Low testosterone, medically termed hypogonadism, occurs when the testes do not produce enough of the primary male sex hormone. This deficiency leads to various physical and psychological symptoms, prompting men to seek treatment. Urologists frequently manage and prescribe Testosterone Replacement Therapy (TRT) for patients who qualify. As experts in the male reproductive and urinary systems, they are uniquely suited to address hormonal health issues related to hypogonadism.
Why Urologists Are Qualified to Prescribe Testosterone
Urologists are surgical and medical specialists focused on the male genitourinary tract and the male reproductive system, which includes the testes responsible for testosterone production. Their training involves a deep understanding of male hormone balance, sexual function, and the anatomy that low testosterone directly impacts.
The scope of a urologist’s practice covers conditions intertwined with testosterone levels, such as decreased libido and erectile dysfunction. They possess the expertise to diagnose the deficiency and assess its potential effects on the prostate and urinary function, a major consideration in older men. Their direct expertise in the anatomical and functional aspects of the male system positions them as leading prescribers of TRT.
How Low Testosterone is Diagnosed
Diagnosis of hypogonadism requires a combination of specific clinical symptoms and confirmatory laboratory testing. Common symptoms that prompt an evaluation include decreased libido, chronic fatigue, loss of muscle mass, and a reduction in the frequency of spontaneous morning erections.
The initial laboratory test is a measurement of total testosterone (TT) levels in the blood. Because testosterone levels naturally fluctuate, the blood sample must be drawn in the early morning, typically between 8:00 AM and 10:00 AM, when levels are at their peak. For a definitive diagnosis, a low total testosterone value (often below 300 nanograms per deciliter, or ng/dL) must be confirmed on at least two separate occasions.
If the total testosterone result is borderline or if the patient has conditions that affect sex hormone-binding globulin (SHBG), the urologist may order a free testosterone (FT) test. Free testosterone represents the active, unbound portion of the hormone available for the body to use. Additional testing includes measuring luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to help determine the cause of the deficiency. Elevated LH/FSH suggests primary hypogonadism (testes origin), while low or normal levels suggest secondary hypogonadism (pituitary or hypothalamus issue).
Available Testosterone Replacement Therapy Methods
Once a diagnosis is confirmed, urologists can prescribe several methods for administering testosterone. The choice of therapy is individualized, balancing a patient’s preference with the goal of maintaining steady hormone levels. Intramuscular injections are common, typically administered every one to two weeks using formulations like testosterone cypionate or enanthate. This method is economical but can result in peaks and troughs in serum testosterone levels, which some patients experience as fluctuations in energy or mood.
Topical gels and creams are applied daily to the skin, usually on the shoulders or upper arms, allowing for gradual absorption. This approach provides more stable, physiological testosterone levels throughout the day. A potential drawback is the risk of transferring the medication to partners or children through skin-to-skin contact, necessitating careful application and washing.
Other options for TRT administration include:
- Transdermal patches, which are applied daily and deliver a consistent dose, though they can sometimes cause skin irritation.
- Subcutaneous pellets, which are small implants inserted under the skin of the hip or buttocks.
Pellets dissolve slowly over three to six months, offering a convenient, long-acting method that provides a steady release of the hormone.
Ongoing Management and Safety Monitoring
Testosterone Replacement Therapy is a long-term treatment that requires consistent monitoring to ensure efficacy and patient safety. Urologists initiate a schedule of follow-up blood work, typically at three to six months after starting therapy, and then annually once the dosage is stabilized. This monitoring checks that testosterone levels are within the mid-normal therapeutic range, often between 400 and 700 ng/dL.
A primary safety concern is the stimulation of red blood cell production, monitored via a complete blood count (CBC) to check hematocrit levels. If the hematocrit rises above 54%, the blood becomes too thick, increasing the risk of blood clots and cardiovascular events, which requires a dose reduction or temporary cessation of TRT. For men over 40, urologists also closely track Prostate-Specific Antigen (PSA) levels and perform digital rectal examinations to monitor prostate health. Liver function tests are included in the monitoring protocol, particularly when oral forms of testosterone are used.