 study by The International Journal of Environmental Research and Public Health surveyed men seeking treatment for low testosterone, and the reasons they laid out for doing so varied greatly:
Side Effects Requiring Immediate Medical Attention
Along with its needed effects, testosterone may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking testosterone:
Less common
- weakness in the arm or leg on one side of the body, sudden and severe
Testosterone Treatments: Why When And How
KATHERINE MARGO, M.D., University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
ROBERT WINN, M.D., Jefferson Medical College, Philadelphia, Pennsylvania
Am Fam Physician. 2006 May 1 73:1591-1598.
Patient information: See related handout on testosterone therapy, written by the authors of this article.
Testosterone treatment is controversial for men and even more so for women. Although long-term outcome data are not available, prescriptions for testosterone are becoming more common. Testosterone is used primarily to treat symptoms of sexual dysfunction in men and women and hot flashes in women. Potential benefits include improved libido, increased bone mass, and increased sense of well-being. In individuals with human immunodeficiency virus infection or other chronic diseases, testosterone has been shown to improve mood and energy levels, even in patients with normal testosterone levels. Testosterone can be administered by injection, patch, topical gel, pill, or implant. Side effects in men include polycythemia and acne. Side effects in women include acne, hepatotoxicity, and virilization and usually only occur when testosterone is used in supraphysiologic doses. Long-term studies of the effects of testosterone on prostate cancer, breast cancer, and heart disease have not been completed. Mammograms and monitoring of prostate-specific antigen, hematocrit, and lipid levels are recommended for patients taking testosterone.
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Introduction To Testosterone Replacement Therapy
Testosterone replacement therapy is a treatment in which additional testosterone is added to a mans body , to increase the concentration of testosterone in his body. It is used to treat hypogonadism, a condition characterised by low levels of testosterone in the blood and clinical symptoms of testosterone deficiency . Hypogonadism occurs when a mans testes do not produce enough testosterone, either because the testes are not working properly, or because the hypothalamus or pituitary gland in the brain are not working properly. The hypothalamus and pituitary glands produce hormones that stimulate testosterone production in the testes.
The aim of testosterone replacement therapy is to increase blood testosterone concentrations to normal levels. In doing so, it can also restore the mans sex drive and expression of male sex characteristics .
Testosterone is one of the oldest marketed drugs and has been used in testosterone replacement therapy since the 1930s.
How Do I Take Testosterone Replacement Therapy
TRT comes in several different forms. Each has pros and cons.
Patches. These are easy to apply. But patches can cause skin rashes and may have to be applied more than once a day.
Gels. You rub gels into the skin daily. They are convenient to use. But you have to be careful that no one comes into contact with the treated area for several hours after you’ve applied it. Otherwise they could get testosterone in their system. A nasal gel is now available that eliminates the risk of exposure to others.
Buccal patch. You put this on your upper gum twice a day. These patches are convenient but can cause irritation or gum disease.
Injections. Injections are given anywhere from 2 to 10 weeks apart. They are inexpensive compared to other treatments. But injections may not provide steady benefits. Your testosterone levels will go back down between doses.
Subcutaneous pellets. Your doctor inserts these under your skin every 3 to 6 months. They are very convenient once they’re put in, but they require minor surgery for each dose.
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Highs And Lows Of Testosterone Dosing
Creams, gels, buccal tablets, nasal spray , underarm solution , and patches are all easy to self-administer, but they have to be done daily.
You also run the risk of accidentally exposing women and children to contact with excessive amounts of testosterone.
Injections can last longer and dont present the contact problems these other methods do. However, irritation can occur at the injection site. You have to go to a healthcare provider or learn to inject yourself.
Some of the negative side effects of TRT are due to the highs and lows of testosterone dosage with conventional administration methods.
With testosterone injections in particular, testosterone levels can start off very high and then become very low before the next injection occurs. This can result in a rollercoaster-like series of changes in mood, sexual activity, and energy levels.
These high peaks of testosterone exposure can lead to testosterone being broken down and converted into estradiol, an estrogen. This excess estrogen can potentially lead to breast growth and tenderness.
Other side effects of TRT may include:
Testosterone Injections And Male Fertility
It may seem logical that testosterone injections would raise sperm counts in a male who is struggling with fertility issues. However, using testosterone injections for this purpose is usually not recommended, as testosterone injections can actually decrease sperm counts.
If you are interested in possibly using testosterone injections to remedy a sperm count issue, you should speak to a reproductive endocrinologist for more information.
