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Low testosterone (T) is a medical condition that can lead to debilitating symptoms. They include depression, fatigue, loss of muscle, loss of body hair, lack of libido, and erectile dysfunction.
If you have any of these symptoms, you should visit a medical specialist for a proper diagnosis and therapy.
One of the most effective treatments for low T is TRT (testosterone replacement therapy). Testosterone is a prescription medication that is under strict regulation because of its abuse potential. Besides, the therapy requires control and monitoring by an experienced doctor to minimize the risk of side effects.
Obtaining testosterone products without a prescription is dangerous because such products are illegal and often counterfeit. There is no guarantee for their ingredients, effectiveness, or safety.
People often fall for their cheaper price but illegal TRT might come at a higher cost in the long-term due to the potential health risks.
Why Do Doctors Prescribe Testosterone?
Testosterone prescription is often the first choice of therapy when a patient has low T levels in the blood and symptoms related to that. But before a doctor can prescribe you testosterone, you have to undergo medical examination and tests.
According to the American Urological Association, low T is defined as total testosterone levels under 300 ng/dL measured in the morning. Your hormonal levels should be tested at least twice to confirm the findings.
If both tests reveal low T and you have at least one symptom then you will be diagnosed with hypogonadism and considered for TRT.
The typical low T symptoms may include:
- Depression and mood swings
- Lack of sexual desire
- Erectile dysfunction
- Low energy levels and chronic fatigue
- Anemia (low red blood cells)
- Loss of body and facial hair
- Muscle loss and reduced strength
- Insulin resistance
Even in the absence of symptoms, your doctor should measure your total T levels if you have unexplained anemia, osteoporosis, diabetes, HIV, infertility or if you have been exposed to radiation, chemotherapy or long-term corticosteroid therapy.
Other methods such as questionnaires are not valid strategies to diagnose or monitor patients with low T
Several medical conditions can lead to low T levels. Most of them are caused by damage to the testicles and an inability to produce testosterone. This group of conditions is called primary hypogonadism and includes:
- Genetic diseases (Klinefelter’s)
- Infections (Mumps)
- Testicular tumors
- Cryptorchidism
- Varicocele
- Radiation
- Trauma
- Andropause
There are cases of hypogonadism when the ability of the testes to produce testosterone is initially preserved but the hypothalamus and the pituitary gland no longer provide any stimulus.
This type of low T is defined as secondary hypogonadism and often leads to testicular atrophy. The possible causes are:
- Genetic diseases (Kallmann syndrome)
- Pituitary tumors
- Traumatic brain injury
- Brain surgery, infections, and radiation
- Drugs (opioids, glucocorticoids)
- Anabolic steroid abuse
As outlined by the international Endocrine Society, several health conditions might be worsened by TRT. Thus you should share all of your previous medical histories with your doctor.
Warn your doctor if you have contraindications such as elevated hematocrit, thrombophilia, obstructive sleep apnea, severe lower urinary tract symptoms, uncontrolled heart failure, myocardial infarction or stroke within the last 6 months.
Another contraindication against TRT is if you have a family history of prostate or breast cancer and you might be at an increased risk. Furthermore, make sure to notify your physician if you are planning fertility in the near future.
How to Get a Prescription For Testosterone Online
Testosterone prescription requires a medical exam, lab tests, and diagnosis by a doctor who specializes in TRT. There is also a possibility of a telehealth or telemedicine exam which must involve complete consultation with your doctor. Thus, in some states, you can receive a legal TRT prescription online.
However, most physicians will prefer an in-person visit initially, as it allows for a more thorough examination and a more accurate diagnosis. In-person visits also allow for better evaluation of possible contraindications as well as close monitoring of potential health risks.
According to the FDA, it is also legal to buy testosterone online, but you should be wary due to the large number of scams posing as online pharmacies. There are scam websites that sell regulated medications but do not require a legal TRT prescription or claim to offer prescriptions themselves. Here’s what you should know about buying testosterone injections online, approved by our doctors.
Purchasing such products might be unsafe and ineffective as there is no guarantee on what substance you might receive
These products are also cheaper but often contain diluted or expired ingredients and might be contaminated with germs or toxins.
