Low-T Therapy in Dallas, TX
What is Low Testosterone?
Hypogonadism (or Low-T) is a condition where the body does not produce enough Testosterone. This is a hormone that plays a key role in masculine development during puberty. If it is low it can cause significant symptoms and Testosterone Replacement Therapy (TRT) may be indicated. Dr. Wierschem has treated thousands of patients for Low-T. He offers a variety of treatment options and will discuss an appropriate treatment plan for each individual patient that is cost effective and convenient. At Dr. Wierschem’s offices in Plano and McKinney, you are always treated by a physician, not a Physician’s Assistant (PA) or Nurse Practitioner (NP).
What are the Symptoms of Low Testosterone?
In adult males, hypogonadism may alter certain masculine physical characteristics and impair normal reproductive function. Signs and symptoms may include:
- Low sex drive
- Erectile Dysfunction
- Decreased ability to concentrate
- Decreased muscle mass
- Development of breast tissue (gynecomastia)
- Loss of bone mass (osteoporosis)
- Hot flashes
What are the Causes of Low-T?
There are 2 basic types of hypogonadism: primary and secondary. Primary hypogonadism is caused when the problem originates from the testicles and Secondary Hypogonadism is caused when there is a problem with the hypothalamus or pituitary gland in the brain where It fails to signal the testicles to produce Testosterone. Either type may be inherited (congenital) or something that develops later in life (acquired). Many times the source of the hypogonadism is not clear.
Causes of Primary Hypogonadism
- Genetic abnormalities
- Undescended testicles (when the testes fail to drop into the scrotum during development)
- Injury to the testicles
- Cancer treatments such as chemotherapy or radiation to the testicles
- A history of mumps or orchitis
Causes of Secondary Hypogonadism
- Abnormalities of the Hypothalamus or Pituitary gland in the brain
- Normal aging
- Inflammatory diseases (such as sarcoidosis)
- Medications – Opiate pain medication and hormone (steroid) use
- Sleep disorders such as sleep apnea
- Concurrent Illness
How is Low-T Diagnosed?
The diagnosis of hypogonadism is usually done with a combination of patient history, physical exam and blood tests. Typically, 2 morning Testosterone levels (before 10AM) are needed to confirm the diagnosis. Sometimes, more hormone testing, imaging or genetic studies are used. Lab testing is very important as this aids Dr. Wierschem in appropriate dosing and management.
Low-T Treatment Options
There are several good options available for the treatment of Testosterone deficiency. If indicated, Dr. Wierschem always recommends weight loss, treatment of sleep apnea, exercise and stress management in addition to Testosterone Replacement Therapy (TRT). Low-T treatment options include:
- Medication – Studies have shown that over the counter (OTC) Testosterone supplements are ineffective in the treatment of hypogonadism. Even DHEA, a natural hormone made by the body that converts into testosterone, has shown little effect on testosterone levels when taken in pill form. Oral testosterone is not used as it can create problems with your liver.
- Testosterone Injections – Testosterone injections (testosterone cypionate, testosterone enanthate) are safe and effective. Injections can be given in a muscle or subcutaneously. Your symptoms might fluctuate between doses depending on the frequency of injections. They are typically given every week or 2 weeks. You or a family member can learn to give Testosterone injections at home to make it more convenient and cost effective for you. If you’re uncomfortable giving yourself injections, a nurse or doctor can give the injections in the office.
- Implantable Pellets – Testosterone containing pellets can be easily placed in the doctor’s office. It is a simple procedure where the pellets are placed in the fatty tissues of the flank or lower back area. The pellets provide longer Testosterone maintenance and are typically replaced every 4-6 months.
- Gel – There are several gel preparations available with different ways of applying them. Depending on the brand, you either rub testosterone gel into your skin on your upper arm or shoulder (AndroGel, Testim), apply with an applicator under each armpit (Axiron) or pump on your front and inner thigh (Fortesta). As the gel dries, your body absorbs testosterone through your skin. Gel application of Testosterone replacement therapy appears to cause fewer skin reactions than patches do. Do not shower or bathe for several hours after a gel application, to be sure it gets absorbed. A potential side effect of the gel is the possibility of transferring the medication to another person. Avoid skin-to-skin contact until the gel is completely dry or cover the area after an application. Some patients do not absorb the gels very well and will need to try another type of therapy if this is ineffective for them. They can also be very expensive if insurance does not cover them.
- Patch – A patch containing testosterone (Androderm) is applied each night to your back, abdomen, upper arm or thigh. The site of the application is rotated to maintain seven-day intervals between applications to the same site, to lessen skin reactions.
- Gum and cheek (buccal cavity) – A small putty-like substance, gum and cheek Testosterone replacement (Striant) delivers Testosterone through the natural depression above your top teeth where your gum meets your upper lip (buccal cavity). This product quickly sticks to your gumline and allows testosterone to be absorbed into your bloodstream.
- Nasal – Testosterone can be pumped into the nostrils as a gel. This option reduces the risk that medication will be transferred to another person through skin contact. Nasal-delivered Testosterone must be applied twice in each nostril, three times daily, which may be more inconvenient than other delivery methods.
However, Dr. Wierschem utilizes peptides and growth hormone medication for his patients which have been shown to improve many of the symptoms associated with Low-T.
Testosterone Maintenance and Therapy
Once you have started a treatment plan, Dr. Wierschem will have you follow up every six months with labs and exam. Testosterone replacement can cause several problems including elevation in your PSA, blood pressure or blood counts. As a urologist, Dr. Wierschem can treat most any complication that may arise without having to refer you to another doctor.
It should be noted that there has not been a study to link testosterone replacement with prostate cancer.
Schedule an Appointment
Dr. Wierschem treats many patients in the Dallas area who suffer from Low-T. To discuss which treatment option is best for you. Call our office today at (972) 596-6733 to schedule an appointment.