As testosterone levels decline as we age, the signs of low testosterone (hypogonadism) may be presented in subtle yet unhealthy ways. You may have already reached out to your primary care physician about weight gain, insomnia, sleep apnea, depression, and erectile dysfunction — all common symptoms of low testosterone. It is very wise on your part to seek the counsel of our board-certified urologist, Dr. Tariq Hakky. He offers diagnostic services and treatment management with hormone replacement therapies at his private practice at Atlanta Cosmetic Urology.
Feeling the impacts of low testosterone or "low T" can present new challenges. In the past, you did not worry about your weight, sexual performance, ability to put on muscle mass (and keep it), proper sleep, or grumpy moods. Dr. Hakky would like to have a talk with you about your hormone levels and how he can make your quality of life better. Dr. Hakky wants you to know that he is on your side. If you are diagnosed with low T, then he will make sure you have the knowledge and the resources to select the appropriate treatment for your lifestyle. In our Atlanta, GA office, we offer therapies through topical treatments (gels or creams), injections, implants, inhalers, and supplemental medications. Our treatments can improve your life in many areas, including your sexual drive, your mental health, your weight, your level of energy, and much more. Dr. Hakky will diagnose and manage testosterone replacement for men, women, and transgender patients. There is no need for a referral. Call today and schedule your appointment to discover the benefits of these wonderful therapies.
"Dr. Hakky is hands down a doctor who cares about the well being of his patients. He goes the extra mile to show how much he cares. He is brilliant, humble and the BEST in his field of study."- M.M. / Google / Jan 27, 2020
"Almost 2 years ago Dr T. Performed a Eurolift leading up to through the procedure all follow ups have been perfect I followed him to his New and HIS PRACTICE. few weeks ago. Still great service by his staff and he is just ON HIS GAME So eurolift A SUCCESS"- B.L. / Healthgrades / Jan 22, 2020
"I've been Dr. Hakky's patient for a bit more than a year now for Low T. In that time, through multiple appointment's he's shown care, professionalism and knowledge above any medical professional I've worked with. He sat next to me with his ipad, wrote out my concerns, his thoughts, the plan moving forward and a directive to direct contact him with any concerns. He then sent that all directly to my email. I am EXTREMELY confident my health is in good hands, and I cannot give him, or his staff enough glowing praise."- Z.B. / Google / Jan 09, 2020
"I've been Dr. Hakky's patient for a bit more than a year now for Low T. In that time, through multiple appointment's he's shown care, professionalism and knowledge above any medical professional I've worked with. He sat next to me with his ipad, wrote out my concerns, his thoughts, the plan moving forward and a directive to direct contact him with any concerns. He then sent that all directly to my email. I am EXTREMELY confident my health is in good hands, and I cannot give him, or his staff enough glowing praise."- Anonymous / Healthgrades / Jan 09, 2020
"Dr. Hakky is such a great doctor. We first found him at a Urology practice in Snellville and were SOOOO happy to hear he was opening his own practice. My husband had an abnormal semen analysis and has Low T, so treatments were typically go to fertility specialist for IVF or IUI. Dr. Hakky introduced us to a newer way to treat both and we are now pregnant with our 2nd child and my husband feels great hormone wise. I am a nurse at a OBGYN practice and we now send all of our abnormal semen analysis patients to him. He has a great personality and knows his stuff. Highly recommend!!"- L.J. / Google / Dec 04, 2019
Living with lower levels of testosterone can affect many aspects of your physical, mental, social, emotional, and sexual health.
Have you noticed that you have trouble sleeping at night or get eight or more hours of sleep and still not feel rested? This is because low T levels can cause insomnia and fatigue. Feeling sluggish for no reason can be very distressing, especially when you are getting a healthy number of hours asleep.
Have you recently gained some weight or find it really difficult to lose a few pounds, like you could in the past? Weight gain is one of the major symptoms visible for everyone to see. You may feel defeated at the gym because working out does not seem to help. Neither does a change your diet. Low T will increase your body fat and diminish your muscle mass.
Low T can take away your sexual vitality. You may have experienced some interruptions in your sex life, such as erectile dysfunction, weak erections, low libido, or no desire in sex.
Mental and emotional health
Depression and moodiness are often overlooked symptoms for low T. There may be days when it is hard to focus or concentrate. Your other compounding symptoms certainly will not improve your mood and intensify your condition.
Your low T symptoms may be keeping you isolated because you just don't feel like being around others anymore. This can only reinforce feelings of sadness and anxiety. Low T can influence all aspects of your life, including your relationships and how you interact with people.