The average cost of testosterone products ranges from $30 to $500 depending on the brand, form, and dosage. Additional costs can come from the doctor’s visit ($100 on average) and laboratory tests.
Depending on whether you are ordered total testosterone alone or in combination with free testosterone and other blood parameters, the cost of the laboratory test can range from $50 to $100.
Types of Testosterone Products Prescribed
TRT prescription can involve various products with different routes of administration, advantages, and disadvantages. Testosterone can be applied via injections, pills, gels, and implants (pellets).
Your doctor will determine which one is the best form of testosterone for you depending on your needs and contraindications.
Generally, injections are the preferred choice for patients who are new to TRT as it allows for precise control and easy adjustment of the dose.
Testosterone Injections
Testosterone injections are the most common form of TRT. They are intramuscular injections that can deliver the exact dose you need. Besides, it is much easier to make dose adjustments if you have side effects or other issues. Also, it’s the fastest way to increase your T levels and manage your symptoms. The three most popular types of injectable testosterone are:
- Testosterone Undecanoate – must be applied every 4-12 weeks
- Testosterone Cypionate – applied every 2-4 weeks
- Testosterone Enanthate – applied every 2-4 weeks
The main disadvantages of testosterone injections include the use of needles and the risk of allergic reactions.
Testosterone Nasal Gel
Testosterone nasal gel has to be applied to the inside of your nose via a spray. Then it can enter your blood flow through the nasal mucosa. The spray must be used three times a day (6-8 hours in between) by applying one pump in each nostril.
You must not blow your nose or sniff for at least an hour after application
Besides, the method is not suitable if you have a condition that causes sneezing, nasal congestion, or runny nose. This complicates long-term adherence to the method.
In addition, it’s less reliable to deliver the exact dosage of the testosterone you need into your system when compared to injections.
Testosterone Pills
Oral testosterone needs to be taken 2-3 times a day with food and usually contains testosterone undecanoate. While it is more convenient than using gels or injections, testosterone pills have significantly lower bioavailability (3-7%) when compared to other forms (90-95% for injections) because it passes through the liver first and gets metabolized there.
Testosterone Pellets
To be effective, testosterone pellets have to be inserted under the skin as implants. They are as small as a grain of rice so the insertion procedure requires just a tiny skin incision in the area of your hip. The procedure is quick and does not require a hospital stay or stitches.
Testosterone pellets are convenient because a single dose can last between 3-6 months and you do not have to use pills, gels, or injections daily.
However, it is much harder to adjust your dosage, so it is not a good option for patients new to TRT
Besides, there is a small risk for infection at the insertion site.
Life During and After the Treatment
According to the latest guidelines, if you are on TRT, your condition should be evaluated every 3 to 6 months during the first year of treatment and then annually.
During these follow-up consultations, your doctor will assess whether your symptoms have improved and if you are suffering from any adverse effects.
Symptoms rather than T levels are the main indicator for evaluating the success of TRT
Generally speaking, 3 to 6 months is a reasonable period for you to see improvement in sexual function, body composition, and mood.
Your physician will also monitor your T levels, as well as other laboratory parameters including hematocrit and prostate-specific antigen (PSA). These tests are necessary for the early detection and prevention of the most common adverse reactions such as prostate enlargement and erythrocytosis.
Apart from managing symptoms and avoiding side effects, the secondary goal is to achieve serum testosterone levels in the mid-normal range.
Testosterone is a controlled substance due to its abuse potential and you will need a new prescription every 6 months. Unlike regular prescriptions which last for 12 months, your prescription will expire after 6 months and you can have no more than 5 refills within this period according to federal regulations.
TRT does not cure hypogonadism but it will help you maintain normal testosterone levels and live without the burden of low T. If you stop TRT the symptoms of hypogonadism will likely return.
Nevertheless, if you have to wean off TRT, the process requires close medical supervision and a gradual approach due to the risk of side effects.
You can receive legal testosterone prescriptions from qualified specialists. Our endocrinologists will carefully assess your symptoms and prescribe you the optimal therapy for your diagnosis. Besides, we will monitor your condition closely to guarantee the safety and effectiveness of TRT.