Transdermal hormone replacement therapy (TRT) plays a key role in men's health, helping to maintain hormonal balance and promote quality of life. In the world of men's health, there's one topic that often gets overlooked: hormonal health.
At Adon Health, we're committed to breaking this taboo. We believe every man has the right to reach his full potential – and that starts with a balanced hormonal system. Testosterone plays a key role in this. It's not just about physical strength, but also about well-being, vitality, and zest for life. Testosterone replacement therapy (TRT) can open the door to a fulfilling life. But is it right for you? Let's explore this path together, with the scientifically sound information you'll find at Adon Health.
The evolution of testosterone therapy
The evolution of testosterone replacement therapy (TRT) is a fascinating journey through time, revealing how our understanding and treatment methods for testosterone deficiency have developed. From the first experiments in the early 20th century that laid the foundation for modern hormone therapy to today's sophisticated treatments tailored to individual needs, TRT has come a long way. Research has continuously contributed to a deeper understanding of testosterone's role in men's health, improving the safety and efficacy of the therapy. This chapter highlights the milestones of this development and how they help men lead balanced and fulfilling lives today.
From the 18th century to the present day: A look at the history of TRT
The evolution of testosterone therapy reflects remarkable progress in medical science and the treatment of men with testosterone deficiency. The history of testosterone and its therapeutic use is a fascinating journey, ranging from the earliest experiments to modern, highly advanced treatment methods.
The origins of testosterone therapy can be traced back to the 18th century, when the surgeon John Hunter conducted the first experiments with testicular transplants. In 1935 , Adolf Butenandt and Leopold Ruzicka succeeded in chemically synthesizing testosterone , for which they received the Nobel Prize in 1939. These discoveries paved the way for the clinical application of testosterone to treat hypogonadism and other conditions.
Over the years, various testosterone preparations have been developed to facilitate administration and improve treatment effectiveness. Originally, testosterone was administered via injections; later, patches, gels, and other delivery methods were introduced, allowing for consistent dosing and fewer side effects ( Barbonetti, D'Andrea, & Francavilla, 2020 ).
The development and refinement of TRT was based on a deeper understanding of the role of testosterone in male physiology and the potential benefits of therapy for men with testosterone deficiency. Research in this area has shown that TRT can not only improve the symptoms of testosterone deficiency but also has positive effects on bone health, muscle mass, sexual function, and overall well-being ( Nieschlag & Nieschlag, 2019 ).
Today, TRT is an established treatment option for men with hypogonadism, with therapy individually tailored to achieve the best possible results. Research in this area remains dynamic, with the aim of further improving therapy and positively impacting men's lives.
Nine symptoms that indicate a testosterone deficiency
Testosterone deficiency, also known as testosterone deficiency syndrome (TDS), affects a significant number of men, particularly with increasing age. The symptoms of testosterone deficiency can be varied and often nonspecific, making diagnosis difficult. Here are some of the most common signs and symptoms that may indicate testosterone deficiency ( Kumar et al., 2010 ):
- Decreased libido: One of the most well-known signs of testosterone deficiency is a decreased interest in sexual activity. Testosterone plays a key role in regulating sexual desire. A significant drop in libido can be an indicator of a deficiency.
- Erectile dysfunction: Difficulty achieving or maintaining an erection can also be related to low testosterone levels. While erectile dysfunction can have many causes, testosterone is necessary for the mechanisms that initiate an erection.
- Fatigue and lack of energy: Men with testosterone deficiency often report general fatigue and a lack of energy that is not improved by sleep or rest.
- Mood swings: Low testosterone levels can lead to mood swings, including depressive moods, irritability, and a lack of concentration.
- Loss of muscle mass and strength : Testosterone is essential for building and maintaining muscle mass. A deficiency can lead to a visible loss of muscle mass and a decrease in muscle strength.
- Increased body fat: A hormonal imbalance, especially a lack of testosterone, can lead to an increase in body fat.
- Changes in sleep patterns: Testosterone deficiency can cause sleep disturbances, including difficulty falling asleep or staying asleep.
