Everything you wanted to know about Testosterone Therapy
Testosterone is often hailed as the cornerstone of male vitality, shaping not only the physical attributes of men but also significantly influencing their mental and emotional well-being. It’s no wonder Austin Powers was always focused on his “mojo”.
This powerful hormone, primarily produced in the testes, is integral to various aspects of male health, from maintaining muscle mass and bone density to regulating mood and sexual function. As men age, testosterone levels naturally decline, leading to a range of symptoms that can impact their quality of life.
“Testosterone plays a critical role in the human body, particularly in the development of secondary sexual characteristics and various androgenic functions. Symptoms indicating a potential need for testosterone therapy include low libido, fatigue, low energy levels, brain fog, high blood pressure, demotivation, and lack of strength,” says Johannesburg general practitioner Dr Giuseppe Trinchero from Premier Body and Health clinic.
Testosterone therapy, also known as testosterone replacement therapy (TRT) has gained attention for its potential to rejuvenate and enhance well-being. With insight from Dr Trinchero, we delve into the intricacies of TRT and the evolving science behind it.
What is it?
TRT is a hormone replacement treatment aimed at restoring healthy testosterone levels in individuals with low testosterone. “For men, normal total testosterone levels should range between six and 27 nmol/L, with free testosterone levels between 200 and 685 pmol/L,” says Dr Trinchero.
Low testosterone is diagnosed through a blood test typically measuring the levels of total testosterone, free testosterone, estrogen, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and sex hormone-binding globulin (SBGH).
“Additional tests may be conducted for a comprehensive analysis of overall bodily function, including thyroid function, full blood count, metabolic markers, sugar, insulin, lipid profile, kidney and liver function, iron studies, vitamin D, vitamin B12 and prostate markers in males. The best time to measure testosterone levels is first thing in the morning when levels are at their peak,” Dr Trinchero says.
Testosterone therapy is available in various forms, including bio-identical creams or gels, injectables and oral medications. The appropriate dosage and method of administration are determined by the patient’s comfort level and baseline testosterone levels, particularly total testosterone and SBGH.
Some patients may receive weekly injections at the clinic, while others may self-administer after completing nurse-led training. Dosages are typically started at a low level and adjusted until they reach the upper range of normal.
Benefits and risks
Testosterone therapy presents a range of both short-term and long-term effects that vary depending on the individual.
“In the short term, men may experience water retention, an increase in hemoglobin levels—sometimes necessitating venesection due to excess red blood cells—along with acne, decreased ejaculation and testicular shrinkage. Men face potential sterility and impotence if testosterone is used alone, along with hair loss, gynecomastia, worsening sleep apnea and prostate enlargement,” says Dr Trinchero.
Despite these risks, the benefits include improved energy levels, enhanced libido, increased muscle mass and better mental clarity while also positively impacting confidence, self-esteem, and overall well- being.
However, it is essential to carefully monitor therapy, as prolonged unsupervised use can lead to serious effects on fertility and cardiovascular health. “With careful administration and regular follow-ups, testosterone therapy can be safely managed, but it’s a treatment that demands vigilance and expertise,” says Dr Trinchero.
Concerns and care
Common misconceptions about testosterone therapy often revolve around its purpose and safety, explains Dr Trinchero. A prevalent misunderstanding is that TRT is primarily a performance- enhancing treatment, whereas it is actually designed to address specific symptoms related to low testosterone.
Another misconception about TRT is that it uses banned substances and is associated with causing prostate cancer, increasing the risk of cardiovascular events, raising blood pressure and making individuals more aggressive. However, Dr Trinchero says that these concerns are not supported by evidence, especially when TRT is administered correctly.
“Common concerns from patients considering testosterone therapy include the method of administration, particularly the discomfort some people feel about self-administering injections. Many patients also worry about potential side effects, such as high blood pressure, and women often fear that TRT will make them more masculine, which it does not.”
Testosterone therapy differs between younger and older patients, primarily in dosage and the duration of treatment. Older men are more likely to be on TRT on a chronic basis, while younger men are generally advised against long-term TRT due to the risk of infertility. Older patients need to be particularly vigilant about prostate health and should undergo regular check-ups and blood tests.
Lifestyle factors, such as diet, exercise and sleep play a crucial role in maintaining healthy testosterone levels. Lack of sleep, smoking, alcohol consumption, and a sedentary lifestyle can contribute to lowering testosterone. Adequate sleep, regular exercise and a balanced diet can help maintain or even boost testosterone levels naturally.
