Many men dismiss their fatigue, moodiness and loss of libido as signs of aging. These may be symptoms of low testosterone levels or low-T. In medical terms these low hormonal levels are called late onset hypogonadism, a condition in which a man’s body does not produce enough testosterone. Low-T occurs in about 20 percent of men over age 60, and as high as 50 percent of men over 80. Men below age 60 are not immune, but are not as likely to suffer the symptoms of this hormonal deficiency.
“Reduction of testosterone levels below normal ranges is usually a subtle process, and symptoms may not always be easy to recognize,” says Dr. John Foley, a urologist at Shore Comprehensive Urology. However, he finds that most men diagnosed with low-T are open to treatment.
“It’s a lifelong proposition since there is no cure currently available to reverse the process,” Dr. Foley explains. “Some or all of these symptoms can be mitigated or reversed with testosterone replacement therapy. Most men, although not all, continue on appropriate treatment that succeeds at restoring normal testosterone levels because they genuinely feel better and because they know it’s better for their overall well being.”
John Hanes, who owns Tricrown Inn for Pets with his wife Polly, is one of Dr. Foley’s patients. “I was tired all the time,” says Hanes. “However, with testosterone replacement therapy, I’ve improved and everything’s gotten better. Even my wife noticed a difference.”
Several options are available to treat low-T and those options are often determined either by patient preference and insurance coverage. One option is testosterone injections. These especially appeal to men who have the flexibility for the weekly or bi- weekly visits to the urologist’s office for the injections. Men or their wives can also be taught proper injection technique for administering the dosage at home.
Another option is the daily use of a prescribed topical agent. Some men don’t object to the morning ritual of applying testosterone gel, but this treatment has some disadvantages. The topical agent must be handled and stored carefully so that women and children in the household are not exposed to any residual gel on the man’s skin. Exposure to the gel has been known to cause side effects. The treatment that worked for Hanes and many other patients is a testosterone replacement therapy option known as Testopel.
“Testopel appeals to many men because it offers them great convenience with steady dependable testosterone levels for up to four months with a minimally invasive five-minute outpatient office procedure,” Dr. Foley explains. Testopel has worked for Hanes, who has used this treatment for about a year now after previously unsuccessful experiences with the gel and injections. “I am very happy so far and it’s more convenient for me.”
Testopel therapy involves implanting small pellets just under the skin in the hip area. Hanes feels this procedure is no more painful than an injection in his hip. “With proper technique and good local anesthesia, most patients tolerate it very well,” Dr. Foley says.
Hanes has not suffered many side effects. ”I can tell when I’m at the end of the period,” he says of the 12-13 weeks between treatments. “I get listless and tired. Dr. Foley is very concerned to keep my testosterone levels even.”
Once the dosage and the timing between implants are figured out, most men can keep their testosterone levels balanced with Testopel implants every three to four months.
“Mr. Hanes seems to be happy now, and his lab values confirm he is maintaining proper testosterone levels,” Dr. Foley says.
Dr. Foley believes topical agents keep testosterone levels balanced in a way that is similar to the body’s natural release of the hormone, but Testopel does a better job than the injections to avoid the up and down swings of testosterone levels. However, Dr. Foley acknowledges that the most appropriate treatment “is one of the three that best suits an individual patient’s needs, desires and pocketbook. They all can achieve the same outcome when properly managed by the physician.”
Hanes feels that Dr. Foley and the staff at Shore Comprehensive Urology have properly and personally managed his care. “The entire staff is very personable,” Hanes says. “I’m welcomed there, and they remember me. Dr. Foley is very professional. He explains everything and asks if I have any questions. He has my interests at heart.”
Dr. Foley is pleased with Hanes’ outcome.
“We aim to provide each patient with a positive, productive and expedient urologic care experience as we build our reputation as the flagship urologic practice on the Eastern Shore,” he says.
Shore Comprehensive Urology is located at 505 Dutchman’s Lane, Building A, Easton with locations at Shore Medical Pavilion in Queenstown and at 2 Aurora Street in Cambridge. In addition to Dr. Foley, the Shore Comprehensive Urology team consists of John Knud-Hansen, MD, Christopher Runz, DO, Duane Cespedes, MD and Christopher Parry, DO. Dr. Parry is based primarily in Chestertown. For more information or to make an appointment, visit www.shorecomprehensiveurology.com or call 410-820-0560.