Online testosterone replacement treatment and programs
Written by Leann Poston, M.D.
Testosterone is a male sex hormone tightly controlled by a feedback loop involving the brain, pituitary gland, and testes. The term hypogonadism is applied to any disorder that results in decreased production of testosterone. Both medical conditions and lifestyle factors can cause a decrease in testosterone production. Aging is one such factor. For this reason, there has been increasing interest over the past several decades in testosterone replacement therapy options. Men with low testosterone levels want to learn more about the programs and treatment centers that may offer testosterone replacement online.
In this article, we will explore risk factors and conditions which may lead to decreased testosterone production, the symptoms that men with low testosterone may experience, and the medical evaluation men should expect prior to considering testosterone replacement therapy.
A part of the brain called the hypothalamus stimulates the pituitary gland to produce gonadotropin-releasing hormones (GnRH) in both the male and female. These releasing hormones increase the levels of two other hormones, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH stimulates the production of testosterone in the testes. Any factor that adversely affects this feedback loop can cause low testosterone levels.
Factors that lead to decreased testosterone production
Hypogonadism or decreased production of testosterone is a condition in which the testes do not produce enough of the male sex hormone, testosterone. Approximately, 4-5 million men in the United States are affected (Seftel, 2006). Aging results in decreased testosterone production by about one percent per year after age 30 to 40. The Baltimore Longitudinal Study on Aging reported that the incidence of low testosterone is around 20 percent in men in their 60s, 30 percent for men in their 70s, and 50 percent for men over age 80 (Harman, 2001). There are many potential causes of low testosterone production that may lead men to seek treatment online for testosterone replacement.
Potential causes of low testosterone production:
- Genetic conditions such as Kleinfelter’s syndrome
- Injuries that damage the testes or decrease its blood supply
- Alcohol abuse
- Medications such as steroids
- Chemotherapy or radiation therapy
Testosterone Replacement Therapy
The American Urological Society defines low testosterone (Low-T) as less than 300 nanograms per deciliter (ng/dl). Low testosterone levels can cause a low sex drive, decreased lean muscle, irritability, fatigue, erectile dysfunction, and depression. Whether low testosterone levels are due to medical conditions such as cancer treatment, genetic conditions, or lifestyle factors such as the aging process, many men are interested in testosterone replacement treatment programs and seek information online.
The F.D.A. and the American Urological Association have both endorsed the use of testosterone supplementation for medical and genetic conditions that lead to symptomatic low testosterone levels. However, health care providers also treat many men with testosterone replacement for low testosterone and its associated symptoms secondary to the aging process or other lifestyle factors. Since all medications and therapies have risks and benefits, it is essential that all men clearly understand the risks and benefits of testosterone supplementation. For this reason, the F.D.A. has required testosterone products to carry the label that there is an increased risk for strokes and heart attacks for some men using testosterone replacement therapies (U.S. FDA, 2015).
Other studies have shown that low testosterone levels are a risk factor for cardiovascular disease as well. Low testosterone levels are associated with obesity, decreased HDL cholesterol, increased LDL cholesterol, high blood pressure, increased incidence of diabetes, and an increase in inflammation, all of which increases the risk of cardiovascular disease (Çatakoğlu, 2017). A thorough history and physical exam, a complete series of blood tests, and a frank discussion with your health care provider can help you determine whether testosterone replacement therapy would increase or decrease your cardiovascular risk profile.
The first step in diagnosing any medical condition is to take a thorough history to identify any potential explanations for the symptoms you are experiencing. Your health care provider may ask questions about the following areas of your health history:
- History of trauma or surgeries
- Current medications and over-the-counter supplements
- History of chemotherapy or radiation therapy
- Risk factors for cardiovascular disease such as obesity, metabolic syndrome, and high blood pressure
- Gynecomastia (enlarged breasts)
- Urinary symptoms
- Sexual history and symptoms
Laboratory Tests for Low-T
Your health care provider may order the following laboratory tests:
- Total testosterone level: Generally two separate testosterone levels are obtained, with both levels taken before noon, as testosterone levels tend to naturally decrease later in the day.
- Luteinizing hormone (LH): LH stimulates the production of testosterone in the testes. Abnormal levels may indicate a problem with the pituitary gland (see image above).
