Men's and Women's
Specialty Health Centers
866-322-2263
Hormone and Infertility Clinic in Noblesville, Indiana

Treatment for Low T

Treatment for men with low testosterone has included DHEA, gels, patches, injectables, and pellets that are put under your skin. Muscle size and strength are increased from the effect of testosterone, body fat is reduced, and related to sexual functioning.
 
When undergoing testosterone replacement therapy, it is important to understand that testosterone needs to directly activate androgen receptors and be metabolized into dihydrotestosterone (by 5 alpha reductase) and estradiol (by aromatization)-both, which increases and diversifies its biologic effects. Muscle size and strength are increased from the testosterone effect, fat mass is reduced through the estrogen effect, and both E and T are needed to maximize sexual function, i.e. obtaining and maintaining an erection and helping to facilitate ejaculation during orgasm.
 
Weight reduction through diet (such as the HCG diet) and exercise may elevate your natural T into the normal level. Replacing DHEA, an over the counter supplement, may be enough to counteract the symptoms of low T.
 
Our experience with the creams, gels, patches, and Axiron has revealed that usually these treatment options, in addition to being a daily hassle, do not get the T levels into the upper range of normal for a young man.
 
Thus, at Men’s Specialty Health Center, our approach is to use natural hormone/bio-identical testosterone therapy in the form of Testosterone pellets and Testosterone injections. Most men who want to be treated for Low testosterone can be. We will perform a simple blood test to ensure you are healthy candidate for therapy.
 
  • Testosterone Pellets
Depending on your symptoms and your serum testosterone blood level, you may be advised to consider subcutaneous insertion of Testosterone pellets-usually, just above your hip bone or in your abdomen. A local anesthetic is given to you, in the office, with varying number of the Testosterone pellets placed. Usually, you’ll start feeling better within 2 weeks, with the peak effect felt in about 6 weeks. Prior to each insertion, your Testosterone level is evaluated to determine the next dose of Testosterone to be inserted. Most men schedule their reinsertions, alternating sides (R to L) about every 2-3 months. It is most convenient for men who live out-of-town and for those who have a very busy life, which precludes scheduling weekly office visits, which are required for T injections.
 
  • Pricing for Testosterone Pellets
New patient appointment $150 (one-time fee)
 
History and Physical-
 
Pellet Insertion fee $150
 
100/mg Testosterone pellet $50/each pellet
 
(On average, 1-10 pellets can be placed depending on the blood results and last up to 3 months. Each patient will require a different number of pellets depending on their individual blood work results.)
 
  • Patches
Two brands of patches are currently available: Testoderm, which is applied to the scrotum, and Androderm, which is applied to other areas of the skin. The time for the peak effect of Testoderm is 3-5 hours, and for Androderm is 6-10 hours. Obviously, there are daily variations in testosterone levels when using the patch.
 
The patches may help you achieve testosterone levels in the low normal range, but you may still be symptomatic. About 2/3rds of patch users develop contact dermatitis sometime during their treatment regimen.
 
Obviously, the scrotal patches would be most inconvenient; it’s a hassle to shave your scrotum, and also reapply the patch after showering using a hair dryer. Those men using the patches are constantly aware of their presence, and often try to hide their use from others, such as in the men’s locker room and during intimacy.
 
I don’t prescribe the testosterone patches since I feel their use is impractical and usually won’t help my patients achieve their goal of feeling normal again with an adequate testosterone level.
 
  • Gels
Transdermal testosterone gel can be administered by applying it directly to the skin. Two pharmaceutical brands are available-Testim and Androgel-and several pharmacies are able to compound a prescribed strength of testosterone for individual patients. Gels are generally better absorbed than creams and need to be applied daily. The levels vary widely during the day based on the rapidity of absorption by the individual patient, and the prescribed dose.
 
A major risk of testosterone gel is the accidental transfer to children (causing premature puberty) and sexual partners (unwanted hair growth), particularly during the first 4 hours after application. To avoid this, some physicians prescribing the testosterone gel may recommend covering the area with a T-shirt. Another drawback of the gel is that the skin has an enzyme, aromatase, which converts more of the testosterone gel to estrogen. Gynecomastia (male breast enlargement) may result due to excess estrogen.
 
Although using a high enough concentration of the testosterone gel may help you achieve your desired level, I haven’t recommended it to my patients.
 
  • Axiron
Eli Lilly has won FDA approval to market their testosterone gel, which is applied daily in the armpit. The men I’ve seen who have been using Axiron at the recommended standard daily dose, have had low normal testosterone levels and have still remained symptomatic. It may be helpful for some, but as a rule, the patients I have seen neede a higher testosterone level than what the Axiron could deliver.
 
  • DHEA
Dehydroepiandrosterone, a precursor of testosterone, estrogen and progesterone is commercially available as an oral unregulated health supplement. Using the standard replacement dose in older men (50mg-100mg), DHEA does NOT significantly increase the serum testosterone level high enough to relieve symptoms of low testosterone. I’ve found it has not been useful to use DHEA as a testosterone replacement in my male patient population.
 
  • Weight Loss
As men age, often due to a gradual decline in Growth Hormone, fat is steadily deposited around the waist (and also inside the abdomen into the omentum). Men may develop the metabolic syndrome, which includes hypertension, arteriosclerosis, and diabetes. Often the excess adipose tissue converts more of the base steroids into estrogen, which continues to rise as the testosterone level continues to decline. Losing weight will help get these levels back into balance. However, by replacing testosterone, central obesity often declines and muscle mass increases, which helps counteract the conditions leading to the metabolic syndrome. I do recommend diet and exercise for men taking testosterone supplementation. Trainers have remarked that their clients on T replacement look forward to their workouts since they get better and faster results!
 
  • Insurance coverage
Testosterone therapy for men with Low T is covered by most insurance companies and approved by the FDA. If you have individual questions concerning your coverage please contact your carrier or our business office to assist you in determining coverage for your procedure.
 
  • Payment Requirements
Our office accepts all major credit cards and personal checks, payment will be required at the time of service. The business office will bill your insurance, on average you will receive reimbursement within 30-60 days.
 
David McLaughlin, MD