Hypogonadism, or low testosterone, is a medical condition defined by the body’s insufficient production of the male sex hormone. Testosterone maintains sexual function, regulates mood, supports bone density, and develops muscle mass. Men with this deficiency often report symptoms such as decreased energy, reduced libido, and a depressed state of mind. A urologist is a medical specialist who is among the first professionals to diagnose and treat low testosterone, offering focused expertise on the male reproductive system.
The Urologist’s Expertise in Treating Low Testosterone
Urologists possess specific training that makes them well-equipped to manage testosterone deficiency, as their practice covers the full scope of the male reproductive tract and associated hormonal systems. Their expertise includes andrology, the branch of medicine dedicated to men’s health, sexual function, and fertility. This allows them to evaluate low testosterone in the context of its direct impact on physical health and sexual performance.
The symptoms of hypogonadism frequently coincide with other conditions of the genitourinary system, such as erectile dysfunction, which is a common complaint among men with low T. By focusing on both the hormonal imbalance and the physical effects simultaneously, the urologist is able to provide a comprehensive treatment strategy. They are skilled at anticipating how Testosterone Replacement Therapy (TRT) may influence co-existing urinary or prostate health issues, which are often present in the patient population.
This specialized knowledge also involves a detailed understanding of the complex signaling between the brain and testes known as the hypothalamus-pituitary-gonadal (HPG) axis. Urologists are trained to investigate whether the testosterone deficiency originates in the testes or in the regulatory signaling from the brain. This systematic approach ensures a treatment plan that addresses the specific origin of the patient’s low testosterone.
Diagnostic Steps for Hypogonadism
The diagnosis of hypogonadism requires both the presence of characteristic clinical symptoms and objective biochemical evidence from laboratory tests. The initial diagnostic step is to measure the total serum testosterone level, a test that must be confirmed on at least two separate occasions. Blood samples are drawn in the early morning, typically between 8:00 AM and 10:00 AM, because testosterone levels are naturally at their highest during this time.
The American Urological Association suggests a total testosterone level below 300 nanograms per deciliter (ng/dL) as a reasonable cutoff point to support the diagnosis of low testosterone. If the total testosterone result is near the lower end of the normal range, the urologist may also measure free or bioavailable testosterone. This measurement helps determine the amount of hormone that is not bound to proteins like sex hormone-binding globulin (SHBG) and is therefore available for the body’s tissues to use.
After confirming a low testosterone level, additional blood tests are ordered to measure luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to determine the cause. This helps differentiate between primary hypogonadism (testicular failure resulting in high LH and FSH) and secondary hypogonadism (a signaling issue from the pituitary or hypothalamus marked by low or normal LH and FSH levels). Identifying the type of hypogonadism is important because it dictates the subsequent treatment strategy. For example, very low testosterone combined with low LH may warrant an MRI to investigate the pituitary gland.
Treatment Options Managed by Urologists
Urologists offer management for the full spectrum of Testosterone Replacement Therapy (TRT) options, allowing them to personalize the treatment based on patient preference and convenience. Intramuscular injections are a common, cost-effective method, typically administered every one to two weeks. This method can sometimes lead to fluctuating symptoms due to a peak shortly after the injection followed by a trough before the next dose is due.
Topical formulations, such as gels or creams, provide the advantage of daily self-application, which helps to maintain more stable testosterone levels throughout the day. Patients using gels must be careful to prevent accidental transfer to others, particularly women and children, as the hormone can be absorbed through the skin. Patches offer another transdermal delivery route, applied daily, but they sometimes cause localized skin irritation or allergic reactions.
Subcutaneous pellets represent a long-acting alternative. These small implants are placed under the skin during a minor in-office procedure and steadily release testosterone over three to six months, eliminating the need for daily or weekly dosing. While offering high consistency and convenience, the pellet method requires a simple procedure for both insertion and eventual replacement.
For men who still desire to have children, urologists may utilize alternative treatments, since exogenous testosterone can suppress the body’s own sperm production. Fertility-sparing options include human chorionic gonadotropin (hCG) injections or selective estrogen receptor modulators (SERMs), which stimulate the testes to produce testosterone internally. Ongoing monitoring is necessary to track testosterone levels, assess the hematocrit to mitigate the risk of blood clots, and observe prostate-specific antigen (PSA) levels.
When to Consult a Urologist Versus Other Specialists
A primary care physician (PCP) can perform the initial screening for low testosterone, but a specialist is often necessary when the diagnosis is complex or symptoms are persistent. An endocrinologist is well-suited for cases where the low T is linked to a broader endocrine disorder, such as a problem with the pituitary gland or thyroid dysfunction.
A urologist becomes the preferred specialist when low testosterone is complicated by issues concerning the male reproductive or urinary systems. This is particularly true if a patient has significant erectile dysfunction, existing prostate health concerns, or has not responded well to initial TRT managed by a PCP. Men interested in preserving their fertility should consult a urologist specializing in male reproduction, as they are expert in fertility-sparing protocols. The urologist’s expertise is also valuable if the hypogonadism is suspected to be caused by a structural or anatomical issue in the testes.