Signs that may point to low testosterone
Testosterone usually declines slowly with age, and many men never have symptoms from it. When levels fall low enough to matter, signs can include:
- Low sex drive
- Erectile difficulties or fewer morning erections
- Persistent fatigue
- Low mood or irritability
- Poor concentration
- Sleep changes
- Loss of body hair
- Reduced bone density
The same symptoms often come from other causes, including sleep apnea, thyroid problems, depression, diabetes, excess body fat, alcohol and certain medications. An internist’s first job is to find out which applies to you.
How low testosterone is diagnosed
Low testosterone is diagnosed with consistent symptoms plus low testosterone confirmed on at least two separate early-morning blood tests, in line with Endocrine Society and American Urological Association guidelines. Morning testing matters because levels are highest early in the day.
Your baseline panel at Embrace Eternal Beauty includes free and total testosterone with SHBG, free and total PSA, a complete blood count, a comprehensive metabolic panel, HbA1c, a thyroid panel, vitamin D and B12.
When TRT is and isn’t appropriate
Testosterone therapy is considered only when low testosterone is confirmed, your symptoms fit, and the benefits outweigh the risks for you. FDA-approved testosterone products are approved for men with low testosterone caused by specific medical conditions; their benefit for age-related decline alone hasn’t been established.
Testosterone isn’t prescribed when levels are normal, for age alone, or for athletic or bodybuilding purposes. If your levels are normal, Dr. Pabona looks for the other causes of your symptoms instead.
Treatment options
When therapy is appropriate, your plan may use:
- Pellets: placed under the skin for steady release over several months, using the EvexiPEL® Method
- Injections: flexible dosing, with adjustments guided by your labs
- Topical testosterone: daily gels or creams for select patients
Pellets made by compounding pharmacies are not FDA-approved, and a pellet’s dose can’t be adjusted once it’s placed. The hormone replacement therapy page explains each option in more detail.
Risks, fertility and monitoring
Testosterone is a Schedule III controlled substance and needs ongoing monitoring. Therapy can raise your red blood cell count (hematocrit), which increases clot risk, and it may affect the prostate, so PSA is checked when appropriate. Other possible effects include acne, fluid retention, breast tenderness and worsening sleep apnea.
Testosterone therapy can lower sperm production and fertility. If you hope to have children, tell Dr. Pabona before starting, because other approaches may fit better.
Whole-health care for men
Men’s care at Embrace Eternal Beauty is guided by internal medicine. Alongside hormone evaluation, your plan may include metabolic labs, an insulin sensitivity and cardiometabolic risk assessment, and preventive guidance. Many men pair it with physician-led medical weight loss, B12 shots or peptide therapy when a physician evaluation shows it’s appropriate.
Every plan is overseen by Dr. Pabona, board certified in internal medicine (ABIM).
Cost and scheduling
Men’s hormone services are typically self-pay, and pricing is reviewed during your consultation. CareCredit financing is accepted. Appointments run until 8 PM, Tuesday through Saturday, at 4328 Central Ave, Suite B, about 35 minutes from Hot Springs Village.
Whole body
Works throughout the body rather than in one skin layer.
Questions
Common questions about men’s wellness
How do you qualify for testosterone replacement therapy?
You need symptoms consistent with low testosterone plus low levels confirmed on at least two separate early-morning blood tests. Your history matters too: prostate or breast cancer, a high red blood cell count, untreated severe sleep apnea, uncontrolled heart failure or plans to have children can affect whether therapy is appropriate. Dr. Pabona reviews everything at your consultation.
What is the average monthly cost of testosterone replacement therapy?
It varies with the type of therapy, the dose and how often you need labs and follow-up. Injections, gels and pellets are priced differently, and lab monitoring is a separate cost. At Embrace Eternal Beauty, men’s hormone services are typically self-pay, and your pricing is reviewed during your consultation. CareCredit financing is accepted.
Where can I get testosterone replacement therapy?
Testosterone is a prescription-only, Schedule III controlled substance, so it should come from a licensed clinician after an evaluation and lab testing, never from an online seller without a prescription. In Hot Springs, Dr. Pabona evaluates men at Embrace Eternal Beauty on Central Avenue and prescribes testosterone only when it’s clinically appropriate.
Does testosterone therapy affect fertility?
Yes, it can. Testosterone from outside the body signals your brain to make less of the hormones that drive sperm production, which can lower sperm counts and fertility, sometimes significantly. If you want children now or in the future, tell Dr. Pabona before starting so you can talk through the risks and other approaches.
What are the side effects of testosterone therapy?
Possible side effects include a higher red blood cell count, acne or oily skin, fluid retention, breast tenderness or enlargement, worsening sleep apnea and reduced fertility. Therapy may also affect the prostate. That’s why treatment includes ongoing monitoring of your testosterone level, hematocrit and, when appropriate, PSA, with dose changes as needed.
What else can cause low energy and low libido in men?
Many things besides testosterone: poor sleep or sleep apnea, stress, depression, thyroid problems, diabetes, excess body fat, alcohol, and medications such as opioids or some antidepressants. That’s why an internist-led evaluation looks at your whole health first. If your testosterone is normal, Dr. Pabona focuses on finding and treating the real cause.
