A urologist can prescribe testosterone replacement therapy (TRT) for men diagnosed with low testosterone, also known as hypogonadism. This intervention is a standard part of their practice, addressing symptoms resulting from the body not producing enough of this androgen hormone. Patients often seek these specialists because low testosterone frequently manifests with issues related to men’s reproductive and sexual health. The diagnosis and management of this hormonal deficiency fall within the scope of urological care.
The Urologist’s Specialization in Hormone Management
Urology focuses on the urinary tracts of both sexes and the reproductive system of men. This expertise makes the urologist highly qualified for managing testosterone deficiency. The testes are the primary site of testosterone production, and these organs are central to the urologist’s expertise. Urologists possess deep knowledge of the hypothalamic-pituitary-gonadal axis, which regulates hormone production.
Initiating TRT requires understanding its potential effects on the male reproductive and urinary systems. Urologists are trained to monitor and manage the localized side effects of testosterone therapy. They carefully track changes in prostate health, such as increases in Prostate-Specific Antigen (PSA) levels, which can occur during treatment. They also address concerns regarding testicular atrophy and the suppression of sperm production, common consequences of using external testosterone.
While a primary care physician can screen for low testosterone, the urologist offers specialized, comprehensive oversight of male reproductive health. They are equipped to identify whether symptoms like reduced libido or erectile dysfunction stem from low hormone levels or other underlying urological issues. This specialized perspective ensures the treatment plan raises testosterone levels while minimizing adverse effects on organs like the prostate and testes. The American Urological Association (AUA) recognizes testosterone deficiency as a core area of urological practice.
Clinical Assessment and Diagnosis of Low Testosterone
Diagnosing low testosterone requires both clinical evaluation and specific laboratory testing. A urologist begins by taking a detailed patient history, focusing on symptoms like chronic fatigue, diminished energy, reduced muscle mass, or changes in sexual function. It is important to confirm that the reported symptoms correlate with measurable hormonal deficiency.
For accurate measurement, blood samples for testosterone testing must be drawn in a standardized manner. Because testosterone levels fluctuate throughout the day, peaking in the morning, the blood draw is typically scheduled between 7:00 a.m. and 10:00 a.m. A diagnosis of hypogonadism requires two separate total testosterone measurements below the accepted threshold, which the AUA defines as less than 300 nanograms per deciliter (ng/dL).
The urologist often orders additional tests beyond total testosterone, such as measuring Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH). These pituitary hormones help determine if the cause originates in the testes (primary hypogonadism) or the brain (secondary hypogonadism). A complete diagnosis also involves ruling out other potential causes for the symptoms, such as thyroid disorders or high prolactin levels. Only after a careful differential diagnosis, combining symptoms with consistently low blood levels, will a urologist proceed with prescribing TRT.
Overview of Testosterone Replacement Therapy Options
Urologists offer a range of clinically proven methods for administering TRT, tailoring the choice to the patient’s lifestyle and medical needs.
Intramuscular Injections
One common method involves intramuscular injections, typically given every one to three weeks. Injections provide a high dose of testosterone, resulting in a temporary peak shortly after administration, followed by a decline until the next dose. Patients are often taught to administer these injections themselves at home.
Topical Applications
Topical applications, such as gels, creams, and patches, are another popular delivery system. These formulations are applied daily to the skin, usually on the shoulders, upper arms, or abdomen, allowing continuous absorption into the bloodstream. A potential consideration is the risk of transferring the medication to partners or children through close skin contact.
Subcutaneous Pellets
Long-acting subcutaneous pellets offer a convenient option for patients who prefer less frequent dosing. These small pellets are inserted by the urologist beneath the skin of the hip or buttocks during a simple office procedure. The pellets slowly release testosterone over a period that usually lasts between three and six months, providing steady hormone levels. Regardless of the chosen method, therapy requires regular follow-up appointments and blood work to ensure testosterone levels remain within a safe and effective range.