Low testosterone, or male hypogonadism, is a condition where the testes do not produce enough testosterone. This hormone is fundamental for male characteristics, including muscle mass, bone density, and sperm production. Testosterone levels naturally decline with age, starting around age 30, at a rate of about 1% to 2% per year. This decline can lead to various symptoms that affect a man’s quality of life, such as decreased energy, changes in mood, and reduced sexual function. Studies indicate that nearly 40% of men aged 45 and older experience low testosterone.
Urologists and Hormonal Health
Urologists are medical specialists with training in the diagnosis and treatment of conditions affecting the male reproductive and urinary systems, including organs such as the kidneys, bladder, prostate, testes, and penis. Their expertise extends to hormonal balance, particularly concerning testosterone, which plays a central role in the healthy functioning of these systems.
Urologists are well-positioned to assess and manage low testosterone due to their understanding of the male endocrine and reproductive systems. They identify how hormonal imbalances can impact sexual function, fertility, and overall well-being. Their practice addresses issues from erectile dysfunction to prostate health, which are often interconnected with testosterone levels.
Diagnosing Low Testosterone
The diagnostic process for low testosterone begins with an evaluation of a patient’s symptoms and medical history. Men seek consultation for persistent fatigue, decreased libido, erectile dysfunction, loss of muscle mass, increased body fat, and mood changes like depression or irritability. These symptoms can also be attributed to other conditions, making a precise diagnosis important.
To confirm low testosterone, a urologist orders specific blood tests. The primary test is a total testosterone level, drawn in the morning (8:00 AM – 10:00 AM), when levels are highest. If the initial result is low, typically below 300 nanograms per deciliter (ng/dL), the test is repeated on a separate day to confirm the diagnosis. Additional blood tests include free testosterone, which measures the unbound, active form of the hormone, and sex hormone-binding globulin (SHBG), a protein that binds to testosterone. High SHBG levels can mean less free testosterone is available, even if total testosterone appears normal.
Other diagnostic tests, such as luteinizing hormone (LH) and follicle-stimulating hormone (FSH), are performed to determine the cause of low testosterone. LH and FSH are hormones produced by the pituitary gland that stimulate testosterone production in the testes. Abnormal levels indicate whether the problem originates in the testes (primary hypogonadism) or in the brain’s pituitary or hypothalamus (secondary hypogonadism). A prolactin blood test may also be ordered, as elevated prolactin levels can indicate pituitary gland issues or tumors that suppress testosterone production.
Treatment Options for Low Testosterone
Once low testosterone is diagnosed, a urologist can offer various treatment approaches, with Testosterone Replacement Therapy (TRT) being a common option. The primary goal of TRT is to restore testosterone levels to a healthy range, typically between 300 and 1000 ng/dL, to alleviate symptoms and improve overall well-being. TRT does not cure the underlying cause of low testosterone but manages the symptoms by providing manufactured testosterone.
Several methods of TRT are available, each with its own application and considerations:
- Testosterone injections are a widely used and often cost-effective method, administered into a muscle or under the skin, typically every one to two weeks.
- Gels and creams are topical applications rubbed daily onto the skin (arms, shoulders, or abdomen) for slow absorption. Care must be taken to prevent transfer to others.
- Testosterone patches are applied to the skin daily, often on the arm or upper body, providing a steady hormone release.
- Oral testosterone medications, including newer formulations designed to bypass the liver, are typically taken twice daily.
- Testosterone pellets are small cylinders implanted under the skin (hip or buttocks), releasing a consistent dose over three to six months.
- Buccal tablets adhere to the gums, releasing testosterone over about 12 hours.
- Intranasal gels are pumped into the nostrils for direct absorption.
Beyond TRT, a urologist may also discuss lifestyle modifications to support hormonal health. These include regular exercise, a balanced diet, and sufficient sleep, all of which contribute to overall well-being and can positively influence testosterone levels. Addressing underlying medical conditions, such as obesity or diabetes, can also be part of a comprehensive treatment plan, as these conditions can contribute to low testosterone. The urologist will monitor blood levels, including hemoglobin and hematocrit, during TRT to ensure safety and adjust dosages as needed.
When to Seek Urological Consultation
Considering a consultation with a urologist for potential low testosterone is advisable when experiencing persistent and bothersome symptoms. These include a notable decrease in sex drive, difficulties with erections, or unusual fatigue that does not improve with rest. Other indicators include unexplained loss of muscle mass or strength, increased body fat, and mood changes such as depression or irritability.
If these symptoms affect daily life or well-being, seeking professional medical advice is a sensible next step. Early consultation is beneficial, as a urologist can accurately diagnose the issue and rule out other potential causes. This specialized assessment ensures appropriate management can begin promptly, rather than self-diagnosing or delaying care.