Testosterone Specialist

Introduction – Testosterone (TRT) Specialist in Rockville, Montgomery County, Maryland

As a testosterone specialist in Rockville, Montgomery County, I am committed to delivering expert care to male patients with hypogonadism using a holistic and evidence-based approach. With a focus on improving the patients’ overall well-being, I offer individualized care to address the complex challenges associated with hypogonadism. My goal is to optimize the health and quality of life of our community members through personalized and integrative care.

Natural Role of Testosterone

Testosterone plays a central role in men’s health, influencing a variety of physiological functions. It is crucial for the development of male reproductive tissues, such as the testes and prostate. Beyond reproduction, testosterone contributes to muscle mass, bone density, and overall strength. Additionally, it has an impact on mood, energy levels, and cognitive functions.

Maintaining adequate testosterone levels not only supports a healthy libido but also contributes to cardiovascular health. With aging, there may be an exacerbated decline in testosterone, potentially leading to various health issues. Understanding and addressing testosterone levels is essential for preserving reproductive, mental, and physical well-being in men.

Testosterone Regulation

Balancing testosterone levels involves a complex interplay among the hypothalamus, pituitary gland, and testicles. The hypothalamus, located in the brain, detects the body’s need for testosterone and releases gonadotropin-releasing hormone (GnRH). GnRH signals the pituitary gland to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones then travel through the bloodstream to the testicles.

In response to LH, the testicular glands produce testosterone. This entire system operates through a negative feedback loop. When testosterone levels are sufficient, signals are sent to the hypothalamus and pituitary to reduce GnRH and LH production, thus maintaining hormonal balance. This intricate regulatory mechanism ensures the proper functioning of the male reproductive system and the maintenance of secondary sexual characteristics.

Definition and Prevalence of Hypogonadism

Hypogonadism, commonly known as low testosterone, is defined by the insufficient production of the primary male sex hormone—testosterone. In a laboratory setting, total testosterone values below 300 ng/dL, measured during fasting in the morning, indicate hypogonadism. However, the precise cutoff depends on factors such as the severity of symptoms, associated medical conditions, and patient’s normal testosterone values (if known) prior to seeking medical help.

Men typically undergo a natural 1-2% decline in testosterone levels each year after age 30. However, some men experience an exacerbated loss of testosterone over time, increasing the prevalence of hypogonadism with age. For example, according to some studies, around 40% of men over 45 may experience low testosterone levels.

Symptoms of Low Testosterone

Male hypogonadism can impact both physical and emotional well-being. Common symptoms include fatigue, diminished energy, and a decline in sexual desire and erectile function. There is a decrease in muscle mass, coupled with an increase in body fat. Emotional changes may manifest as mood swings and irritability. Reduced sperm production can result in infertility. Additionally, insufficient testosterone can affect secondary sexual characteristics, leading to a reduction in facial and body hair growth

Types of Male Hypogonadism

Primary hypogonadism

Primary hypogonadism, also known as testicular failure, occurs when the testicles are unable to produce sufficient testosterone. Causes include genetic conditions like Klinefelter syndrome, undescended testicles, testicular injury, radiation exposure, chemotherapy, and infections. 

In primary hypogonadism, the laboratory pattern often reveals elevated levels of gonadotropins, including LH and FSH as the body attempts to stimulate testosterone production. However, despite increased stimulation, total testosterone levels are typically low, reflecting the testicular dysfunction. Free testosterone levels, which represent the biologically active form of the hormone, may also be reduced. 

Diagnosis involves assessing blood hormonal levels (see below) and testicular imaging when necessary. This approach enables a testosterone specialist to determine the underlying cause and tailor appropriate treatment strategies.

Secondary hypogonadism

Secondary hypogonadism is characterized by dysfunction in the hypothalamus or pituitary gland, key components of the brain that regulate testosterone production. Causes include tumors, trauma, or other conditions affecting these brain structures, as well as certain medications and systemic illnesses.

