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Can low testosterone return to normal?

Treatment for low testosterone is an ongoing process and usually will continue long term. As with many other chronic conditions, if you stop the therapy, the problem returns — your testosterone levels will drop back down to below-normal levels.

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A diagnosis of low testosterone, or low T, can be the answer to a number of concerns you’ve been having — your low energy, the decrease in your sex drive, or feeling depressed. But it also presents questions: Mainly, what happens next?

There's no quick fix, but your first step is to follow up with your doctor, who may recommend treatment for low testosterone. Aside from causing a drop in your sex drive and energy levels, low testosterone can increase your risk for heart disease, depression, type 2 diabetes, and osteoporosis.

How to Treat and Manage Low Testosterone: First Steps

If your low testosterone is caused by an underlying health condition, such as obesity, type 2 diabetes, or sleep apnea, treating that condition may help improve low testosterone, says Ahmer Farooq, DO, assistant professor of urology at Loyola University Medical Center in Maywood, Ill. Many doctors also recommend an overall healthy lifestyle as a first approach. But even if you’re prescribed testosterone treatment, diet, exercise, stress management, and other healthy habits are important to keep symptoms of low testosterone at bay as well. "Eat foods that are low in saturated fat and exercise regularly," Dr. Farooq says. A 2013 study published in The Journal of Sexual Medicine found that men who engaged in moderate-intensity aerobic exercise for more than 3½ hours each week had greater improvement in testosterone levels, sexual function, and losing weight and belly fat than men who got less than 2½ hours of physical activity a week.

Treatment Options for Low Testosterone

Treatment for low testosterone may involve hormone replacement therapy. "Essentially, the body is being given the testosterone it’s lost," says Farooq. For some men, testosterone replacement therapy can help improve sex drive, ease symptoms of depression, and increase energy levels. Treatment may also boost muscle mass and bone density. Testosterone replacement therapy is available in several different forms, Dr. Farooq says. The most common form is a topical gel. About 70 percent of men on testosterone replacement therapy apply these gels daily. "Gels are used in places where men are less likely to come into contact with women or children, such as the inner thigh, shoulder, or armpit," Farooq says. And the gel should only be applied to areas of the body covered by clothing to avoid contact with others.

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About 17 percent of men treated for low T receive testosterone injections every 7 to 22 days. Testosterone levels peak two to three days after the injection and then slowly drop until the next dose of the hormone is given. There are also testosterone patches that men can use. These patches can be placed on areas of the body such as the back, stomach, upper arm, or thigh. About 10 percent of men with low testosterone use the patches. The skin absorbs the testosterone, which is slowly released into the bloodstream. An uncommon option, used by no more than 3 percent of those men being treated for low T, is implanted testosterone pellets. Over the course of three to four months, the pellets slowly release testosterone into the body. The procedure must then be repeated. Only rarely are oral medications used to treat low T because these medications have potentially harmful side effects to the liver.

When Will Treatment for Low Testosterone Start Working?

For men who are prescribed testosterone replacement therapy, it usually takes three to six months to work, Farooq says. "Some men may see improvement sooner, but for most men it's a gradual process,” Farooq says. “Don’t expect a miracle overnight." Research published in 2011 in the European Journal of Endocrinology, however, suggested that the effects of testosterone replacement therapy on men's libido and symptoms of depression may begin after three weeks. Treatment for low testosterone is an ongoing process and usually will continue long term. As with many other chronic conditions, if you stop the therapy, the problem returns — your testosterone levels will drop back down to below-normal levels.

Potential Risks of Low Testosterone Treatment

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The number of men using testosterone replacement therapy in the United States has increased dramatically over the past several years. Several short-term studies have shown it to be an effective treatment in appropriately selected individuals, but the long-term effects remain unclear. Like any other medication, testosterone replacement therapy carries certain risks. Although research has shown mixed results, it could possibly stimulate growth of existing prostate cancer. Men who’ve been diagnosed with breast cancer or prostate cancer aren’t candidates for testosterone replacement therapy, Farooq says. Testosterone replacement could also contribute to sleep apnea. Farooq says that men should be screened for sleep apnea before receiving treatment for low testosterone. Treatment for low testosterone could also limit sperm production, cause your body to make too many red blood cells, or lead to acne or enlargement of the breasts. "It's important to look at a man’s low testosterone levels and weigh the risks and benefits of treatment," Farooq says. He also says that bringing your spouse or partner with you to checkups can help if you feel apprehensive about discussing your concerns or symptoms with your doctor.

When to Schedule Follow-Ups With Your Doctor

"During the first year of treatment for low testosterone, men are usually seen every three months to check their blood and testosterone levels," Farooq says. Among the tests you can expect are the prostate-specific antigen (PSA) screening test for prostate cancer and blood tests to measure lipids, liver function, and red blood cell count. "If you’re healthy after one year, follow-up visits may be spaced out to every six months," Farooq says. "It’s important to make sure you’re not developing any of the potential side effects of treatment."

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