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Personalizing Care for Patients with Low Testosterone

January 2022
Stanton Honig, MD
Professor of Clinical Urology
Yale Urology
330 Orchard Street, Suite 164
New Haven, CT 06511


Managing patients with low testosterone is both an art and science. It is important to find a doctor who understands and is familiar with multiple options for the delivery of testosterone to patients who would benefit from this therapy.

Patient should not be screened for low testosterone. However, if you are a patient and you feel like you have a low sex drive or your energy level is low and feeling sluggish, this may be a result of low testosterone.

You should be checked for testosterone levels in the early morning. This is because in most patients, testosterone levels are highest in the morning.

  • You should also be checked for hormone levels called luteinizing hormone or LH and follicle stimulating hormone or FSH. This will help identify the underlying cause of the problem.

If your testosterone is low, you should have a discussion with your doctor to discuss the pluses and minuses of testosterone replacement therapy.

In 2022, there are multiple delivery system options for testosterone replacement therapy. These include pills by mouth, Once per week subcutaneous injections, Once every two weeks intramuscular injections, testosterone nasal spray, topical gels as well as four-month depot pellets. At Yale Medicine Urology, we try to personalize care to specific needs of the patient.

After you have been started on some form of treatment, you should have a follow-up visit to discuss how your symptoms are being controlled and to have follow up blood test to measure your testosterone levels, your blood count. This is important because a small percentage of patients may see a mild thickening of their blood or hematocrit. If you are over 50 or have a family history of prostate cancer, you should have a screening test for prostate cancer or PSA as well.

Is important to find a doctor who understands all these medications so they can help you choose the best option for you. For instance, it is important to check testosterone levels about 4 to 6 hours after taking medicines by mouth or by nasal spray. This is when testosterone levels peaks with this type of treatment. On the other hand, with subcutaneous testosterone injections usually there is a steady state so it does not matter when you have the blood test drawn. With intramuscular testosterone therapy, if you check blood levels three days after treatment it would likely be high. At seven days, it will be in the normal range and at 10 days it will likely be low. Finding a doctor who understands this is very important to optimizing your care.

Patients who are considering children in the future need special consideration. Most Testosterone therapy will lower sperm count , in many cases to zero. The good news is that there are options for increasing testosterone that will not have a negative effect on Sperm. Findings a physician who understands this and asks the right questions is very important as well.

At Yale Medicine Urology. we have a full understanding of testosterone replacement therapy and offer all treatment options. If you have the signs and symptoms of low testosterone such as low sex drive, low energy or decreasing muscle mass, feel free to reach out and make an appointment to receive personalized care.