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Who Uses Testosterone Replacement Therapy
Testosterone replacement therapy is used to treat men who have received a definitive diagnosis of hypogonadism. In order to be diagnosed with hypogonadism, a man must have both low blood concentrations of testosterone and clinical symptoms of deficiency . As most of the causes that underlie testosterone deficiency are untreatable, most men who commence testosterone replacement therapy must be treated for the rest of their lives. In men with reversible or age-related causes of testosterone deficiency, testosterone replacement therapy is not used.
| For more information, see Male Hypogonadism. |
Know The Health Warnings Of T Supplementation
When it comes to treatment, there are a variety of forms of testosteronefrom gels to adhesive pellets to injectionsthat can be administered to men.
However, you should be aware that patients who use transdermal gels to restore normal T levels should be careful to avoid any risk of transferring testosterone gels to women and children.4 Covering the shoulders or upper arms where the gel has been applied is sufficient to protect against accidental exposure of this hormone to others.
From a reproductive standpoint, both professional organization guidelines note that men who are trying to conceive should not receive testosterone treatments because it impairs sperm production.
Even when testosterone replacement is stopped, there will be a period of time during which it will take sperm production a while to recover, says Dr. Mulhall.
Theres no magic to diagnosing or treating testosterone deficiency, says Bhasin. Like any other condition its really important to have accurate measurements and be rigorous in the diagnosis and a major concern has been starting treatments without an appropriate diagnosis.
The result has been that half the people never refill their prescriptions and about three quarters of men given a testosterone prescription will not be using testosterone after the first year, he said. It’s a bona fide condition that is under diagnosed and over treated.
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What Are Warnings And Precautions For Testosterone
Warnings
Serious pulmonary oil microembolism reactions, involving urge to cough, dyspnea, throat tightening, chest pain, dizziness, and syncope reactions and episodes of anaphylaxis reported during or immediately after administration of testosterone undecanoate injection may occur after the first dose
Observe patients for 30 minutes in a healthcare setting to provide immediate medical treatment in event of serious POME reactions or anaphylaxis
Because of the risks of serious POME reactions and anaphylaxis, testosterone undecanoate is available through a restricted program under evaluation and mitigation strategy called the Aveed REMS Program
This medication contains testosterone. Do not take Aveed, Depo-Testosterone, Delatestryl, or Testopel if you are allergic to testosterone or any ingredients.
Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.
Contraindications
Gynecomastia.
Cardiovascular Risks
- Edema with or without congestive heart failure may be a complication in patients with pre-existing cardiac, renal, or hepatic disease
- Diuretic treatment may be necessary in addition to discontinuance of the drug
- If drug therapy is restarted, use a lower dosage
Healthy males with delayed puberty
- Monitor bone maturation by assessing bone age of wrist and hand every 6 months
- May accelerate bone maturation, compromising final adult height
Pregnancy and Lactation
Side Effects Not Requiring Immediate Medical Attention
Some side effects of testosterone may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.
Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
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A Booming $38 Billion Market
Despite this, the TRT market expected to reach $3.8 billion globally by 2022, up from $2 billion in 2012 is booming. According to Global Industry Analysts, the uptick is being fueledby the growing prevalence of hypogonadism due to the increase in the aging male population. Hypogonadism is the medical term for the condition in which the testicles don’t make enough testosterone. The condition, roughly defined as having a level under 300 ng/dl, affects about 30 percent of men over age 65.
Other factors include the rising awareness of the disease, improved diagnosis rates, availability of therapies, preference for easy-to-use products and expected approval of new-generation drugs in the pipeline, said Global Industry Analysts.
Another major driver is the overprescription of TRT to young men, wooed by the promise of heightened energy, muscle mass and sex drive. Between 2003 and 2013, TRT use quadrupled in men between 18 and 45 years old, who most frequently were prescribed the medication by their doctors, outpacing prescription in older men for whom the drug is intended, according to a 2017 study in the Journal of Urology.
The industry has a “tremendous amount of conflicts of interests,” said Thomas Perls, a professor of Medicine at Boston University, who describes TRT as “disease mongering,” or “redefining a disease so that it greatly enlarges the potential population that would be interested in the drug, with the addition of mass marketing,” he said.
What Are Dosages Of Testosterone
Dosages of Testosterone:
Dosages of Testosterone Should Be Given As Follows:
Adult and Pediatric Dosage Forms & Strengths
Injectable solution : Schedule III
- 100mg/mL
Injectable solution : Schedule III
- 200mg/mL
Injectable solution : Schedule III
- 250mg/mL
- 12.5mg, 25mg, 37.5mg, 50mg
Dosage Considerations
Serious adverse reactions have been reported in individuals who abuse anabolic androgenic steroids and include cardiac arrest, myocardial infarction, hypertrophic cardiomyopathy, congestive heart failure, cerebrovascular accident, hepatotoxicity, and serious psychiatric manifestations, including major depression, mania, paranoia, psychosis, delusions, hallucinations, hostility, and aggression.
