Testosterone Therapy

Testosterone Therapy: Transdermal, Injection, or Pellet (Testopel) Therapy

There are many symptoms associated with hypogonadism, or a reduced testosterone level. These include low energy, poor concentration, increased weight, decreased muscle mass, low bone density, depression, low libido (sex drive), erectile dysfunction, and low sperm count. Testosterone therapy, when used in hypogonadal men, can be a safe and effective way to treat these symptoms.1,2

Testosterone should not be used if you are trying to get pregnant - infertility in the male is a side effect of testosterone, and there are other medications that you should use to raise your testosterone levels if you are trying to get pregnant. Individualized, long-term testosterone therapy has been shown to improve bone density, stabilize mood, normalize body fat and body muscle, increase energy, and increase libido.3

Many men see significant improvement in symptoms with testosterone therapy. It is important, however, that you use your testosterone medication only as directed. This includes needle safety for injection therapy as well as limiting exposure of loved ones to testosterone gel. It is also important for you to participate in laboratory and office follow-up; your response to testosterone therapy will be monitored closely. We look forward to evaluating your symptom improvement at your next follow-up appointment.

As with any new medication, you may notice side effects from your testosterone therapy. This may include, but are not limited to, the following:

  • Pain at the injection site, if on injection therapy
  • Increased energy
  • Increased libido (sex drive)
  • Acne
  • Increased aggression
  • Increased hematocrit, or red blood cell count
  • Increased prostate size

Long-term testosterone replacement therapy can also limit the amount of testosterone made within your body. This has consequences on fertility, as lack of testosterone within the testes can cause a significant decrease in sperm production. Please contact us if you have further concerns regarding fertility.

Should you have questions or concerns about your new medication, or if you develop significant side effects, please contact our office at As discussed above, laboratory and clinic follow-up is an important part of your treatment course to monitor both treatment response and risk of developing side effects. We look forward to seeing you at your next follow-up appointment.

  1. Bhasin S, Cunningham G, Matsumoto A, Snyder P, Swerdloff R, Montori V. Testosterone therapy in adult men with androgen deficiency syndromes: An endocrine society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism. 2006; 91(6):1995-2010.
  2. De Ronde W. Testosterone gel for the treatment of male hypogonadism. Expert Opinion on Biologic Theory. 2009 Feb;9(2):249-253.
  3. Laksham K, Basaria S. Safety and efficacy of testosterone gel in the treatment of male hypogonadism. Clinical Interventions in Aging. 2009; 4:397-412.

Arimidex

What do you need to know about Anastrozole (Arimidex)?

Arimidexis a medication that alters hormone levels within your bloodstream. Specifically, it reduces the production of estrogens by preventing the conversion of testosterone into a particular estrogen, estradiol. By doing so, testosterone levels rise and estradiol levels are lowered.

  • To evaluate the effectiveness of Arimidex, your testosterone level, estradiol level, and the ratio of testosterone to estradiol will be monitored throughout your course of therapy.

    Arimidex, by raising testosterone levels, has been found to reduce the symptoms of male hypoandrogenism such as low energy, reduced muscle mass, low libido (sex drive), and erectile dysfunction.

  • It has also been found to improve sperm production and sperm recovery rates in oligospermic and azospermic men.3 Though research shows promising results, the use of Arimidex in males remains an off-label use of this medication.

As with any new medication, you may notice side effects while taking Arimidex. Side effects may include:

  • Nausea
  • Insomnia
  • Bone Pain
  • Cough
  • Increased red blood cell count
  • Increased liver enzymes

Rare, but serious side effects that have been reported include:

  • Blood Clots
  • Cataracts
  • Stevens-Johnson Syndrome, a serious rash caused by a drug intolerance

Clomid

What do you need to know about?