- Blood prolactin level: Prolactin is a hormone that stimulates breast development and milk production in the female. Increased levels in the male may be a sign of a benign pituitary tumor among other possible causes.
- Blood hemoglobin/hematocrit level: Low hemoglobin levels may indicate a medical problem such as anemia. Testosterone replacement therapy can cause an increase in red blood cell production, thus a baseline hemoglobin/hematocrit level is recommended prior to treatment and at intervals after treatment has been started.
Additional lab tests or studies may be required based on your blood test results and your medical history.
Testosterone replacement therapy has been used by millions of men worldwide to treat the side effects of decreased testosterone production (Grech, 2014). As men have learned more about the risk and benefits of testosterone replacement treatment, and online resources have made the best testosterone treatment and therapy options and programs more accessible to all, the number of men between the ages of 40 and 65 who have been tested and subsequently treated for Low-T has increased.
Testosterone Supplement Imposters
Many testosterone supplement imposters are available online. These herbal and nutrient supplements are not regulated by the F.D.A. and many contain unknown ingredients and adulterants, making them both ineffective and unsafe (Balasubramanian, et al., 2019). Physicians can point to cases where these testosterone imposters have included banned substances, including steroids, which resulted in serious adverse effects for consumers (Geyer et al., 2008).
The bottom line
The best online programs and treatment facilities offer an evaluation for Low-T, followed by a requirement for a prescription for testosterone replacement therapy by a licensed health care provider. Invigor Medical is a full-service telemedicine healthcare provider that partners with a fully licensed, U.S. based pharmacy to provide online healthcare.
How to seek online treatment for Low-T and testosterone replacement therapy
Invigor Medical offers telemedicine appointments with health care providers in your state. The first step is to complete an online medical history. A full panel of blood testing is required, as the diagnosis of low testosterone requires documentation of both a low testosterone level and the symptoms associated with low testosterone levels.
After your history forms are complete and you have your blood panel results evaluated, the next step is for a licensed Invigor Medical health care provider in your state to review your lab results and discuss treatment options with you. If they find you to be a suitable candidate for testosterone replacement therapy, the Invigor Medical health care provider will send a prescription to either our compounding pharmacy partner or your local pharmacy for testosterone intramuscular injections and the supplies.
Your online Invigor Medical health care provider will discuss the risks and benefits of testosterone replacement therapy, signs and symptoms to watch for that indicate improvement of your testosterone levels, and lifestyle changes you may consider that set you up for the best health outcomes from testosterone replacement therapy.
To learn more about Invigor Medical and how it can support your quest to determine whether you can improve your health and decrease symptoms of Low-T, please visit Invigor Medical website at https://invigormedical.com/
While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.
- Alp Burak Çatakoğlu, Muammer Kendirci. Testosterone replacement therapy and cardiovascular events. Turk Kardiyol Dern Ars. 2017; 45(7): 664-672
- Balasubramanian, A., Thirumavalavan, N., Srivatsav, A., Yu, J., Lipshultz, L. I., & Pastuszak, A. W. (2019). Testosterone Imposters: An Analysis of Popular Online Testosterone Boosting Supplements. The journal of sexual medicine, 16(2), 203–212. https://doi.org/10.1016/j.jsxm.2018.12.008
- Geyer H, Parr MK, Koehler K, Mareck U, Schänzer W, Thevis M. Nutritional supplements cross-contaminated and faked with doping substances. J Mass Spectrom 2008;43:892–902. doi:10.1002/jms.1452.
- Grech, A., Breck, J., & Heidelbaugh, J. (2014). Adverse effects of testosterone replacement therapy: an update on the evidence and controversy. Therapeutic advances in drug safety, 5(5), 190–200. https://doi.org/10.1177/2042098614548680
- Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab. 2001;86:724–731.
- Seftel, A. Male hypogonadism. Part I: Epidemiology of hypogonadism. Int J Impot Res 18, 115–120 (2006). https://doi.org/10.1038/sj.ijir.3901397
- U.S. Food & Drug. (2015). FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use. Retrieved from https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-cautions-about-using-testosterone-products-low-testosterone-due#:~:text=Testosterone%20is%20FDA%2Dapproved%20as,cause%20a%20condition%20called%20hypogonadism.