TRT ~ Low Testosterone

Testosterone levels peak in most men during the early to mid-20s. Between the ages of 40 and 70, the hormone-producing cells begin to wear away, causing men to lose nearly 60 percent of peak levels. Key symptoms of testosterone deficiency include depression, fatigue, low sex drive, irritability, hair loss, thinning and wrinkling of the skin, weight gain and weakening of bone and muscle tissue. Eventually, hormone imbalances can set the stage for the development of more serious conditions like heart disease, osteoporosis, pre-diabetes and erectile dysfunction. While many popular medications such as Viagra are available to help sustain an erection, none of these drugs work effectively without adequate testosterone. Appropriate hormone treatment could eliminate the need for Viagra and enable the man to have normal sexual function. Dr Ghayouri M.D. is an experienced endocrinologist that does testosterone replacement therapy in San Diego and LaJolla

The Androgen Deficiency in Aging Males (ADAM) Questionnaire

The following questionnaire, the Androgen Deficiency in Aging Males (ADAM) questionnaire, was developed at St. Louis University Medical School to detect the symptoms related to decreased testosterone levels in men.

The questionnaire contains the following ten questions:

  1. Do you have a decrease in libido (sex drive)?
  2. Do you have a lack of energy?
  3. Do you have a decrease in strength, endurance, or both?
  4. Have you lost height?
  5. Have you noticed a decreased enjoyment of life?
  6. Are you sad, grumpy, or both?
  7. Are your erections less strong?
  8. Have you noted a recent deterioration in your ability to play sports?
  9. Are you falling asleep after dinner?
  10. Has there been a recent deterioration in your work performance?

Any man answering “yes” to question 1 or 7 or any three other questions has a high likelihood of having a low testosterone level and should see his physician to be evaluated. If testosterone is low on appropriate testing, most of these symptoms are reversed or improved with testosterone replacement. A personalized hormone replacement therapy has positive benefits that can improve your life.


Lower testosterone levels may begin as early as the 40’s and 50’s.  Many factors can cause a decrease in testosterone levels. Before starting long-term testosterone replacement, a man should be carefully evaluated for other causes of  low testosterone. Pituitary or brain tumors can result in low testosterone and the treatment for these conditions may be surgery or other drugs.

Prescription drugs may affect sexual function and reduce testosterone levels. Other less causes can include nutritional factors, insomnia, stress and other life-style issues. When these conditions are recognized and treated, testosterone may normalize without the need for testosterone treatment.

Borderline-low values for total serum testosterone should be further evaluated, particularly in elderly and obese men. Because hypogonadism may be the initial sign of a pituitary tumor or systemic disease, a thorough workup is essential, especially in younger men. Classic symptoms of androgen deficiency (and male hypogonadism) at any age include fatigue, loss of muscular strength, poor libido, hot flushes, and sexual dysfunction. A morning measurement of total serum testosterone level is the screening test of choice for male hypogonadism. Patients with moderately low (200-350 ng/dL [6.94-12.15 nmol/L]) total serum testosterone levels should have their free or bioavailable testosterone level determined.

Some recent studies supported the view that an age-related decline in testicular function may occur with associated symptoms, and testosterone replacement treatment improved lean body mass, increased hematopoiesis, decreased low-density lipoprotein (LDL) levels in conjunction with a constant ratio of LDL to high-density lipoprotein (HDL), improved libido, and improved well-being in older men with low testosterone levels.

HGH Therapy

Generally, prostate size and prostate-specific antigen (PSA) levels do not change in comparison with otherwise normal men. Elder men with hypogonadism have significantly reduced mean growth hormone level. Patients with adult-onset growth hormone deficiency also have increased cardiovascular-related mortality . Testosterone treatment results in a significant increase in 24-hour mean serum growth hormone value . Perhaps testosterone has an important role in the control of growth hormone secretion in adulthood, and testosterone therapy may have a positive clinical influence.

Contraindications to Testosterone Therapy and Gonadotropin Therapy

Men with prostate cancer, male breast cancer, or untreated prolactinoma.

Men with symptomatic prostatism should undergo evaluation and treatment for this problem before testosterone replacement therapy is considered.

    Relative Contraindications to the Use of Testosterone

    Sleep apnea and polycythemia, which may cause hyperviscosity.  Testosterone treatment will tend to reduce sperm counts and testicular size and should not be used in men currently seeking fertility.

      The following preparations of testosterone have been approved by the FDA for clinical use:

      • Long-acting intramuscular preparations
      • Short-acting intramuscular preparations
      • Scrotal patches
      • Transdermal patches
      • Transdermal gel
      • Orally administered agents (Orally administered testosterone is quickly metabolized by the liver and cannot achieve sufficient blood levels over time to be useful.)

      Monitoring Issues and Side Effects of Testosterone Therapy

      Periodic follow-up when receiving testosterone therapy is needed. During the first year of such therapy, the clinical response and the side effects should be monitored at 3- to 4-month intervals.

      Examination of the prostate should be done routinely, along with a prostate-related symptom assessment every 6 to 12 months. PSA levels should be determined annually in older men receiving testosterone replacement therapy. Testosterone treatment should not be administered to men with high PSA values or significantly increasing PSA levels.

      Testosterone, and especially dihydrotestosterone, stimulates growth of the the prostate and seminal vesicles, but this growth did not exceed the volumes expected in normal men. Men in whom symptomatic prostatism develops should undergo assessment before testosterone replacement therapy is continued.

      Gynecomastia may result from the aromatization of testosterone to estradiol. Men with a genetic susceptibility to alopecia may note worsening of this problem with testosterone therapy. Testosterone stimulates the bone marrow production of erythrocytes. The result is an increased hematocrit in some men,  thickening blood and increased risk of blood cloth formation. The hematocrit should be determined regularly first 1-2 years.

      Lipid disturbances in testosterone-treated male patients are generally not a problem because of the aromatization of testosterone to estradiol. The ratio of HDL to total cholesterol generally remains constant.

      The recognition, evaluation, and treatment of hypogonadism in the male patient are often dismissed by the patient and overlooked by the physician. The proper hormonal balance is essential to maintain optimal health.  Throughout your life, and particularly when you enter middle age, information about your body’s hormone production provides keen insights to help maintain a healthy and vigorous life.

      At Sarapy Clinic, your consultation for hormone replacement therapy program is easy, and discreet. After initially testing your hormone levels through a quick blood draw, you will return for an appointment to review the results. If your level is low and you are a candidate for hormone replacement therapy, your first dose will be given at the clinic, with thorough instruction on how to administer the rest of your doses in the comfort of your own home.

      After that, your next in-office appointment wont be for two to three months. All of your doses will be delivered in discreet packaging, right to your door.

      Continued Monitoring is the key success for our patients with Dr. Sarah.

      You will be required to return 60 days after the initial lab work to have additional lab tests performed. This ensures that the dosage and the clinical results are on track with the specific treatment goals.

      If you have any concerns or questions about low testosterone, please email Doctor Sarah.