In secondary hypogonadism, the laboratory pattern typically shows low or normal levels of LH and FSH. However, total and free testosterone levels are often decreased, reflecting the impaired stimulation of the testicles from the brain via LH and FSH.

Diagnosis and management involve a comprehensive assessment by a specialist in testosterone, including blood tests and pituitary imaging studies to identify underlying causes.

Complications of Low Testosterone 

Untreated male hypogonadism can lead to various complications affecting both physical and mental well-being. Some of the potential complications include:

  • Sexual Dysfunction: Hypogonadism can result in erectile dysfunction, reduced libido, and difficulties with sexual performance, affecting overall sexual health.
  • Infertility: the same process that causes low testosterone levels may contribute to impaired sperm production, leading to fertility issues.
  • Physical Changes: Loss of muscle mass, increased body fat, and reduced bone density may occur, potentially leading to conditions like osteoporosis.
  • Mood Changes: Hypogonadism can contribute to mood swings, irritability, and an increased risk of depression.
  • Fatigue: Low testosterone levels may cause fatigue, reduced energy levels, and a general sense of lethargy.
  • Cognitive Decline: Some studies suggest a potential link between low testosterone and cognitive decline, impacting memory and cognitive function.
  • Metabolic Effects: Hypogonadism is associated with insulin resistance and an increased risk of metabolic conditions such as type 2 diabetes.
  • Cardiovascular Health: There is evidence suggesting a connection between untreated hypogonadism and an increased risk of cardiovascular issues, including heart disease.
  • Loss of Body Hair and Gynecomastia: Hypogonadism can lead to the loss of body and facial hair and may contribute to the development of gynecomastia (enlarged breast tissue).
  • Decreased Quality of Life: The combination of physical and psychological symptoms can significantly impact the overall quality of life for individuals with untreated hypogonadism.

The Benefits of Improving Testosterone Levels

Increasing testosterone levels in male hypogonadism can be highly beneficial. As mentioned earlier, testosterone plays a central role in maintaining various aspects of male health, including sexual function, muscle mass, bone density, and overall well-being. Addressing low testosterone levels can lead to improvements in erectile function, libido, and fertility. Moreover, it contributes to the preservation of bone health and muscle strength, reducing the risk of conditions like osteoporosis. 

Beyond physical effects, optimizing testosterone levels can positively impact mood, cognitive function, and energy levels, enhancing the overall quality of life for individuals with hypogonadism. Interventions such as hormone replacement therapy are tailored to restore testosterone balance, improving symptoms, and reducing the risk of complications associated with untreated hypogonadism.

Laboratory Testing for Hypogonadism

The diagnosis of hypogonadism involves several laboratory tests to assess hormonal levels and rule out other underlying causes. The timing of these tests is crucial, typically performed in the morning during fasting when testosterone levels are highest. Below, I outline key laboratory tests ordered for male hypogonadism. It’s essential to interpret these tests in the context of the individual’s symptoms, medical history, and overall health.

  • Total Testosterone: Measures the overall amount of testosterone in the blood.
  • Free Testosterone: Assesses the portion of testosterone that is not bound to proteins and is freely available for use by the body.
  • Sex Hormone-Binding Globulin (SHBG): Examines the protein that binds to testosterone, affecting its availability for use.
  • Luteinizing Hormone (LH): Evaluates the pituitary gland’s stimulation of the testicles to produce testosterone.
  • Follicle-Stimulating Hormone (FSH): Another indicator of testicular function, often measured alongside LH.
  • Prolactin: Elevated levels can impact testosterone production, indicating potential anomalies with the pituitary gland.
  • Estrogen: Estrogen imbalance may contribute to hypogonadal and gynecomastia symptoms.
  • Prostate-Specific Antigen (PSA): Monitors prostate health, especially important for individuals considering testosterone replacement therapy (TRT).
  • Hematocrit: Evaluates red blood cell levels, as TRT can increase hematocrit, potentially leading to polycythemia.

