Low Testosterone (Male Hypogonadism)
What Is It?
Testosterone deficiency in men causing fatigue, decreased libido, erectile dysfunction, decreased muscle mass, increased body fat, mood changes, and bone loss. Requires confirmation and evaluation for cause.
How Is It Diagnosed?
Two fasting morning total testosterone levels <300 ng/dL on separate days. Free testosterone for borderline cases. LH, FSH (low = secondary; high = primary). Prolactin, CBC, BMP, lipid panel.
How Is It Treated?
Testosterone replacement therapy (TRT): topical gels (AndroGel, Testim), intramuscular injections (testosterone cypionate/enanthate), subcutaneous pellets. Monitor hematocrit, PSA, lipids, and symptoms. Treat secondary causes (pituitary, obesity).
Tests and Imaging Typically Needed
Total testosterone (fasting, 8 AM), free testosterone, LH, FSH, prolactin, SHBG, BMP, CBC, PSA, lipid panel, thyroid, MRI pituitary if secondary hypogonadism.
Approximate Self-Pay Costs
Office visit: $95-$150. Testosterone and hormone panel: $80-$150. Testosterone gels: $50-$100/month. IM injections: $15-$30/month.