- Reduced body hair: A decrease in body hair can also be a sign of a testosterone deficiency.
- Changes in testicular size: A shrinking of the testicles can be another physical sign of a testosterone deficiency.
It's important to emphasize that these symptoms can also be caused by other medical conditions, and the presence of one or more of these signs does not automatically confirm a testosterone deficiency. Don't panic if some of the symptoms apply to you. We know how stressful and complex men's lives can be. Performance pressure, work-life balance, family, friends, career—all of this can put us under enormous stress. Often, we react by developing bad habits: less sleep, poor diet, lack of exercise, and insufficient relaxation. We all know these patterns that aren't good for us. A thorough examination and blood tests by a doctor are still absolutely necessary to make an accurate diagnosis. But we also have good news for you: Treating a diagnosed testosterone deficiency can significantly improve quality of life by helping to alleviate the symptoms listed above ( Barone et al., 2022 ).
Why do men experience a testosterone deficiency?
A testosterone deficiency can be caused by a variety of factors, ranging from specific medical conditions to certain lifestyle factors. Therefore, at Adon Health, we consider the big picture and each man's entire medical history.
Medical conditions that lead to testosterone deficiency
Testosterone deficiency can result from various health problems. Chronic diseases such as diabetes, kidney failure, and liver disease can directly affect testosterone levels. Hormonal disorders affecting the hypothalamic-pituitary-gonadal axis can also lead to deficiency. Traish et al. (2011) indicate that approximately 30% of men aged 40–79 are affected by testosterone deficiency, with a prevalence that strongly correlates with age and common medical conditions such as obesity, diabetes, and hypertension.
Lifestyle factors that can lead to testosterone deficiency
Lifestyle has a significant impact on testosterone levels. Overweight and obesity are closely linked to low testosterone levels, with visceral fat playing a key role. An unhealthy diet high in processed foods and sugar, as well as a lack of physical activity, can also contribute to low testosterone. Stress and insufficient sleep also negatively affect testosterone production. Kelly and Jones (2015) highlight that low testosterone levels are associated with increased fat mass, particularly central obesity, and reduced fat-free mass in men, underscoring the importance of a healthy lifestyle.
At Adon Health, we understand that treating low testosterone goes beyond hormone replacement therapy. It's about addressing the underlying causes, whether through medical intervention for medical conditions or by promoting a healthy lifestyle. A holistic approach that encompasses both physical and emotional health is crucial to helping men reach their full potential.
How is a testosterone deficiency diagnosed?
At Adon Health, we take the diagnosis of low testosterone very seriously. We know that testosterone levels in the body can naturally fluctuate – for example, they are higher in the morning and can decrease throughout the day. To account for these natural fluctuations and ensure an accurate diagnosis, we always conduct two blood tests, at least one week apart.
This approach helps us capture each man's individual biological variability and ensure we don't misdiagnose or miss a testosterone deficiency. It's crucial that we rely on dependable data because a testosterone deficiency can cause a range of symptoms that significantly impact quality of life. By performing two tests, we can improve the accuracy of our diagnoses and ensure our patients receive the treatment they need.
Effects of testosterone and TRT in the body of men
Testosterone replacement therapy (TRT) can offer significant benefits for men diagnosed with low testosterone by not only improving symptoms but also reducing the risk of long-term health problems. At Adon Health, we understand the importance of an individualized approach and base our recommendations on the latest scientific findings.
How does testosterone work in your body?
On a biological level, testosterone acts in the male body through a variety of mechanisms that go far beyond the known effects on sexual function and secondary sexual characteristics.
Testosterone binds to androgen receptors in target tissues, leading to the activation or inhibition of gene expression responsible for the development and maintenance of male characteristics, as well as a wide range of physiological processes in the body.
- Muscle growth and maintenance: Testosterone promotes muscle growth and protein synthesis, leading to an increase in muscle mass and strength. It also counteracts muscle atrophy by exerting anti-catabolic effects on muscle tissue ( Bhasin et al., 1996 ).
