Understanding Low T


Low T is more common than you think.

Dr. Stacy Olliff is a board-certified provider in our Conyers Office.

You can hardly turn on the radio or television these days without hearing a commercial for low T. But what exactly is low T and what causes it? Stacy Olliff, M.D., a physician at Eagles Landing Family Practice, says he’s seeing more and more cases of low testosterone in both older and younger men. Dr. Olliff says low T is a common problem in men, and seeking help is important to their overall health.

Question: What is testosterone and what role does it play in the body?

Dr. Olliff:  Testosterone is the primary sex hormone in men. It is mainly produced in the testicles, but a smaller amount is also produced in the brain (adrenal glands). It is the main driver of puberty in boys and once grown, men need proper levels of testosterone for muscle mass, strong bones and prevention of osteoporosis, as well as a healthy sex drive.

Question:  What causes low testosterone or low T?

Dr. Olliff: There are different forms of low T. Knowing which type is important in discovering the cause and proper treatment. The most common reason for low testosterone is that the testicles are no longer producing the same amount of hormone they used to. This is the vast majority of what we see. Decreased testosterone production in the testicles is largely due to age, but we’re also seeing it in more and more younger men. Low T can also stem from the brain not producing signals for the testicles to produce testosterone. Other causes of low T can include cancer, infections, radiation exposure, genetic disorders, autoimmune diseases, etc.

Question:  What happens when there’s too little testosterone produced?

Dr. Olliff: When men aren’t producing enough testosterone, there are adverse effects on bones and muscles. Low levels can even lead to injuries, fatigue, problems with concentration, moodiness and depression. In younger patients, low T impacts male fertility. And of course it has an impact on a man’s sex drive and his ability to maintain an erection.

Question:  How is low T diagnosed?

Dr. Olliff: Because low testosterone tends to mirror other medical problems, I make screening for low T routine. When a patient presents with certain symptoms, we administer a blood test to gauge the total testosterone level as well as the “free T” level. Many physicians are just looking at that total testosterone level, which is what insurance companies seem to focus on as well. But looking at the free T level is important because your total testosterone may be within what’s considered normal levels, but the free T – the testosterone that’s active in the body – may be low.

Question:  If my levels come back low, what happens next?

Dr. Olliff:  If the patient’s testosterone level is low, we bring them back in and recheck it. Insurance companies tend to want two tests that show levels below a certain threshold before they’ll cover any type of treatment. I check several other important labs to determine the cause, including PSA level since testosterone can increase the size of the prostate and worsen prostate cancer.

Question:  How do you treat low T?

Dr. Olliff:  There are several ways to replace testosterone. When it comes to symptom improvement and increasing testosterone levels, I have seen the best results with testosterone pellets (Testopel). Many primary care providers don’t do this procedure in the office like we do at ELFP. It is relatively quick and involves the doctor inserting testosterone pellets just beneath the skin of the lower back/upper glute. The capsules gradually release testosterone over a three-to-six-month period. The drawback is that the treatment is expensive, and it can be tricky to get insurance to cover it.

In my experience the next best option would be testosterone injections, but patients don’t tend to like those as much because, for one, they involve needles. Plus, some find it inconvenient to come in regularly, which is what the injections require. Other options are testosterone gels and creams, but they are also insurance dependent and come with risks of transfer to a spouse or children who might contact the same area. testosterone tablets are available but I do not prescribe them because of the potential for liver toxicity. Other oral options are fertility drugs such as Clomid and hCG. These kick start the brain to send the signal to the testicles to produce testosterone. (In women, these drugs help produce estrogen.)

Question:  Why do you think more younger men have low T?

Dr. Olliff: Doctors have theories, such as the foods we’re consuming, but we just don’t know for certain. One link we can make is between steroid use and low T. We know that teens and young men who have done anabolic steroids can see problems with testosterone that can follow them for the rest of their lives. I recommend avoiding all the over-the-counter testosterone supplements because they can potentially cause the body to stop producing testosterone naturally.

Question:  What about the increase in marketing surrounding low T? Good or bad?

Dr. Olliff:  I believe the commercials have been a good thing. More men are aware of it now, and I feel like it’s removed some of the stigma surrounding what is actually a common men’s health issue. I would encourage men who see those ads and think they could have low T to contact their physicians. It’s important to know what’s causing the low T to treat it appropriately and safely, plus there could always be another medical issue that’s causing the symptoms. Additionally, you’re going to need a prescription for testosterone replacement therapy if you hope to have insurance cover the costs.

If you suspect you have low T, schedule an appointment with your family doctor. Dr. Olliff regularly screens and treats patients with low testosterone at his office in Conyers. View our locations to find a clinic near you!

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