My husband was tested and found to have very low testosterone levels.

Question:

My husband was tested and found to have very low testosterone levels.  He wants to use bioavailable hormones rather than the patch he was prescribed.  How do you determine his dosage, and how would the testosterone be applied.

Answer:

For men with low testosterone, we first determine this by doing a saliva test.   This is a test with four samples of saliva that are taken on a single day, and sent to a specialized laboratory.  The laboratory will analyze the saliva and give us a report of not only the testosterone, but other important hormone levels as well.  The reason we use saliva testing is because it will give us information on the bioavailable amount of testosterone rather than the total amount of testosterone, which is found in the blood.  This can often be misleading because a lot of testosterone in the blood stream is bound to protein such as albumen and cannot be readily utilized by the body.  To find a more accurate assessment of his true bioavailable testosterone level, we use saliva testing.  If he was truly low in testosterone, we would replace his testosterone using a Bio-identical testosterone cream.  The dose is individualized for the patient and compounded at a compounding pharmacy.  The dosage would be based on his saliva levels and he would apply the cream every day to the inner arms or inner thigh area.  The cream rubs in at about 1 minute, and then is reapplied on a daily basis.   We do not prescribed testosterone in the pill form because the oral form of testosterone has been linked with liver cancer.   Therefore, I always use the testosterone in the cream form.  At three months’ time, we would recheck his hormone levels and adjust his dose as necessary.  It is very important to keep the dose in the optimal range.  Additionally men with testosterone need exams and PSA blood tests drawn every six months, as testosterone does not increase the risk of prostate cancer.  If there was prostate cancer, we would want to hold off on using any type of hormonal therapy.  Therefore, we are very rigorous in our screening for any prostate abnormalities. Posted by Dr. Allison Pontius