Truly, we want you to be comfortable with your selected testosterone replacement therapy and be consistent in taking your medication. There are several options (with both pros and cons to each) for you to choose: topical gels or creams, intramuscular injections, implants, and inhalers. Testosterone replacement therapy does have some risks or side effects to watch out for and monitor with routine doctor visits and blood work, such as:
- Thick blood (hinders blood thinners, as well)
- Increase the probability of a blood clot in the legs, lungs, and/or brain
- Acne and skin irritations
- Hypercalcemia (too much calcium in the blood causing weak bones)
- Bloating (especially in the arms and legs)
- Hair loss (male pattern baldness)
- Worsening of heart (cardiovascular) and brain (cerebrovascular) health
- Interference with other medications (like insulin for diabetics)
- Possible breast tissue growth (gynecomastia)
- Tenderness and inflammation of the breast tissue
- Potential prostate and breast cancer progression
- Reduction in the size of the testicles
- Liver damage or disease
- Exacerbate sleep apnea
- Difficulty with urination
- Infertility (lowered sperm count, poor quality sperm production)
- Unintentionally giving a dose of testosterone through skin-to-skin contact with your partner or children if using a topical therapy
Your preference matters. In your consultation with Dr. Hakky, he will share the options that are right for you. It is also important to keep in mind what your insurance will or will not cover. Here is a summary of the delivery methods we offer for testosterone replacement therapy:
Topical Testosterone Therapies
When you select a topical testosterone therapy for low T, you will have the option to apply the medication directly to your skin (usually on the shoulders, upper arms, abdomen, or inner thighs). Dr. Hakky prefers to prescribe Testim, AndroGel, Foresta, and Axiron dosages. This is considered one of the easiest testosterone delivery methods (in comparison to implants or injectables). The drawback to topical gels and creams is that the medication can be imparted to your loved ones who come into skin-to-skin contact with the application area. The low T cream can also transfer through your clothes. You may need to weigh the pros and cons of topical treatments with Dr. Hakky before selecting this method.
Rest assured, many men with low T have found that intramuscular injections of hormone replacement medications are the most effective and satisfactory method of delivery — if you can learn to tolerate needles and/or giving yourself an injection. Dr. Hakky can prescribe Testosterone Cypionate, Testosterone Enanthate (Xyosted™), or Testosterone Undecanoate (Aveed).
Pellet therapy or Testopel® (a subcutaneous testosterone pellet replacement therapy) can be implanted into the skin for several months for continuous dosage of testosterone. The pellets, which hold 75 mg of testosterone, have to be replenished every 3 – 4 months (based on your treatment plan), which means that there is no need for daily dosing. Dr. Hakky can place 10 – 14 small pellets under your skin in a quick office visit. There are risks to having a testosterone implant, such as bleeding, allergic reaction, infection, and more that can be discussed when deciding if this is the right method for you.
If you feel uneasy about injections of testosterone or having a subcutaneous pellet implant, Dr. Hakky can offer you an inhalable testosterone gel called Natesto® Nasal Gel. To administer this medication, you would blow your nose first. Then, you would spray one dose into each nostril three times a day. You would not be able to pass the hormone on to others if they touch your skin as they would with a topical testosterone application.
There are additional medications that may be prescribed to decrease the symptoms of low testosterone:
For low sperm production — Clomid
Clomid is an estrogen regulator, which means that it decreases the amount of estrogen (in men) to boost the production of other hormones, like FSH (follicle-stimulating hormone) or luteinizing hormone (LH). This results in an elevated testosterone level and sperm count.
For elevated estrogen levels — Arimidex
Arimidex is known as an "estrogen blocker." When you increase the amount of testosterone in the body with hormone replacement, you are also boosting estrogen levels because the aromatase with your testosterone is taken away to be converted into estrogen. This leads to more symptoms of low T and estrogen dominance (20 – 30 range). By taking Arimidex with your testosterone hormone replacement therapy, the medication can keep your estrogen levels in check.
For decreasing the effectiveness of the estrogen in your blood — Nolvadex
You can take an oral medication called Nolvadex or tamoxifen citrate to lessen the powerful punch estrogen can give your testosterone levels without changing your estrogen level.
For better balance in testicular health and testosterone production — hCG
Injections of Human Chorionic Gonadotropin (hCG) can prompt testosterone production within your testicles. These hCG injections can assist in maintaining the size of your testicles and help them function better.
For hypoactive sexual desire disorder (HSDD) – Addyi
Addyi is a non-hormonal, oral prescription medication that has proven successful in the treatment of HSDD or loss of sexual desire for both men and women. The medication offers promising results when testosterone replacement therapy proves ineffective. An added benefit is the fact that Addyi is an oral medication, which frees you from the burden of needles, patches, or pellets.
What to Expect
Because we are adjusting your hormone levels with testosterone replacement therapy, Dr. Hakky will want to monitor your progress (regardless of the type you select). He may ask for the following:
- A physical exam once a year
- A blood panel to check your hormone levels quarterly (every 3 – 5 months)
- A biannual blood test to check your lipid, hemoglobin, hematocrit (red blood cells), and prostate-specific antigen counts (every six months)
Plan Your Procedure
Boost Your Numbers
Let's take a look at your hormone levels to see if you would benefit from a testosterone replacement therapy. Low T can be treated with multiple modalities, like gels, injections, implants, and/or inhalers. Dr. Hakky will assess your hormone levels to find out which would be best for you. Call Atlanta Cosmetic Urology in Atlanta, GA today to get started and boost up your testosterone levels.