A urologist is highly qualified to diagnose and manage low testosterone, often referred to as hypogonadism or Low T. Low T is a deficiency in the male sex hormone that can negatively affect multiple body systems. Urologists specialize in the male reproductive and urinary tracts, making them experts in conditions involving hormonal function and sexual health. Their training covers the entire process of care, from initial testing to long-term hormone replacement therapy.
Defining the Urologist’s Role in Male Health
A urologist’s expertise focuses on the male genitourinary system, which includes the testes where testosterone is primarily produced. This specialized focus naturally positions them to address hormonal issues that directly impact reproductive and sexual function. Many symptoms of Low T, such as reduced libido and erectile dysfunction, are already within the urologist’s scope of practice. The ability to distinguish between a simple testosterone deficiency and a more complex urological issue is a core strength of this specialty.
While an endocrinologist focuses on the body’s entire endocrine system, the urologist approaches Low T through the lens of male sexual health and the practical application of replacement therapies. Urologists manage conditions that overlap with Low T, such as male infertility or prostate health. This allows for a comprehensive and integrated treatment plan.
Comprehensive Diagnosis of Low Testosterone
The diagnostic process for Low T begins with a detailed review of symptoms and a physical examination to identify clinical signs of hormone deficiency. A urologist will look for physical indicators such as reduced body hair, changes in breast tissue, and a physical assessment of the testes and penis. This initial evaluation helps to differentiate Low T from other conditions that may present with similar symptoms, like fatigue or depression.
Confirmation of hypogonadism requires specific blood tests, which are considered the definitive step in diagnosis. The most important measurement is the total testosterone level, which the American Urological Association (AUA) identifies as less than 300 nanograms per deciliter (ng/dL) for a clinical diagnosis. Because testosterone levels fluctuate throughout the day, the blood draw must be timed correctly, typically occurring in the morning between 7:00 AM and 10:00 AM, when levels are naturally at their peak.
To ensure accuracy, the AUA recommends that a diagnosis of Low T should only be made after obtaining two separate total testosterone measurements on different mornings. Additional blood work often includes luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to help determine the underlying cause of the low testosterone—whether the problem originates in the testes (primary hypogonadism) or the brain (secondary hypogonadism). Measuring sex hormone-binding globulin (SHBG) may also be necessary to calculate free testosterone, which is the amount of hormone biologically available to the body’s tissues.
Urologist-Supervised Treatment Options
Once a diagnosis is confirmed, a urologist will supervise Testosterone Replacement Therapy (TRT) using one of several administration methods. The choice of method is highly individualized, depending on patient lifestyle, preference, and the desired stability of the hormone level.
Administration Methods
- Intramuscular injections are a common approach, delivering testosterone directly into the muscle tissue weekly or every few weeks. This method is effective for achieving consistent therapeutic levels but requires frequent administration.
- Topical gels and creams offer convenient daily application, absorbed through the skin on the shoulders or upper arms. Patients must take precautions to prevent transfer of the medication to partners or children through skin-to-skin contact.
- Transdermal patches function similarly to gels, adhering to the skin and releasing testosterone daily. Some patients may experience localized skin irritation at the application site.
- Subcutaneous pellets can be implanted just beneath the skin, typically in the hip or buttocks area, during a simple in-office procedure. These pellets slowly release testosterone over three to six months, providing a long-acting and consistent level.
Ongoing Management and Fertility Concerns
Starting TRT requires ongoing clinical monitoring by the urologist to ensure the treatment is safe and effective. Regular blood tests are necessary to check that testosterone levels remain within the normal therapeutic range and to monitor for potential side effects. Specifically, the hematocrit level, which measures the concentration of red blood cells, is checked periodically because testosterone can stimulate red blood cell production, potentially leading to polycythemia.
Prostate health also requires monitoring, typically through regular digital rectal exams and measurement of Prostate-Specific Antigen (PSA) levels. Urologists are experts in interpreting these results and managing the prostate during hormone therapy. This long-term oversight is integrated into the treatment plan to mitigate risks associated with TRT.
A unique concern addressed by a urologist is the impact of TRT on fertility, as external testosterone suppresses the brain signals necessary for sperm production. For men of reproductive age who desire to maintain fertility, standard TRT is often contraindicated due to the risk of severely reduced sperm count. In these cases, the urologist may prescribe alternative treatments, such as human chorionic gonadotropin (hCG) or selective estrogen receptor modulators (SERMs) like clomiphene citrate, which stimulate the body’s natural testosterone production while preserving sperm count.