Hypogonadism
Primary hypogonadism : Testicular failure due to diseases and conditions in the body such as cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome, orchiectomy, Klinefelter Syndrome, chemotherapy, or toxic damage from alcohol or heavy metals these men usually have low serum testosterone levels and gonadotropins above normal range Hypogonadotropic hypogonadism : Gonadotropin or luteinizing hormone-releasing hormone deficiency or pituitary-hypothalamic injury from tumors, trauma, or radiation these men have low testosterone serum concentrations but have gonadotropins in the normal or low range.
< 12 years
- Safety and efficacy not established
â¥12 years
Delayed Puberty in Males
< 12 years
- Safety and efficacy not established
â¥12 years
Orphan sponsor
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The Pros And Cons Of Testosterone Therapy
The number of men who take testosterone has dropped dramatically in the past few years, in part because of growing awareness of the risks that may accompany it. Should you avoid it?
Testosterone, a hormone, helps men maintain muscle, bone health, libido, and the ability to perform in the bedroom. But beginning in their mid-30s, men lose an average of just under 2% per year. Eventually, that drop could lead to hypogonadism, or low testosterone. This happens to 1 in 5 men in their 60s, and the likelihood rises as men get older. Testosterone replacement treatment aims to boost those low levels back up.
But TRT has had its ups and downs in the past 2 decades. From 2001 to 2013, prescriptions rose by 300% following marketing efforts that proclaimed it could restore energy, alertness, mental focus, and sexual function. Then, over the next 3 years, the number of men taking it dropped by half as studies revealed potential risks, particularly to heart health.
âI do see some men who are more hesitant to take testosterone supplementation,â says Michael Eisenberg, MD, director of the Stanford Male Reproductive Medicine and Surgery Program at Stanford Health Care in Palo Alto, CA. âWe talk about the risks, as thatâs what weâve gotten more information on in recent years.â
However, Eisenberg stresses that men with very low testosterone have a higher chance of developing heart disease, osteoporosis, and other problems if they go untreated.
What Is Low Testosterone
This medical condition is also called hypogonadism. A low T level is one that is below the normal range, which can very widely. It is measured with a blood test. Some signs or symptoms of low testosterone are problems with erections or decreased sex drive. Testosterone levels should be checked early in the morning, and an abnormal test should be repeated. Testosterone levels vary throughout the day, and a mans T level will vary from one test to the next.
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Testosterone For Transgender Men And Transmasculine People
Transgender men and other transmasculine individuals may use testosterone to masculinize their bodies in order to align their bodies with their gender identity.
Unlike transfeminine people who need to use a testosterone blocker in order for gender-affirming hormone therapy to be effective, there is no need to block the production of estrogen when taking testosterone. Testosterone is a more biologically effective hormone, and it will induce changes when taken on its own.
Does Low Testosterone Cause Infertility
Low testosterone does not cause infertility. Sperm production is actually stimulated by hormones other than testosterone. Testosterone is required for sperm production, but the level in the testes where sperm are produced is many times higher than in the blood. Even men with low or borderline T levels may have sufficient T levels for sperm production.
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If A Man Is Infertile And Taking Testosterone What Are His Options
A man should see a male reproductive specialist who will perform a complete history and physical examination for him. He will need to have hormone testing, at least two semen analyses, and possible additional testing performed. He will need to stop taking testosterone and have hormone tests and semen analyses checked periodically as it could be months before his sperm count returns to baseline.
Diseases And Conditions That Affect Testosterone
Men can experience a drop in testosterone due to conditions or diseases affecting the:
- Testes direct injury, castration, infection, radiation treatment, chemotherapy, tumors
- Pituitary and hypothalamus glands tumors, medications , HIV/AIDS, certain infections and autoimmune conditions
Genetic diseases, such as and hemochromatosis can also affect testosterone.
Women may have a testosterone deficiency due to diseases of the pituitary, hypothalamus or adrenal glands, in addition to removal of the ovaries. Estrogen therapy increases sex hormone binding globulin and, like aging men, this reduces the amount of free, active testosterone in the body.
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Do I Have To Inject Myself On Trt
If you have trouble injecting yourself, GameDay Men’s Health offers in-and-out injection appointments to our TRT patients. This is the most common option for many newcomers to TRT since you can just close your eyes and let us do the injection for you.
You may also ask a friend or family member to help with the first few injections if you prefer to do them at home.
In the long-term, it behooves you to become comfortable with doing TRT injections by yourself. Its not always practical to find someone to inject you, especially if you live alone or want to maintain privacy about your TRT.
Just breathe and relax, you got this.