“Natural ways to boost testosterone may be recommended depending on a patient’s blood results. Certain natural supplements are known to support the body’s normal production of testosterone and can be used either in conjunction with or as an alternative to therapy, depending on individual needs,” explains Dr Trinchero.
“Stress can significantly impact testosterone levels, as high stress has been linked to a drop in normal testosterone levels, leading to hormonal imbalances. This imbalance can affect activities requiring stamina, concentration and energy, making stress management a critical component of testosterone therapy. Managing stress effectively can help maintain more balanced hormone levels, improving overall mental and physical strength.”
Monitoring and follow-up
Follow-up care involves frequent blood tests and regular doctor visits.
Testosterone levels should be monitored every three months to ensure the treatment is effective and to adjust dosages if needed. Signs that the therapy is effective include increased confidence, higher energy levels and enhanced libido, says Dr Trinchero.
However, he urges that those undergoing TRT should report any adverse symptoms or changes to their healthcare provider.
“For males, these include testicular shrinkage, loss of libido, development of breast tissue, hair loss and depression. For females, symptoms to report include mood swings, changes or cessation of the menstrual cycle, hair loss and weight gain. If testosterone therapy is not suitable, alternative treatments include peptide therapy and natural supplements. These options can be considered if TRT is contraindicated or if additional support is needed.”
Genetic factors can also significantly influence an individual’s response to TRT; some individuals may inherit genetic variations that affect testosterone production, transportation or response to the hormone.
For example, in a 2023 study in Nature Genetics, new genetic variants associated with low testosterone levels were identified after analysing the genomes of over 200 000 men. Certain gene variants have also been found to disrupt the function of the hypothalamus and pituitary gland, which are critical for regulating testosterone production. Further, comorbidities, such as diabetes and obesity, can impact the effectiveness of TRT.
“While TRT can be beneficial for individuals with obesity, who often have low testosterone levels, its effectiveness may be diminished when combined with other health conditions. In such cases, TRT usually needs to be combined with other medications for managing weight and other related issues,” says Dr Trinchero.
“Testosterone therapy is highly customisable based on a patient’s unique hormonal profile. At clinics, TRT protocols are tailored according to individual blood results and assessments, ensuring that each patient receives a treatment plan suited to their specific needs. This personalised approach often results in extremely positive responses from patients.”
Advancements in testosterone therapy
Dr Trinchero explains that TRT has progressed tremendously and is a completely safe option when administered properly, following the correct diagnostic procedures and patient criteria. “TRT has become an extremely safe therapy when done correctly and based on patient blood results, if required,” he emphasises.
TRT was primarily administered in the form of an injection, gel or patch, but there has been progress in oral administration, which has been formulated to avoid liver toxicity.
“Another significant shift has been the development of custom- compounded bio-identical hormones that closely mimic the molecular structure of hormones produced naturally within the human body. This high degree of similarity means that the body can more effectively use these hormones without the side effects often associated with synthetic alternatives,” says Dr Trinchero.
The growing preference for natural and personalised medicine has catapulted the demand for bio-identical hormone replacement therapy (BHRT), attributed to its reduced side effects and improved patient outcomes compared to synthetic hormone replacements.
The latest innovations in BHRT for testosterone replacement involve precise hormone level assessments through advanced diagnostic testing that allows for hormone doses to be tailored to each individual’s requirements. These systems ensure a steady hormone delivery, avoiding the peaks and troughs associated with traditional methods. The result is a more balanced hormonal state throughout the day, leading to better patient satisfaction.
“Revolutionary advancements are not only refining how testosterone levels are supplemented, but also transforming the patient experience from one of mere treatment to total lifestyle enhancement. Innovative delivery systems, bespoke treatment plans and real-time hormonal monitoring are just the beginning—the very concept of testosterone therapy is being reimagined,” says Dr Trinchero.
“Furthermore, the integration of telemedicine and digital health tracking tools have revolutionised how clients approach hormone replacement therapy (HRT). These technologies enable consistent monitoring of symptoms and hormone levels, facilitating fine-tuning of the treatment plan in real-time. Clients can communicate with their healthcare providers directly through telehealth platforms, ensuring swift adjustments to their therapy as needed.”
About Premier Health
Premier Health and Body are a dedicated medical and health industry team, specialising in HRT, nutrition and fitness planning, IV therapy and BHRT. Premier Hormone Health and Wellness is a clinic specialising in HRT. They offer various treatments, including testosterone replacement therapy, bio-identical hormone replacement, weight loss, hair restoration, sexual wellness and cognitive function enhancement.