Low Testosterone: Symptoms, Treatments, and Concerns

Low testosterone

Hello Dr.
Du,
I have been feeling fatigued for a long time and need to sleep over ten hours every night.
Since puberty, I have experienced mild gynecomastia symptoms (with hard lumps under the nipples).
I conducted hormone tests, and the results showed a total testosterone level of 320 ng/dL and an estradiol (E2) level of 41 pg/mL, while LH, FSH, and prolactin levels were normal.
Considering my age, is my testosterone level too low and my estrogen level too high? I consulted a doctor, but they suggested that since I am relatively young, I should just exercise more and sleep earlier, and follow up in a few months.
However, I have been doing weight training more than three times a week for several months, and my diet and routine are normal.
I would like to know your opinion on this matter.
Additionally, I have some questions regarding treatment options: If I undergo testosterone replacement therapy to increase my testosterone levels, is there a high risk of infertility in the future? I have heard that using hCG and hMG in conjunction can help maintain fertility; is this true? What is the approximate cost of these treatments, and are they covered by health insurance?
Besides testosterone replacement therapy, I have also seen the use of SERM (such as Clomiphene) and AI (Anastrozole) to boost testosterone while simultaneously reducing the effects of high estrogen.
Do you have any experience with these treatments, and are there any doctors in Taiwan who utilize this approach? Thank you!

LowT, 20~29 year old female. Ask Date: 2018/11/28

Dr. Du Mingyi reply Urology

Early use of hormone therapy can affect fertility, so it is not recommended.
Given your current testosterone levels, there is no need for special supplementation.
If you really need to consult an expert, you can visit Dr.
Huang Chih-Hsien at Taipei Veterans General Hospital.

Reply Date: 2018/11/28

More Info

Low testosterone, or hypogonadism, can significantly affect an individual's quality of life, leading to symptoms such as fatigue, decreased libido, mood changes, and even physical changes like gynecomastia (the development of breast tissue in men). Your reported testosterone level of 320 ng/dL is indeed on the lower end of the normal range for adult males, which typically spans from about 300 to 1,000 ng/dL, depending on the laboratory reference values. Your elevated estradiol (E2) level of 41 pg/mL may also contribute to some of the symptoms you're experiencing, particularly gynecomastia.

Given your age and the symptoms you've described, it is understandable that you are concerned about your hormonal balance. While lifestyle changes such as regular exercise and a healthy diet are essential, they may not be sufficient to address hormonal imbalances in some individuals. It is crucial to have a comprehensive evaluation by an endocrinologist or a specialist in men's health who can assess your hormonal levels more thoroughly and consider other underlying conditions that may be contributing to your symptoms.

Regarding testosterone replacement therapy (TRT), it can effectively increase testosterone levels and alleviate symptoms associated with low testosterone. However, one of the concerns with TRT is its potential impact on fertility. Testosterone replacement can suppress the natural production of testosterone by the testes, which can lead to decreased sperm production and, consequently, infertility. To mitigate this risk, some practitioners recommend using human chorionic gonadotropin (hCG) alongside TRT. hCG can stimulate the testes to produce testosterone and maintain sperm production, helping to preserve fertility.

The cost of testosterone replacement therapy can vary widely based on the type of treatment (injections, gels, patches, etc.) and the healthcare provider. In many cases, insurance may cover part of the costs, but this can depend on your specific plan and the medical necessity determined by your healthcare provider. It is advisable to check with your insurance provider regarding coverage for TRT and associated medications.

In addition to TRT, other options like selective estrogen receptor modulators (SERMs) such as Clomiphene citrate and aromatase inhibitors (AIs) like Anastrozole can be used to manage low testosterone levels and high estrogen levels. Clomiphene works by stimulating the pituitary gland to produce more luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which can increase natural testosterone production. Anastrozole can help lower estrogen levels, which may alleviate some symptoms of gynecomastia.

In Taiwan, there are healthcare providers who utilize these alternative therapies, but it is essential to find a physician experienced in managing male hormonal health. They can provide personalized treatment plans based on your specific hormonal profile and health goals.

In summary, it is crucial to pursue further evaluation and treatment options with a qualified healthcare provider who can address your concerns about low testosterone and elevated estrogen levels. They can help you navigate the various treatment options available, including the potential benefits and risks associated with each. Regular follow-ups and monitoring will be essential to ensure that your treatment plan is effective and safe.

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