Lifestyle Changes are Essential

Lifestyle changes play a vital role in managing male hypogonadism. Regular exercise, particularly resistance training, has been shown to boost testosterone levels. A balanced and nutritious diet that includes sufficient amounts of vitamin D and omega-3 fatty acids is important for hormonal health. 

Adequate sleep is also essential, as testosterone production predominantly occurs during deep sleep. Stress management through techniques like mindfulness and relaxation exercises can help minimize the impact of stress on testosterone fluctuations. 

Additionally, limiting alcohol consumption and avoiding excessive exposure to environmental toxins can contribute to improved hormonal balance including testosterone levels. Lifestyle modifications when combined with medical therapy can offer a holistic approach to improve symptoms and overall well-being in individuals with hypogonadism.

Medications for Male Hypogonadism

Managing male hypogonadism involves a variety of therapies tailored to address a patient’s symptoms, comorbidities, and testosterone deficiency . The choice of treatment depends on the specific diagnosis, underlying causes, and patient preferences. Complementary and lifestyle interventions further contribute to comprehensive care.

Testosterone Replacement Therapy (TRT):

  • Intramuscular Injections: Administered into the muscle, typically every week.
    • Aveed is an exception as it is injected every 10 weeks at a physician’s office.
  • Subcutaneous Injections: Administered under the skin, once weekly as well.
  • Topical Gels: Applied to the skin, providing a controlled release of testosterone.
  • Topical Patches: No longer available at the time of this writing.
  • Oral Testosterone: While less common, oral testosterone preparations exist. However, they are not widely used due to potential liver toxicity and variability in absorption.
  • Subcutaneous Pellets: Implanted under the skin, releasing testosterone gradually over several months.
  • Clomiphene Citrate: Clomiphene is an oral medication that stimulates the production of LH and FSH, promoting fertility and the natural production of testosterone. It is often used in cases of secondary (central or pituitary) hypogonadism.
  • Human Chorionic Gonadotropin (hCG): hCG injections are sometimes used to stimulate the testicles, enhancing fertility and promoting increased testosterone production.
  • Selective Estrogen Receptor Modulators (SERMs): Oral medications like tamoxifen are occasionally used to block estrogen’s effects, indirectly promoting testosterone production. This intervention can be particularly helpful in patients with gynecomastia.
  • Aromatase Inhibitors: Aromatase inhibitors, such as anastrozole, may be used to prevent the conversion of excess testosterone into estrogen. They can also be helpful in improving gynecomastia, in addition to diminishing the degradation of testosterone.
  • Supplements: Some over-the-counter options may be beneficial for balancing or enhancing testosterone levels in specific cases. Examples include fenugreek, maca, ginseng, ashwagandha, and d-aspartic acid, among others.

Patient Follow Up 

Ongoing monitoring of patients with hypogonadism involves a comprehensive approach. Regular laboratory testing, including measurements of total testosterone, free testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and hematocrit, is critical and typically recommended every 2-3 months.

Observing symptoms such as sexual dysfunction, fatigue, and mood changes is essential for assessing treatment success. Additionally, addressing comorbidities, such as metabolic conditions and cardiovascular risks, is integral to overall patient wellness. Patient preference and feedback on their sense of well-being should guide treatment adjustments, as individual responses to therapy can vary.

This multifaceted approach ensures personalized care by optimizing both the physical and subjective aspects of the patient’s health. Regular, clear communication between a testosterone specialist and the patient plays a vital role in achieving the best possible outcomes.

Summary

My dedication as a testosterone specialist in Rockville revolves around providing expert care to male patients with hypogonadism. Through a holistic approach, as supported by medical evidence and clinical experience, I strive to improve the overall well-being of my patients by offering personalized therapies. My ultimate objective is to optimize the health and quality of life for our community members.

Dr. Tashko

Dr. Tashko is an ABIM board-certified endocrinologist with additional certifications in lipidology, hypertension, and obesity medicine. He delivers personalized, holistic care to patients in Montgomery County, Maryland.