- Fat distribution: Testosterone influences fat distribution in the body and contributes to a reduction in visceral fat. It acts on adipocytes and can modulate lipid metabolism, leading to less fat accumulation ( Blouin et al., 2008 ).
- Bone health: Testosterone plays an important role in maintaining bone density. It acts directly on bone cells and promotes bone formation and mineralization, which reduces the risk of osteoporosis ( Vandenput & Ohlsson, 2013 ).
- Psychological and cognitive functions: Testosterone influences mood, well-being, and cognitive functions. It acts on the central nervous system and can affect neurotransmitter activity, which may lead to improvements in depression, energy, and cognitive function ( Hackett et al., 2016 ).
- Cardiovascular system: Testosterone can have positive effects on the cardiovascular system by, for example, supporting vasodilation and influencing cholesterol levels, which can contribute to improved heart health ( Jones et al., 2011 ).
Testosterone replacement therapy: When is it appropriate?
Do you feel your energy and vitality are declining? Do you feel like you're not the person you used to be? Then a testosterone deficiency could be the cause. In this case, testosterone replacement therapy (TRT) can help significantly improve your quality of life.
So when should you consider therapy?
If you have the following symptoms:
- Decreased libido and sexual function
- Erectile dysfunction
- Fatigue and lack of motivation
- Reduced muscle mass and strength
- Increase in body fat
- Mood swings and depressive moods
If a questionnaire yields a positive result:
The AMS questionnaire (Aging Males' Symptoms) can help diagnose a testosterone deficiency.
If your lab test shows low testosterone levels:
- A testosterone level in the blood serum below the reference range may indicate a deficiency.
- Two measurements taken at least one week apart are necessary to obtain a reliable diagnosis.
If there are no contraindications:
Before undergoing TRT, possible contraindications should be ruled out, e.g., cardiovascular diseases, prostate cancer, and liver diseases.
When is a TRT not right for you?
Testosterone replacement therapy (TRT) can be an effective treatment for men with hypogonadism, a deficiency of testosterone. The therapy can improve quality of life by alleviating symptoms such as fatigue, decreased libido, and loss of muscle mass. However, TRT is not suitable for every man. In some cases, the decision to undergo this therapy requires careful consideration.
- Urgent desire to have children: Men who are actively trying to father a child should not consider TRT. Testosterone can suppress sperm production. Once the therapy is completed, it can take several months for sperm production to return to normal.
- Existing prostate cancer: Testosterone can promote the growth of prostate cancer cells. Therefore, TRT is contraindicated in men with a known history of prostate cancer.
- Polycythemia: TRT can lead to an increased number of red blood cells (erythrocytes). In men with pre-existing polycythemia, a condition characterized by an overproduction of red blood cells, this can lead to complications such as thrombosis.
- Untreated sleep apnea: TRT can worsen the symptoms of untreated sleep apnea. Therefore, this therapy should only be used with extreme caution in men with existing sleep apnea.
- Liver dysfunction: The liver is responsible for breaking down testosterone. In men with liver dysfunction, TRT can lead to an accumulation of testosterone in the body and thus to side effects. Studies suggest that TRT does not have a significant effect on liver enzymes in men with normal liver function. However, caution is advised when using this therapy in men with liver disease.
Before deciding on TRT, it's important to speak with a doctor to weigh all the potential risks and benefits of the therapy. The doctor will assess your individual situation and help you make the best decision for your health. That's why our testosterone tests always include a telemedicine consultation with a doctor.
Our mission: Your health
At Adon Health, we care deeply about the well-being of every man. We understand that low testosterone is not just a number on a lab report, but a condition that can profoundly impact daily life and quality of life. By providing state-of-the-art, science-based treatments, we strive to help men regain their health and live fulfilling lives.
Our mission goes beyond simply treating symptoms. We want to raise awareness of the importance of hormonal health and reduce the stigma often associated with seeking help for health problems.
The benefits of TRT reflect only part of our vision. We believe that every man should have access to comprehensive medical care that considers not only the physical, but also the emotional and psychological aspects of his health. Adon Health is more than just an online platform: We are a partner on your journey to a healthier, happier you.
