Internal Medicine, Lipid & Wellness of Fort Myers Newsletter

Dr. Kordonowy

Dr. Marconi

Review of Therapy:

Testosterone Replacement Therapy (TRT)

I would like to introduce myself. I am Dr David F Marconi MD, board certified in Family Medicine. I am sure many of you are aware I joined Dr Kordonowy in private practice starting February of 2022. As a new addition to the practice, I am excited to contribute content to the practice newsletter. I would like topics to be relevant and interesting to you, our patients. This newsletter is focused on testosterone replacement for men with low testosterone. Inspiration for the topic came after several new patients requested evaluation and treatment for possible low testosterone.

What are the symptoms of Low Testosterone?

Hypogonadism or Low Testosterone (Low-T) is defined as a low testosterone level leading to a cluster of symptoms, possibly including decreased sexual desire (libido), energy, mood, muscle mass, strength, depression and increased body fat. It may also lead to reduced bone mineral density and anemia.

Testosterone Replacement Therapy (TRT) is appropriate for patients with symptomatic hypogonadism, including those with congenital, age-related, or idiopathic (unexplained) hypogonadism.

Goals of treatment

The principal goal of TRT is to reduce symptoms of Low-T by replacing testosterone. Blood testosterone levels should be kept within the normal physiologic range, generally, between 300-1000 ng/dl in serum. Therapy is individualized for each patient in order to address deficiency symptoms and improve function. Levels greater than 1000 ng/dl are generally not targeted as this will come at the risk of side effects and excess blood hemoglobin production which may lead to clotting in the arteries or veins.

Benefits of TRT

Improvement in:

Vitality

Energy

Muscle Mass

Bone Strength

Mood

Sexual Pleasure

Potential Therapy Side effects:

Testicular Atrophy

Low Sperm Counts

Increased Blood Counts

Acne

Baldness

High Blood Pressure

Aggressive Behavior

Gynecomastia (Increased Male Breast Tissue)

High Cholesterol

Liver abnormalities

Enlargement of Prostate

Elevation in Prostate Antigen level

Acceleration of Active Prostate Cancer

Who Should Not use TRT?

Patients with:

Active Prostate Cancer

Active Breast Cancer

Elevated Prostate Levels

Untreated Sleep Apnea

Uncontrolled High Blood Pressure

Uncontrolled Heart Failure

Increased Blood Counts

Men Desiring Fertility

Monitoring

Baseline Blood testing is needed to confirm deficiency before therapy is considered and periodically for dose adjustments and treatment monitoring. Common lab testing include: testosterone, hemoglobin, hematocrit, liver tests, and prostate testing. Other tests may be recommended in some cases.

FAQ:

Is it safe?

Yes, when therapy is properly monitored and kept within normal therapeutic ranges.

Can testosterone cause prostate cancer?

No, testosterone replacement itself cannot cause cancer, however it can accelerate active or unrecognized prostate cancer.

Is this treatment expensive?

Medication cost ranges from $20 to $180 monthly.

Will this correct my Erectile Dysfunction?

Sometimes, it depends on what type of ED you are experiencing.

Is Bioidentical T Special?

All testosterone is bioidentical when in the bloodstream. Not all products produce the same results and thus monitoring levels is a key to management.

Can I stop TRT?

Yes, however, it needs to be tapered slowly to avoid recurrence of symptoms. It is generally advised to continue long term unless there are side effects.

How is TRT used/applied?

Formulations available include: Buccal, oral tablet, injection, implants, or topically using a patch cream or gel. The most common formulation is injection.

What Level do you target?

Treatment is individualized per patient. Rather than aiming for a level the goal is symptom improvement within a safe therapeutic range.

Internal Medicine Lipid & Wellness Practice of Fort Myers

Thank you for your reading my first practice newsletter. I am excited to be part of the practice and look forward helping Dr. Kordonowy maintain a high quality, high service practice and value for new patients.

Here at Internal Medicine Lipid and Wellness we pride ourselves on providing excellent patient centered preventative and diagnostic care for patients aged 16 and up.

The best compliment you can offer a doctor is a patient referral. I look forward to helping your friends and family!

Sincerely,

Dr David Marconi MD

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