Testosterone Therapy
Natick, MA
Low testosterone has become a controversial topic, and misinformation about low testosterone and testosterone treatment abounds. However, expert and affordable care for men who have low testosterone is within reach at Metrowest Urology. Low testosterone has become a controversial topic in recent years, sometimes leaving patients without a clear understanding of their condition and treatment options.
At Metrowest Urology, our physicians are nationally recognized experts in the field. We aim to help patients understand how testosterone influences their health and life goals and provide safe, effective, and affordable testosterone replacement therapy (TRT) treatment.
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Our Experts
Our physicians have had a front-row seat as testosterone has become a controversial topic in recent years. Our research has influenced FDA opinion and national guidelines on treatment of low testosterone and we have been key players in the development of novel TRT treatment approaches. We use the insight gained from these experiences to help our patients clearly understand their individual conditions and the optimal treatment options for them.
Dr. Kacker is a leading researcher on the influence of testosterone and metabolism and made a key finding of a statistical error in a widely reported study which, incorrectly, implied that testosterone can increase the risk of heart attack and stroke. Dr. Kacker is involved in the development of new therapies to treat low testosterone and is the inventor and driving force behind AndroSphere, a new approach currently being developed with a team of international pharmaceutical companies.
UNDERSTANDING LOW TESTOSTERONE
Testosterone is the main hormone produced by the testicles. Testosterone plays an important role in the regulation of Mood, Metabolism, and Sexual Function. Men with low testosterone may suffer from symptoms or health issues in one or more of these areas:
MOOD
Symptoms Related to Low Testosterone
- Lack of motivation or drive
- Depression
- Labile Mood/Short-Fuse
- Irritability
- Sleep apnea
- Anxiety
- Reduced self-confidence
METABOLISM
Symptoms Related to Low Testosterone
- Low bone density (osteopenia or osteoporosis)
- Insulin Resistance and Propensity for Diabetes
- Weight Gain/Difficulty losing weight with diet and exercise
- Loss of muscle mass or strength
- Low Energy/Loss of Endurance
SEXUAL FUNCTION
Symptoms Related to Low Testosterone
- Erectile Dysfunction (particularly morning erections)
- Difficulty reaching Orgasm/Climax
- Decreased Ejaculate Volume
- Decreased Penile Sensitivity
PHYSICAL
Symptoms Related to Low Testosterone
- Increase in body fat
- Swollen or tender breast tissue
- Loss of body hair
- Reduce beard growth
Some men with mildly low testosterone may have very few of these symptoms. However, other men with more severe low testosterone may have several symptoms in multiple domains.
HOW IS LOW TESTOSTERONE DIAGNOSED?
Low testosterone is often diagnosed on the basis of low testosterone levels on blood tests (biochemical low testosterone). While many insurance policies and other guidelines use strict blood tests to define low testosterone, the true condition is far more complex. The amount of testosterone that one man needs may be very different from another man, due to differences in the ability of the body to access and use testosterone. Some men who may have low blood tests do not actually have any signs or symptoms of low testosterone and may not need to be treated. Conversely, some men may have testosterone levels in the normal range but actually be functionally lacking in testosterone and benefit from TRT treatment.
TRT BENEFITS FOR MEN:
TRT therapy is a safe, convenient, and effective treatment that provides a steady dose of natural hormones on a consistent basis. One of the main benefits is that it can help tackle hormonal imbalances that cause weight gain, low energy and libido, brain fog, and poor sleep and greatly enhance your quality of life.
Short Term Benefits of TRT:
- Increased vitality
- Increased energy levels
- Increased libido/ sex drive
- Improved erectile quality
- Improved cognitive function
- Better appetite regulation
- Better quality sleep
Long Term Benefits of TRT:
- Prevents hair loss
- Aids in weight loss and weight management
- Improved mood (reduce depression, anxiety, irritableness)
- Improved memory and concentration
- Restored muscle mass + bone density
- Improved cholesterol levels
- Enhanced strength
- Improved blood sugar regulation
- Reduced risk of heart disease
WHY MEN DEVELOP LOW TESTOSTERONE
While testosterone is produced by the testicles, only roughly 10-20% of low testosterone occurs due to failure or loss of the testicles. The majority (80-90%) of testosterone has to do with the pituitary gland. Normally, the pituitary gland controls the production of testosterone by sending signals every hour or two to the testicle to tell it to produce testosterone. Lack of pituitary signaling (sometimes called secondary hypogonadism) is the most common cause of low testosterone.
Testosterone levels, on average, do decrease with age, low testosterone is not an inevitable part of aging. In fact, as many men age the pituitary gland can increase its stimulus to the testicle and compensate for slowing the function of the gland. Low testosterone due to insufficient signals from the pituitary can occur in men of any age due to drugs/medications, sleep disturbance, being overweight, having diabetes, high blood pressure, as well as damage to the testicles.
HOW IS LOW TESTOSTERONE TREATED?
Several companies and clinics take advantage of the controversies around and offer expensive, and often unnecessary, treatment protocols and supplements. Fortunately, there are several affordable or insurance-covered options.
The most common treatment for low testosterone is to administer more testosterone. This can come in the form of a gel, injection, intranasal gel, or implantable pellet. Testosterone is not currently available in a safe oral pill or tablet. The optimal type of testosterone treatment is an individual decision, based on levels and goals of treatment.
Testosterone may also be treated by stimulating the testicles to produce more testosterone. The most effective way to achieve this is to treat with hCG (human chorionic gonadotropin). hCG has the advantage of maintaining fertility and testicular activity but can involve several injections per week. Clomiphene citrate is a more convenient oral treatment that can also increase testicular testosterone production. Clomiphene citrate, however, modulates estrogen and can have highly variable effects. In general, it is not as effective at improving symptoms and health effects of low testosterone compared to testosterone itself or hCG.
