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TRT in Australia – Dr Matthew Davies

Male patients regularly come to me asking about low testosterone levels (a.k.a. low T or testosterone deficiency). Common symptoms include decreased energy, mood problems, erectile dysfunction and a reduced sex drive (libido) to name just a few.

Men aren’t always keen to talk about personal issues with their GP. However, once we break the ice, we can start looking into the cause of your symptoms. We’ll explore the role that checking testosterone levels plays and get to work on a treatment plan.

I tell my patients that many factors can cause symptoms of low T. These include age, certain diseases or pre-existing conditions, and lifestyle choices. The reasons may not be immediately obvious, but it’s always worth checking for testosterone deficiency as part of a complete health consult.

Testosterone replacement therapy (TRT) may help, though I must stress this treatment isn’t suitable in all cases.

What is Testosterone?

There are many myths about testosterone, including that it supercharges your sex life and has an incredible impact on athletic performance. These stories are fueled by tales from the internet, drug companies selling their products, and by the rantings of the ultra-beefed-up guy at the gym (who’s “done his research”).

But let’s look at some facts.

Testosterone is the primary male sex hormone responsible for a variety of essential bodily functions. It’s produced in your testicles and relies on a complex interaction with your brain and body.

Essential for healthy sexual and reproductive function, testosterone plays a vital role in maintaining good health for both young and older men. It’s an important ingredient for healthy bodily functions such as:

  • maintaining muscle mass and strong, healthy bones;
  • regulating your mood and libido;
  • producing sperm;
  • distributing fat around your body.

If your body is deficient in testosterone, it may struggle to maintain these normal functions.

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How Common is Low Testosterone in Men?

In Australia, testosterone deficiency occurs in about 0.5% of men under the age of 50. This number increases substantially with men above 50, with some researchers putting the figure at 19-39%.

Blood testosterone levels peak somewhere between 20 and 30 years of age. These levels then slowly fall year-on-year as part of the natural ageing process.

Some men experience more symptoms than others, though the reasons are unknown. It’s thought men with other health issues such as obesity, chronic illness, smoking and excessive alcohol consumption are more likely to be affected.

Is it Dangerous to Have Low Testosterone?

Having untreated low testosterone levels relative to your age can have a serious impact on your health.

Your bone density can be severely compromised at very low testosterone levels, potentially resulting in osteoporosis.

There’s also a risk of Alzheimer’s disease, diabetes, depression and heart disease.

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What are the Main Causes of Low Testosterone?

A common cause of low testosterone is when your testicles don’t produce enough of the hormone. This is known as hypogonadism.

Primary hypogonadism occurs when underactive testes fail to produce enough testosterone for normal bodily functions. Genetic conditions can be the culprit (e.g. Klinefelter Syndrome), as too can damage to the testes from physical injury or the effects of chemotherapy.

Secondary hypogonadism results from damage to your pituitary gland or hypothalamus – areas of your brain that regulate testosterone production in your testicles. Conditions such as diabetes, obesity and sleep apnea can be to blame. Bad genetics, chronic disease, opioid consumption and ageing also play a role.

When exploring the possibility of low testosterone levels, it’s important that your GP examines you for signs of other health issues. Some examples of health issues include diabetes, obesity, anabolic steroid use and hormonal imbalance such as hypothyroidism.

Signs and Symptoms of Low T

Symptoms of having low testosterone can vary enormously depending on the age that levels fall. Common symptoms include:

  • lower energy than usual and fatigue;
  • mood swings and irritability;
  • weight gain;
  • low libido;
  • erectile dysfunction;
  • concentration and memory problems, and
  • weak muscle strength.

With these symptoms being so varied, along with a number of physical and psychological illnesses overlapping, it’s little wonder testosterone deficiency remains under-diagnosed.

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Diagnosis and Treatment

Doctors can only start the process of diagnosing testosterone deficiency with at least two separate blood tests – I promise we’re not wasting your time by sending you twice. Day-to-day hormone blood levels vary so much that one reading isn’t enough to confirm if there’s a problem.

Don’t panic if your testosterone readings are consistently low. The next step is to refer you to a hormone specialist known as an endocrinologist to see what treatment is right for you.

Treatment of confirmed low T typically involves Testosterone Replacement Therapy (TRT). There are many excellent testosterone specialists, as well as several TRT clinics in Melbourne.

In tandem, we must ensure you’re as healthy as possible in terms of diet, exercise and sleep.

What is Testosterone Replacement Therapy?

TRT is a treatment for testosterone deficiency. It involves topping-up ypour body with the hormone.

Only an endocrinologist can prescribe the treatment, which is administered through injections, gels and lotions, tablets or skin patches. They’ll help decide the right TRT delivery method for your individual circumstances.

Your GP will need to provide you with a referral. They’ll work with your endocrinologist to ensure ongoing therapy remains the right choice for you.

You may be wondering why all men don’t just take testosterone supplements anyway. The reason is that TRT can come with some undesirable side effects, especially if your body is making enough of its own.

Excess testosterone can cause acne, mood changes, male-pattern baldness and gynaecomastia – also known as man boobs. It can also result in reduced sperm production and cause benign swelling of the prostate gland, which may lead to problems passing urine.

Concerning prostate cancer, research shows that excess levels of testosterone can cause tumours to grow more rapidly.

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Tips to Naturally Maintain Healthy Testosterone Levels

Weight control, a proper diet, good sleep patterns and regular exercise are crucial factors in maintaining healthy hormone levels. As many of my patients will testify, I’m forever telling them to get out of the Cross-Fit studio and spend more time exercising outside.

Importing rhino horn or tiger paw supplements from who-knows-where have absolutely no proven benefits. Likewise, there’s no convincing evidence that over-the-counter ‘testosterone boosting’ supplements from your local pharmacy help at all.

As always, feel free to make an appointment if you have any questions or are worried about suspect symptoms.

Dr Matthew Davies is a GP at Doctors of South Melbourne. His special interests include men’s health and sexual health.

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