Testosterone is a steroid hormone regulating not only the sexual function, but also metabolism, urinary health as well as many other critical functions. In most cases, testosterone concentration decreases slowly after the age of 40 and does not cause abrupt symptoms.
Yet, some men might experience a pack of symptoms representing a clinical condition called Testosterone Deficiency (TD), or hypogonadism in males, which is attributed to low levels of testosterone. At present, some 30% of men globally suffer from testosterone deficiency or hypogonadism as indicated by diverse studies.
Testosterone begins to decrease after age 40
the Endocrine Society that defines TD as low serum testosterone (usually <280 ng/dL in healthy young men) along with the following symptoms of hypogonadism:
- decreased sexual function
- loss of pubic and/or axillary hair
- loss of concentration and/or motivation
- decline in cognitive function
- low mineral density in the bones
- loss of work capacity and muscle strength
- depression or poor mood.
Testosterone is available in the body in the following forms:
- free testosterone,
- testosterone bound to albumin
- testosterone bound to sex hormone-binding globulin (SHBG)
In healthy young men, just 1-2% of testosterone is free, some 40% is albumin-bound and easily dissociates to free testosterone, while the remainder is bound to SHBG, and does not easily dissociate and is effectively biologically unavailable.
Serum levels of testosterone remain approximately stable until about age 40. After age 40, total levels of testosterone decrease by 1% to 2% annually, and serum free testosterone levels decrease by 2% to 3% annually. Testing of free testosterone levels is recommended when a patient falls in the low normal range of total testosterone.
Testosterone screening: How to Do It Correctly?
When testosterone deficiency is suspected, the experts of My Canadian Pharmacy www.mycanadianpharmacypro.com recommend measuring total serum testosterone as the initial test. Since testosterone levels change throughout the day and peaking in the morning, they must generally be measured before 10 am.
In healthy young men, the lower limit of the normal testosterone range is 280 to 300 ng/dL, but may fluctuate depending on the laboratory. If the levels are abnormal (<280 ng/dL), run another test at least a month later before deciding for testosterone replacement.
Patients with chronic diseases, such as diabetes, obesity, liver disease, thyroid disease, or nephrotic syndrome are likely to have an increase in SHBG. For such patients, free testosterone levels also need to be measured. If a man has a total testosterone level in the low normal range and the symptoms of hypogonadism combined with a free testosterone level below the lower limit of normal (usually around 50 ng/dL), testosterone replacement can be suggested.
Many men over 65 years of age may have testosterone levels below the normal range. Some experts suggest establishing the age-adjusted normal ranges, and recommend not starting the testosterone replacement therapy in such men until serum levels drop below 200 ng/dL, as opposed to 280 ng/dL.
Medicines such as opioids and glucocorticoids, as well as acute or subacute illnesses can affect testosterone levels. Testosterone levels must not be measured while a patient is receiving these medicines or recovering from illnesses.
Does Testosterone Replacement Improves Viagra Results?
The experts at My Canadian Pharmacy have been carefully monitoring the clinical research and academic discussion regarding the simultaneous use of PDE5 inhibitors, such as Viagra, and Testosterone Replacement Therapy (TRT).
In a 25-year study of 2,000 patients of the Centre for Men’s Health, 60% of patients stated their symptoms improved with TRT, rising to some 90% when enhanced with a PDE5 inhibitor. Dr. Malcolm Carruthers who runs the clinic believes that doctors should consider TRT when men report problems with sexual function. ‘Viagra might work for a while, but then the testosterone deficiency gets worse and the ED comes back,’ he says.
On the other hand, clinical scientists from the University of Florence are more cautious. They believe that even though testosterone modulation of erectile process is broadly accepted, using TRT in men with ED does not have to be a default option due to increased risk of side effects, especially in older men.
They have summarized relevant medical data, with an emphasis on randomized controlled trials and original molecular studies performed over the past 20 years. They found that although testosterone regulates nearly every component of erectile function and clinical data support the use of testosterone replacement in hypogonadal individuals with ED, the benefit-risk ratio is uncertain in senior patients.
In other words, although studies confirm the meaningful overlap of ED and hypogonadism, the by-default simultaneous use of PDE5 inhibitors with TRT should being questioned. Initially proposed as a rescue therapy for non-responders to PDE5 inhibitors, the simultaneous use approach was incorrectly converted into a combination therapy.
Scientists from the University of Florence suggested a pathophysiology-oriented procedure designed to avoid inappropriate treatments that provides guidelines to whether treatment should be started with PDE5 inhibitors, TRT only, or both.
