What is male HRT? Dr.Crews breaks it down

Overview

Testosterone deficiency (TD), also known as hypogonadism, is a common men’s health issue that can stem from testicular failure, brain-related causes, medications, stress, or obesity. Symptoms may include reduced sex drive, erectile difficulties, low energy, mood changes, loss of muscle mass, and infertility. Diagnosis usually involves blood tests, and management may include testosterone replacement therapy (TRT), though strict federal guidelines apply due to risks and potential misuse.

Note: The content of this blog is for informational purposes only and does not replace professional medical diagnosis, advice, or treatment.

What are the causes

Testosterone deficiency (TD) is referred to medically as “hypogonadism” and has several potential causes.

• Testicular failure, causing insufficient testosterone production (this can be due to genetic conditions, injuries to the testicles & failure of the testicles to descend into the scrotum during puberty),
• An issue with the brain’s transmission of commands to the testicles, causing insufficient testosterone production (this can be due to genetic conditions, brain tumours, injuries to the brain & certain inflammatory diseases)
• “Functional” TD usually is reversible once the underlying cause is dealt with (for example, TD can be due to certain medications, stress, obesity & poorly controlled chronic health conditions),
• A combined problem with the brain and testicles (a rare cause of TD),
• The term “male menopause” or “andropause” has become more widely known over recent years. This is unhelpful terminology relating to TD in older adults (late onset hypogonadism - “LOH”). It suggests that there is a sudden loss of testosterone in older life (similar to the process of menopause in females), which actually does not occur in men. Testosterone decline is usually steady, starting from age 30. Initially, this gradual loss will usually cause no symptoms, but it may start causing symptoms once testosterone levels drop below a certain threshold. Current medical research cannot provide a precise percentage of men who have LOH, but some research suggests up to 40% of men over 40 may have this condition, but not all men have symptoms (without symptoms, this is called subclinical LOH).

Note: This information is for educational purposes only. You should consult a GP before attempting lifestyle modifications or home remedies to ensure they are safe for your specific condition.

What are the symptoms

There are many symptoms of TD, many of which may also be features of other illnesses & diseases. TD symptoms may include;

• A large belly +/or the development of “man boobs”
• Reduced frequency of sexual thoughts / desire to have sex
• Reduced frequency of morning erections
• Difficulty in getting or maintaining an erection firm enough to engage with sex
• Small testicles
• Difficulty conceiving a child (ie - reduced fertility)
• Mood swings or irritability
• Lack of enthusiasm or depressed mood
• Loss of muscle mass or reduced ability to exercise
• Poor concentration or short term memory
• Low energy levels
• Reduced body hair.

When to see a GP for TD?

Current medical guidance suggests seeing a doctor (usually your GP) if you consistently have more 1 or more of the aforementioned symptoms, as screening for TD (along with other health conditions) may be considered, this will usually involve blood tests.

What is Hormone Replacement Therapy?

Replacing the deficient hormone with prescribed medication (Hormone replacement therapy - “HRT”) may be a consideration, but as male hormonal health is a complex area of medicine, this often requires a large amount of medical knowledge. Some GPs do not have experience in this field and may need to refer you on to a endocrinologist or urologist to help further. There are strict federal guidelines on who can receive subsidy for the cost of TRT under the pharmaceutical benefit scheme (PBS). This is due to the potential for misuse - administering certain hormones (usually in very high doses) has been widely publicised within elite sports to aid building & maintaining muscle tissue which in turn can lead to improved power & endurance.

Performance-enhancing substances are not medications, but are manufactured products that, once taken, will mimic natural hormones in the body in the body (again, usually in very high doses). Utilising testosterone or performance-enhancing substances are classed as “doping” in the realms of professional sports and are prohibited under the World anti-doping code. The code may provide some strictly controlled exceptions for using TRT for athletes with legitimate medical reasons.

Despite these strict federal guidelines, worldwide medical research does indicate that there may be a role for TRT for symptomatic men whose testosterone levels fall below a certain threshold. A decision whether TRT is required involves creating an individualised treatment plan between doctor & patient, which includes a thorough risks .vs. benefit assessment of starting TRT. As this therapy is usually a long-term strategy, the possible ongoing private charges for this medication (if it is prescribed outside of the strict federal guidelines) will also need to be taken into account.

Possible side effects of TRT include

• Increased risk of blood clots and cardiovascular issues
• Stimulation of prostate gland to grow (which can worsen some existing prostate problems)
• Reduction of sperm production (which may lead to infertility)
• Breast swelling / tenderness
• Acne

Note: If you experience sudden chest pain, shortness of breath, or signs of a blood clot (such as swelling or pain in a single leg), call 000 immediately or visit the nearest Emergency Department.

How can telehealth help

Despite the complexities surrounding this area of men’s health, telehealth doctors would be able to have a preliminary discussion with a patient to address initial questions or queries. However, signposting to other clinicians for further support will likely be necessary as a physical assessment is necessary in the early stages to check vital signs (such as blood pressure & pulse), as well as considering the need for a genitalia +/or breast examination.

Note: To ensure continuity of care, a summary of your telehealth consultation can be shared with your regular General Practitioner to assist in your ongoing management and physical examinations.