TRT TOPICAL GEL
Testosterone gel is a simple and convenient form of TRT. You apply the gel topically to the skin once a day allowing it to absorb directly into the bloodstream.
PROS
This method provides a dependable absorption rate and is ideal for individuals looking for a non-invasive and pain-free method. Additionally, modifying the dose is also easy. Your doctor can prescribe different strengths, and you can adjust the amount used based on your individual needs.
CONS
Topical gel carries a risk of transferring to others ,so you will need to avoid skin-to-skin contact at the application site. Additionally, some individuals may experience irritation or allergic reactions at the application site.
TRT INTRANASAL GEL
Intranasal gel is another low maintenance form of T therapy that is convenient and needle-free. You apply the fast-absorbing spray inside your nose three times a day.
PROS
Similar to topical gel, intranasal gel provides a steady absorption rate, leading to better testosterone levels. Additionally, some research suggests that intranasal gel may not hinder sperm production, unlike other forms of TRT. This makes it a viable option for men concerned about their fertility.
CONS
Since the gel is absorbed into the bloodstream through the nasal mucosa, some individuals may experience a bad taste in their mouth. Additionally, individuals may also encounter nasal discomfort such as runny nose, sneezing, congestion, sneezing, nosebleeds, and nasal dryness while using this medicine. There is also a risk of transferring the gel to others through nasal secretions.
TRT INJECTION
Injections are a popular form of T replacement therapy that can quickly and effectively boost testosterone levels. They are generally administered in the buttocks, thigh, shoulder, or abdomen every one to two weeks.
PROS
Injections are often the preferred method of TRT due to their effectiveness. Injections provide a speedy boost of testosterone, with levels peaking a few days after injection. Another advantage with this method is that it delivers a precise dosage of hormones into the body and can be prescribed at different strengths depending on your individual needs.
CONS
TRT injections require monthly, biweekly, or even weekly recurring treatments, which may make this form of T therapy less than ideal for someone with a busy schedule. Additionally, some individuals may experience discomfort at the injection site, making frequent injections bothersome for someone who has a difficult time with needles. There can also be fluctuations in testosterone levels between injections, leading to a rollercoaster-like effect.
TRT PELLET IMPLANT
Hormone pellets release a steady dose of testosterone for 3-6 months. This method provides a stable, long-lasting dose of hormones in the body that can better stabilize mood and energy levels. Pellets are inserted in a non-surgical procedure and dissolve over time.
PROS
Unlike other TRT methods which can fluctuate in delivery, pellets provide consistent hormone delivery as they slowly dissolve over time. Additionally, pellets are a preferred method due to their convenience and ease of use. Hormone pellets can last up to 6 months and only require additional insertion procedures 2-4 times a year.
CONS
After pellet insertion, minor swelling, bruising, or redness can occur at the treatment site. Additionally, you will need to avoid vigorous exercise or activity for a few days to prevent the pellets from shifting or expelling. You will also need to avoid submerging the treatment site in water. Pellets cannot be removed, which may not be ideal if you need to adjust the dosage. You will need to wait until your dosage dissolves, or for your doctor to administer additional pellets.
IS TESTOSTERONE THERAPY SAFE?
Like all medical treatments, testosterone replacement therapy has both risks and benefits. A judicious treatment plan involves minimizing and monitoring risk while optimizing benefits.
All formulations of testosterone lead to infertility and testicular atrophy. Some men may also experience acne/oily skin, breast symptoms, acceleration of male pattern baldness, and an increase in red blood cell count. Certain forms of testosterone therapy can lead to fluid retention, which is often temporary.
Historically, there have been concerns around testosterone and prostate health, although our current understanding shows that testosterone does not seem to increase the risk of prostate problems or prostate cancer. More recently, concerns have been raised that testosterone may increase the risk of heart attack and stroke. However, the vast majority of research on testosterone shows that it is safe and may even be beneficial in avoiding cardiovascular disease. Our physicians at Metrowest Urology can help discuss these controversial issues in detail and in the context of your individual health.
HOW MUCH DOES TRT COST?
Dr. Kacker customizes your testosterone replacement to meet your specific needs. Therefore, the cost of this hormone therapy will vary per person. During your consultation at Metrowest Medical Wellness, we will break down the cost of treatment in detail. We will also discuss available financing options.
AT WHAT AGE SHOULD YOU START TESTOSTERONE REPLACEMENT?
Most men who seek TRT are over 40 years old, however, men of all ages can begin testosterone replacement. Typically, symptoms of low T can start as early as 30 years old. Patients who begin treatment before hormonal imbalances become severe can enhance their quality of life and reduce negative symptoms. You can speak with Dr. Kacker during your consultation to discuss any questions or concerns you may have and determine if TRT is right for your body and your age.
WHAT OUR PATIENTS SAY
Testimonials
Amazing service. Temperature checking during covid at all points of reception. Great navigation to your specific facility within the building. The assistant to the doctor also made sure the doctor is available for examination on time. Ample of parking available. I would recommend anyone looking for Healthcare appointment here.
I ask my primary care doctor to see the Michael Jordan of urology in Massachusetts so he sent me to Metrowest Urology.
I highly recommend Metrowest Urology. My primary doctor referred me to them several years ago. They are very caring, and professional. I mostly have been seeing Stephanie Pena. She is the best.
The best enthusiastic effective I was given regimen of support hose, ibuprofen cialis limiting my nighttime intake of fluids. Last night I got up, only once to pee rather than three or four has made a significant impact on my sleep, and my psyche, I would recommend them to anyone.
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