Low Testosterone: Symptoms, Risks, and Treatment Options

Q: Low Testosterone: Symptoms, Risks, and Treatment Options

Hello： <br>1. <br>Will the testicular function of sperm production be permanently damaged after this, or will it return to normal once the injections are stopped? I've also heard that the testicles may shrink—it's advisable to visit a medical center to identify any underlying cau

Testosterone deficiency

Hello Doctor: I would like to ask you about low testosterone levels.
I am currently 35 years old and unmarried.
My libido has decreased significantly (from DIY three times a week to once every two weeks).
I often feel sleepy after dinner and sometimes experience palpitations (which I believe are due to work stress).
Therefore, I underwent some tests.
I have a night owl personality, usually going to bed around 2 AM and waking up at 8 AM (which means I am somewhat sleep-deprived).
When I was about 16 years old, I had a right inguinal hernia that I delayed surgery for about three years.

On February 29, 2020, my testosterone level was 314.67 ng/dL (reference range: 229.00-902.0).
The doctor at the clinic said it was normal but on the low side.
On October 20, 2020, my testosterone level was 2.520 ng/mL (reference range: 3.5-10) (this was drawn at 8 PM at a urology clinic, and the report indicated low levels in red; the doctor recommended testosterone injections).
On October 31, 2020, my testosterone level was 263.8 ng/dL (reference range: 250.56-1062.72 ng/dL) (this was drawn in the morning at a medical center, and the doctor suggested adjusting my schedule and exercising more).
I have undergone other brain examinations, which were normal.
On January 2, 2021, my testosterone level was 288.5 ng/dL (reference range: 250.56-1062.72 ng/dL) (this was drawn in the morning at a medical center; since I am unmarried, the doctor advised me to monitor it).
On November 18, 2021, my testosterone level was 2.350 ng/mL (reference range: 3.5-10) (this was drawn in the morning at a urology clinic, and my most recent blood test showed even lower levels.
The doctor at the clinic still recommended short-acting testosterone injections, once every two weeks for three months, then reassess).
The clinic doctor mentioned that if testosterone levels stabilize after three months, I could stop and start again as needed, or pause the injections when I want to have children.

I have several concerns:
1.
Will this cause permanent damage to the testicular function of sperm production, or will stopping the injections prevent that? I have also heard that the testicles may shrink.

2.
My erectile function is currently normal; will having received injections and then stopping affect my erectile function negatively?
3.
My body hair and nasal hair have turned white; is this related to andropause?
4.
If I choose to ignore this issue, will I enter andropause earlier?
I have many questions, and I would appreciate your help in answering them or recommending a doctor in the southern region for consultation.
Thank you!

Mr. Fu, 30~39 year old female. Ask Date: 2021/11/26

Dr. Du Shixi reply Urology

Hello:
1.
Will the testicular function of sperm production be permanently damaged after this, or will it return to normal once the injections are stopped? I've also heard that the testicles may shrink—it's advisable to visit a medical center to identify any underlying causes of the deficiency.

2.
Currently, erectile function seems to be normal.
Will it be affected after stopping the injections? The injections typically require multiple sessions over several months for improvement; long-term effects may occur.

3.
The pubic hair and nasal hair have turned white; is this related to menopause? It should not be related.

4.
If I choose to ignore it, will I enter male menopause earlier? It depends on whether the underlying cause can be identified.

Wishing you good health.

Reply Date: 2021/11/26

More Info

Understanding low testosterone (hypogonadism) is crucial, especially considering your symptoms and lab results. Testosterone is a vital hormone in males, influencing libido, energy levels, mood, and overall health. Your reported symptoms, such as decreased sexual desire, fatigue after meals, and occasional feelings of anxiety, align with common manifestations of low testosterone.

Symptoms and Risks of Low Testosterone
Low testosterone can lead to various symptoms, including:
1. Decreased Libido: As you've noted, a drop in sexual desire is a significant indicator. This can affect relationships and overall quality of life.

2. Fatigue: Feeling excessively tired, especially after meals, can be linked to hormonal imbalances.

3. Mood Changes: Anxiety and mood swings can occur, potentially exacerbated by work stress.

4. Physical Changes: Low testosterone can lead to reduced muscle mass, increased body fat, and even changes in hair patterns, such as graying.

Lab Results Interpretation
Your testosterone levels have shown fluctuations, with some readings falling below the normal range. The reference values for testosterone can vary, but generally, levels below 300 ng/dL are considered low. Your most recent results indicate a concerning trend, suggesting that your testosterone levels may be insufficient for optimal health.

Treatment Options
Your doctor has suggested testosterone replacement therapy (TRT), which can be effective in restoring testosterone levels and alleviating symptoms. Here are some considerations regarding TRT:
1. Injection Frequency: The proposed regimen of short-acting testosterone injections every two weeks is common. This approach can help stabilize hormone levels, but it’s essential to monitor your response and adjust as necessary.

2. Fertility Concerns: One of your primary concerns is the potential impact of TRT on sperm production and testicular size. Testosterone replacement can suppress the body's natural testosterone production, leading to testicular atrophy and reduced sperm production. However, if you decide to stop TRT, your body may gradually resume natural testosterone production, although this process can vary from person to person. If you plan to have children, discussing options like human chorionic gonadotropin (hCG) therapy with your doctor may help maintain fertility while on TRT.

3. Erectile Function: Generally, TRT can improve erectile function if low testosterone is the underlying cause. However, there is a possibility that if you stop TRT after a period of use, your erectile function may be affected, particularly if your body has become reliant on the therapy.

4. Aging and Hair Changes: The graying of body hair is often associated with aging rather than testosterone levels. While testosterone does influence hair growth, graying is primarily a genetic and age-related phenomenon.
5. Men's Health and Aging: Ignoring low testosterone may lead to symptoms that could resemble early male menopause, including fatigue, depression, and decreased libido. Addressing low testosterone proactively can help mitigate these risks.

Recommendations
1. Consultation with a Specialist: It would be beneficial to consult an endocrinologist or a urologist specializing in male reproductive health. They can provide a more comprehensive evaluation and tailored treatment options.

2. Lifestyle Modifications: In addition to medical treatment, consider lifestyle changes such as regular exercise, a balanced diet, and adequate sleep. These can significantly impact testosterone levels and overall well-being.

3. Regular Monitoring: If you start TRT, regular follow-up appointments are crucial to monitor testosterone levels, assess side effects, and adjust treatment as needed.

4. Discuss Concerns Openly: Make sure to communicate all your concerns with your healthcare provider, including those about fertility, erectile function, and any side effects you experience during treatment.

In conclusion, low testosterone is a manageable condition, and with the right approach, you can alleviate your symptoms and improve your quality of life. Don't hesitate to seek a second opinion or further evaluation from a specialist if you feel uncertain about your treatment plan.

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