HJAR Jan/Feb 2024

HEALTHCARE JOURNAL OF ARKANSAS I  JAN / FEB 2024 47 Brad Houston, MD Arkansas Urology Available treatment for low T Low T treatments can be performed with topical gels, creams, liquids, and patches, with some options remaining on the skin for up to four days. Many patients see success in balancing their testosterone levels with short-acting or long-acting testosterone in- jections. These injections are typically given once a week, biweekly, or once a month. Healthcare professionals will occasionally recommend oral testosterone treatments, which resemble medicine tablets and sit above the incisors. The testosterone is re- leased over a 12-hour period but should not be chewed or swallowed. Intranasal gels may also be prescribed, with patients instructed to manually perform the short-acting treat- ment three times daily. Some patients receive pellets under the skin of their upper hip or buttocks, requir- ing local anesthesia and a small incision. These pellets dissolve slowly and release the testosterone over the course of three to six months. The importance of an accurate diagnosis and treatment Our role as healthcare professionals is to deliver the highest level of care to each and every patient. Acritical misdiagnosis can not only result in incorrect treatment plans, but it also puts patients’ mental health and wellbeing at risk. Receiving a diagnosis or medical results you weren’t expecting demands introspec- tive processing. Consider a patient who vis- ited your clinic with low T symptoms, only to be told they’re infertile. Suddenly, they’re grappling with fear, doubt, worry and con- fusion — all while experiencing symptoms that are diminishing their comfort. What if it really was low T all along? To reverse your findings would pose a re- lief to that patient, but the immediate, men- tal effect a diagnosis can have on a patient is such a fragile thing. Low T often evokes feelings of embarrassment or reduced mas- culinity in men, greatly underscoring the im- portance of a correct diagnosis. If a patient is expressing all the warning signs and symptoms of lowT, yet the effects are caused by another irregularity or condi- tion in the body, it’s our oath-bound duty to find the root of the symptoms. It goes without saying that misdiagnoses are to be avoided at all costs, but when ex- amining clients suffering from symptoms related to low T, it’s imperative that we be as thorough as possible in our testing and review. Each patient is unique. Never simply write off low testosterone levels as a con- sequence of aging. Examine the evidence from all angles. Conduct a thorough review of your patient’s health history and data before delivering your diagnosis. It could change their life — physically andmentally. n REFERENCES 1 Urology Care Foundation. “What Is Low Testosterone?” Accessed November 2023. https://www.urologyhealth.org/urology-a-z/l/ low-testosterone Brad Houston, MD, graduated from the University of Arkansas for Medical Sciences with both a Mas- ter of Public Health and a Doctor of Medicine. Upon the completion of the third year of medical school, Houston received the Barton Foundation Scholar- ship.The Barton scholarship is awarded annually only to students who complete the prior year of medical school with the highest grade point average. After completing medical school at UAMS in Little Rock, he completed an internship and residency in urology at University of Tennessee Health Science Center. Acquired conditions that may affect the testes and the production of testosterone in- clude testicle injury or removal; orchitis due to bacterial, viral, or sexually transmitted in- fection; chemotherapy or radiation therapy; tumors in the body; or anabolic steroid use. Some patients experience low T symp- toms due to secondary hypogonadism, a condition that affects the hypothalamus and/ or pituitary gland, producing lower levels of luteinizing hormones (LH) and follicle-stim- ulating hormones (FSH). This can lead to de- creased testosterone and sperm production. Congenital conditions that may lead to secondary hypogonadism include isolated hypogonadotropic hypogonadism, Kall- mann syndrome, and Prader-Willi syndrome. Acquired conditions that have been known to lead to secondary hypogonad- ism include hypopituitarism, hyperprolac- tinemia, iron overload (hemochromatosis), Cushing’s syndrome, cirrhosis, kidney failure, HIV or AIDS, alcohol use disorder, poorly managed diabetes, obesity, sleep apnea, and a brain or head injury. Medications may also lead to secondary hypogonadism. There are many other possible reasons for these symptoms, such as opioid use, certain congenital conditions, loss of or harm to the testicles, diabetes, and obesity. In some cases, infertility can be tied to low testosterone levels. However, present- ing common symptoms or traits of low tes- tosterone does not always correlate with a diagnosis of infertility. Erectile dysfunction can also be misdi- agnosed as indicative of low T, even though ED is much more likely to stem from smok- ing, thyroid-related issues, high cholesterol, stress or anxiety, alcohol consumption, dia- betes, or high blood pressure.