Purpose of Treatment
Testosterone therapy is prescribed to help improve symptoms related to hormonal imbalance, such as including fatigue, low libido, weight gain, muscle loss, brain fog, and mood stability, poor concentration, depressed mood, weight gain, or reduced physical performance.
Expected Benefits:
Testosterone therapy may result in improvement of symptoms including increased energy and motivation, enhanced libido and sexual satisfaction, improved mood and cognitive clarity, improved lean muscle mass and fat loss, and better overall sense of well-being.
Testosterone may be prescribed in various forms, including injections, transdermal creams, pellets, or compounded lozenges.
Risks and Side Effects:
As with any hormone therapy, testosterone therapy carries potential risks and side effects, which may include: acne or oily skin, hair gowth (face/body), mood swings or irritability, deepening of voice, clitoral enlargement, menstrual changes or cessation, fluid retention or edema, elevated red blood cells (erythrocytosis), breast tenderness, sleep disturbances or sleep apnea.
In the past, testosterone products carried a black box warning about possible risks such as heart attack, stroke, blood clots, and death from heart disease. This warning has since been removed, and while these concerns are still mentioned in medical discussions, they are not considered proven risks.
Alternatives to Testosterone Therapy:
You may choose not to undergo testosterone therapy.
No Treatment: Choosing not to treat hormone deficiency may result in continued or worsening symptoms and increased risk for conditions associated with testosterone loss.
Lifestyle Modifications: Incorporating diet, weight management, exercise, or sleep aids to alleviate symptoms.
Non-Hormonal Medications: Certain traditional medications, such as antidepressants (SSRIs) for mood changes or low libido, and other drugs used to address aging-related symptoms, may also be used in place of hormone therapy.
Other Hormonal Options: Use of DHEA or other supplements.
Off-Label Use and Informed Consent:
The use of testosterone therapy in women is considered off-label by the FDA. Despite this, clinical studies and extensive practitioner experience support its safety and benefit in selected patients. This treatment is based on your symptoms, labs, and clinical judgment. You have the right to refuse or discontinue therapy at any time.
Treatment and Monitoring:
Treatment is customized and dosing may change depending on symptoms and labs. Goal serum free testosterone level is between 4–7 ng/dL. Labs will be monitored regularly, including CBC, CMP, SHBG, testosterone, and estradiol. Dose adjustments are based on symptom improvement or occurrence of side effects.
Infertility and Fertility Considerations:
Testosterone therapy may interfere with fertility and should not be initiated in patients who are planning pregnancy. The potential risks of miscarriage or teratogenic effects in the event of an unplanned pregnancy, or from inadvertent exposure to a pregnant or breastfeeding woman, must be carefully considered.
Topical Testosterone (Cream) and Transference Risk:
If using topical testosterone cream, there is a risk of unintentional transfer to others including men, children, pets, and pregnant women through direct skin contact.
Patients are instructed to:
- Wash hands thoroughly after application
- Cover the application area with clothing
- Avoid skin-to-skin contact with others for at least 4 hours
- Wash any contaminated clothing or bedding separately