Men: Before Initiating Testosterone Replacement

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There are some men whose low testosterone symptoms are not severe enough to require replacement but instead need to have their own production of testosterone stimulated. Men in this situation with borderline blood levels like 405 Total Testosterone and 130 Free Testosterone may be symptomatic and may benefit from treatment.

Young men will sometimes benefit from oral medications or supplements that can stimulate total testosterone production. Unlike the promises made in supplement advertisements, medical stimulation of testosterone production does not work for all men (in fact less so as men), and often I find that after a trial of medical stimulation or other medical treatment I still must begin replacement of testosterone with pellets.

I discuss this option with my patients of course and let them decide whether their symptoms warrant replacement of their testosterone versus a three-month course of medication meant to stimulate/optimize their own production of testosterone. This method can buy them months to years without replacing their own T, but it is not effective in everyone.

One medication we use to increase a man’s available testosterone is Arimidex. Arimidex lowers Estrone, a hormone present to varying degrees that binds testosterone and renders it ineffective. This medication is effective only if the patient will also decrease alcohol, decrease carbohydrate intake, and increase exercise. DIM is a supplement that works in different mechanism but results in a decrease of Estrone and increase of Free T. Both can be used together.

In some men, DHT is elevated at the cost of using up free T. By blocking the conversion of some of this hormone, free T increases. It is important not to decrease DHT below 25 because it is necessary for sexual function and muscle development. The drug that is given for elevated DHT is Finasteride(Propecia, Proscar) 5 mg usually lowers the DHT and elevates the free T and may prolong the time the man can wait before he undergoes replacement T. The supplement that acts to lower DHT is Saw Palmetto.

In men younger than 50, and preferably younger than 40, the stimulation of T by HCG shots is often used for fertility reasons. This is a short term very expensive answer for young men to see if we can kick start the production of T. It does not work in older men.

Men that opt for stimulation of their own testosterone production will be asked to repeat blood work after three months of treatment and schedule a visit to see how they are doing and determine whether they might still need T pellets to resolve their symptoms.

The diagnostic process for evaluation and treatment of men with low T is complicated and requires an experienced physician with communication skills that sense the needs of the patient.