Experts of My Canadian Pharmacy recommend using TRT in combination with Viagra (or other PDE5 inhibitors) only when a patient depends on the letter for achieving erection and when his testosterone levels measurements are below 280 ng/dL in younger men, or below 200 ng/dL in men over 65 years of age. TRT should NOT be given to individuals with symptoms related to hypogonadism (e.g. decreased libido or fatigue) who have normal serum testosterone levels.
Overview of Testosterone Replacement Products
A variety of TRT products formulated from different active ingredients are obtainable in the market nowadays.
The different TRT products include:
- injection (parenteral)
- oral drug forms
- transdermal gels/patches/solutions
- buccal adhesives/gums,
- implants.
The patches/gels segment accounts for a leading share in the market because of the strong sales of branded preparations. Touching the growth rate, though, the segment of testosterone injections is slated to outperform others with more patients turning to such products as they are comparatively cheap and may be self-administered. Oral formulations are less recommended due to adverse effects on lipids and potential hepatotoxicity. Moreover, oral preparations have brief half-lives, handicapping their ability to attain and keep normal testosterone levels.
Most Popular Testosterone Replacement Drugs
At My Canadian Pharmacy, you will be able to choose from a variety of TRT products. Let us walk you through the most common types of TRT products and their pros and cons.
Parenteral testosterone is administered as an intramuscular injection, at 2-4-week intervals. This regimen suggests variations in testosterone levels, with supernormal levels shortly after shot and subnormal levels immediately prior to ensuing injections.
Pellets containing 75 mg of testosterone get implanted hypodermically. The traditional dose is 150 mg (2 pellets), but may be as high as 450 mg (6 pellets). The therapeutic effects of testosterone pellets last for 3-4 months, on average, and up to 6 months.
Transdermal testosterone formulations are prescribed most frequently. They include gels, solutions, and patches. They help achieve stable testosterone levels that linger in a normal range when used daily.
- Testosterone gels are meant to be applied to the skin, NOT the genitals, and must be covered with clothing immediately after drying for 5-10 minutes at least.
- Testosterone solutions are applied daily to each underarm. The initial dose is 60 mg applied under each arm and may be corrected based on follow-up testosterone levels.
- Testosterone patches may be applied to the abdomen, back, or limbs. A skin rash may occur in about 33% of patients using testosterone patches and may result in discontinuation.
Buccal testosterone needs to be applied to the buccal mucosa every 12 hours for therapeutic levels without major fluctuations. The tablet forms to the gum and softens, remaining undissolved and it needs to be removed by lapse of 12 hours. The most typical adverse effects are taste alteration and mucosal irritation.
Do not hesitate to contact us directly to get an initial expert consultation on testosterone replacement options most appropriate to your lifestyle, considered testosterone replacement therapy results you want to achieve as well as testosterone replacement therapy cost.
Contraindications to TRT
Contraindications to TRT include hepatic dysfunction (cirrhosis), heart failure, breast cancer, and prostate cancer. Current guidelines also do not recommend giving testosterone to individuals with severe lower urinary tract signs, with IPSS (International Prostate Symptom Score) over 19.
On-going Monitoring for Testosterone Replacement Therapy Risks is Essential
Patients receiving TRT must have their testosterone levels measured at three, six, and twelve months following the beginning of therapy, and then annually for as long as TRT continues. TRT should ideally achieve testosterone concentration levels in the middle normal ranges. Further monitoring should incorporate a serum hematocrit at the beginning, and at 6 months, and then annually if hematocrit stays within normal range. Hematocrit testing is necessary since testosterone boosts production of red blood cells from the bone marrow, and that may lead to polycythemia. TRT must be discontinued or dosage reduced if a patient’s hematocrit climbs above 54%, as there might be a risk of blood clotting, though, typically, such events develop rarely.
Monitor PSA. Although TRT does not escalate the risk of prostate cancer, the authoritative Endocrine Society, none the less, recommends getting a PSA (prostate specific antigen) level and doing a digital rectal exam in patients over 40 years of age prior to starting TRT. Repeat the PSA at six months and annually thereafter. Further assessment for prostate cancer is demanded if the PSA rises more than 0.4 ng/dL per year. TRT must be avoided if the individual’s PSA level exceeds 4 ng/mL (or exceeds 3 ng/mL in high-risk patient groups) or if there is a significant prostatic hypertrophy or a palpable nodule.
Get a lipid panel as well as liver function lab tests. Lipid deviations – predominantly a decline of high-density lipoprotein cholesterol – might happen during testosterone replacement therapy. Obtain these tests at the beginning and then once a year during TRT duration.