Clomid is a medication that will work to elevate certain hormones released by the pituitary gland in the brain. These hormones, in turn, will stimulate both the production of testosterone and the production of sperm, or spermatogenesis, within the testis. It is anticipated that these actions will help reduce the symptoms of hypoandrogenism and/or, by increasing sperm count, may help to improve non-obstructive azoospermia. Large-scale studies have found sustained increases in testosterone, increases in strength, reduction of fatigue, and improvement of erectile function among men taking Clomid for hypoandrogenic symptoms.1,2Studies have also found that the use of Clomid is correlated with a return of sperm to the ejaculate in up to 10% of azoospermic men who remained on the medication for 3 months.3While research shows promising results, the use of Clomid in males remains an off-label use of this medication.

As with any new medication, you may notice side effects while taking Clomid. Some of these symptoms are consequences of increased circulating testosterone while other symptoms may indicate more serious side effects.

Side effects may include:

  • Changes in libido (sex drive)
  • Changes in mood
  • Changes in energy level
  • Increased aggression
  • Male-patterned baldness
  • Blurred Vision
  • Headaches
  • Increase in hemoglobin (a blood protein that transports oxygen and adds viscosity, or thickness, to your blood)
  • Enlargement of the prostate gland

Please notify our offices if you are experiencing side effects that are limiting your quality of life. We may be able to change your Clomid dosing (titration) or alter other medications to limit these side effects. The laboratory values we ask to monitor throughout your treatment will be used to screen for some of these possible side effects and help us prevent them from becoming serious issues.

  1. Kim E, Crosnoe L, Bar-Chama N, Khera M, Lipshultz L. The treatment of hypogonadism in men of reproductive age. Fertility and Sterility. 2012 Mar;99(3):678-79.

HCG

Human Chorionic Gonadotropin (hCG) Hormone Therapy

Human Chorionic Gonadotropin (hCG) is a hormonal treatment that can be used to increase testosterone levels in men. It is a treatment option for men who are suffering from symptoms of low testosterone, or hypogonadism. hCG stimulates the body’s own production of testosterone which is in contrast to direct testosterone replacement like testosterone injections and testosterone creams. Preserving the body’s production of testosterone is particularly important for testicular function and fertility, as intratesticular testosterone is required to maintain testis size and sperm production. Research has found hCG to increase energy, libido (sex drive), strength, and mood in hypogonadic men.1 This has been found in men who are hypogonadic for unknown causes as well as in men who have reduced testosterone production due to long-term exogenous testosterone supplementation. hCG can also be helpful in the infertile man. By increasing intratesticular testosterone, hCG has been found to increase the likelihood of sperm retrieval in men with non-obstructiveazospermia, or lack of sperm in the ejaculate.2 Goals for hCG therapy are highly individualized. Your treatment goals and dosing regimen were discussed during your office visit. Please contact your provider if you have additional questions or concerns about your new medication.

As with any medication, you may experience side effects with hCG therapy. Some of these are a result of increased testosterone levels while other symptoms may indicate more serious side effects. Side effects may include:

  • Pain at the injection site
  • Changes in libido (sex drive)
  • Changes in mood
  • Changes in energy level
  • Weight gain
  • Increased hematocrit (red blood cell concentration) and risk for blood clot
  • Prostatic enlargement

Please contact our offices at if you are experiencing significant side effects. We may be able to alter the dose of this and/or other medications to limit these side effects. Additionally, please refer to your instructions for laboratory and office follow-up. Adherence to this follow-up schedule will help to identify and limit significant side effects. With further questions or concerns, you may contact your provider through the above number or through the MyChart communication system.

  1. Kim E, Crosnoe L, Bar-Charma N, Khera M, Lipshultz L. The treatment of hypogonadism in men of reproductive age. Fertility and Sterility. 2013 Mar;99(3):718-24.

Shinjo E, Shiraishi K, Matsuyama H. The effect of human chorionic gonadotropin-based hormonal therapy on intratesticular testosterone levels and spermatogonial DNA synthesis in men with non-obstructive azospermia. Andrology. 2013 Aug;1(6):929-35.

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