Low Testosterone Therapy in Los Angeles & San Francisco

Treating low testosterone and balancing your hormone levels can be life changing. It can help you feel youthful and energetic and improve your libido, muscle mass, cognition, and more.

As a leading male sexual health specialist, Dr. Turek is a top choice for testosterone replacement therapy (TRT) for men in San Francisco and Los Angeles. His expertise and innovative thinking allows him to offer many safe options to patients to best address their goals and preferences. That’s part of why Dr. Turek has been named one of the “Best Doctors in America” for 15 years running.

Testosterone replacement therapy requires ongoing monitoring, which Dr. Turek’s team will personally manage.

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Symptoms of Low Testosterone

The symptoms of low testosterone can include any of the following:

• Decreased or low libido
• Difficulty getting or keeping an erection
• Changes in mood
• Fatigue
• Depression
• Anger
• Decreased in memory or other cognitive functions
• Reduced muscle strength
• Increased abdominal girth
• Hair thinning or balding
• Increased facial wrinkling
• Pale skin
• Smaller or softer testicles
• Low bone mineral density

The symptoms tend to develop gradually and can differ in severity. Some men only experience one or two symptoms. What is puzzling about the symptoms of low testosterone is that they are often attributed to the inevitable consequences of the aging process. For this reason, Dr. Turek will thoroughly examine other medical conditions that can also lead to low testosterone levels before engaging in treatment. In doing so, he can  often “cure” testosterone imbalance, which means that men can avoid testosterone supplementation.

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Diagnosing Low Testosterone

To diagnose low testosterone, Dr. Turek will take a complete history of your symptoms, both physical and psychological. He will order bloodwork to look at various forms of testosterone and pituitary hormones as well as general hormonal and metabolic issues and evaluate the results in the context of your symptoms.

Although there is some disagreement as to what constitutes “normal” and “low” testosterone levels, below 300 ng/dL is considered low by national guidelines. However, testosterone levels above 300 ng/dL can be low in men who previously showed much higher levels. Blood tests are typically repeated to confirm initial findings. Other tests, such as a DEXA bone density scan, may be ordered at Dr. Turek’s discretion.

Dr. Turek likes to distinguish between two types of low testosterone:

• Primary hypogonadism, which occurs when a testicle fails to produce enough testosterone (due to disease, age, or testicle loss) for a healthy quality of life;
• Secondary hypogonadism, which occurs when the testicles can produce testosterone but are not receiving the proper hormone signals from the brain to maintain normal production. This is referred to as a “lazy pituitary” state.

Both types of hypogonadism can be treated with testosterone replacement. However, Dr. Turek has found that, for secondary hypogonadism, naturally improving the stimulation to the testicle with pills can restore or augment normal testosterone levels very effectively and avoids testosterone replacement.

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Low Testosterone Treatment Options

Dr. Turek’s goal is to normalize testosterone levels without causing significant side effects. Testosterone replacement can be administered in several ways:

• Topical gels: This most popular option involves rubbing a topical solution on clean, dry skin. It is easy to apply and must be done daily. Brand names include AndroGel, Testim, and “Tureksterone” (the latter being Dr. Turek’s own deodorant formulation that is applied to the underarms instead of deodorant).
• Oral capsules: Testosterone in pill form has been available in Europe for a long time, but only recently received FDA approval. Although this form of therapy is the easiest and has minimal side effects, it can be quite expensive since it is not often covered by insurance. Brand names include Jatenzo, Tlando, and Kyzatrex — to date, no generic form has been released.
• Short acting, self-injectables: Self-administered weekly or biweekly injections are another popular form of testosterone replacement. This is the least expensive testosterone option; it involves injecting testosterone into the muscle or abdominal fat. It can be obtained as testosterone cypionate, testosterone enanthate, or Xyosted.
• Long-acting injection: This form of therapy is administered by a medical professional, but only needs to be done once every 10 weeks. It is available as Aveeed (testosterone undecanoate).
• Subcutaneous pellets: Tiny, slow-release pellets are implanted under the skin, slowly releasing testosterone into the body over several months. They typically need to be placed at 4-6 month intervals by a medical provider. These pellets are sold as Testopel and other generic forms.
• Intranasal spray: This testosterone gel is sprayed into the nose multiple times per day. Although it is a good option for preserving sperm production, it is not appropriate for patients with sinus conditions. It is available under the brand name Natesto.

Recently, “bioidentical” testosterone has become a popular option in testosterone replacement therapy, but there is no significant difference between any of thedrug forms of testosterone and the molecular copy of the real hormone, including safety standards. In Dr. Turek’s opinion, “bioidentical” is essentially a marketing buzzword not recognized by the FDA.

In cases of low testosterone due to poor stimulation of the testicle (i.e. secondary hypogonadism), Dr. Turek uses a class of drugs called selective estrogen receptor modulators (SERMs) to stimulate the testicle to make normal testosterone levels. These testosterone “boosters” include oral options like clomiphene citrate (the most popular option), enclomiphene, and tamoxifen (Nolvadex) or injectable options like human chorionic gonadotropin. While these options are not currently approved by the FDA for this purpose, they have been found to be very effective at normalizing testosterone levels without disrupting sperm production or reducing testicle size.

Dr. Turek will review the pros and cons of each approach with you and help you select the option that best suits your needs. He will monitor you regularly (more frequently during the first few months of treatment) to assess the effectiveness of the treatment and adjust the dose as needed.

Testosterone Treatment Safety

Side effects of TRT can include water retention, reduced sperm production and infertility, worsening of existing sleep apnea, testis atrophy or shrinkage, breast tenderness, liver toxicity, and possible worsening of detected or undetected prostate cancer. Dr. Turek regularly monitors his patients during their first year of TRT to ensure that his patients remain in good health with minimal side effects. He also measures testosterone levels to determine if dosages should be adjusted. If testosterone levels remain stable after a year, patients can be evaluated once per year.

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Testosterone and Fertility

If you are considering testosterone therapy, you should be informed of its effect on your fertility. Testosterone therapy leads to reduced sperm production. Within 10 weeks of starting therapy, 90 percent of patients have sperm counts of zero. It is normal to see sperm counts normalize 6 to 12 months after stopping testosterone therapy. Testosterone therapy in the setting of desired fertility is best approached using SERMs or hCG therapy instead of testosterone replacement therapy, and Dr. Turek has ample experience treating this condition. He is also an expert at helping men who have been taking anabolic or high doses of testosterone for sports, training, or bodybuilding purposes to get “back to normal” without experiencing dramatic falloffs in energy or quality of life.

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Learn More about Testosterone Therapy

If you are experiencing symptoms of low testosterone and would like to discuss them with a trusted men’s sexual and reproductive health expert, please schedule a consultation at The Turek Clinic. Contact us today to request an appointment.