Testosterone Deficiency

Testosterone Deficiency (Low T)

Dr. Pugach no longer treats men with Low T and refers patients to USC Institute of Urology at Keck Medicine USC.


Testosterone DeficiencyOne of the most common conditions treated at Pacific Coast Urology’s Male Health & Hormone Center of Excellence is Low Testosterone. Also know as Low T, andropause and male menopause, Low T is being diagnosed with increasing frequency. Largely ignored in the past, Low T is now recognized as one of the most important issues in men’s health today. Not only does it cause symptoms ranging from low libido to depression, it also has been linked to many serious medical conditions (see below for medical conditions that may be associated with low testosterone).

I am Eric N and for the last 3 years, I have been visiting Dr. Pugach for the symptoms of men low Testosterone level. In the first year, I was getting T-shots once every 3 weeks, but I noticed that it was too time consuming so I was requesting self-control T-shots but monitoring through Dr. Pugach and the P.A (Evans Tran).

They are very professional and very supportive through the years. I am more active at working out at the gym and toned up my muscles. They recommended and provided the right medication for men’s E.D symptom which in a way, helps me in my case. My sex life style changes to better, etc. Overall, I highly recommend to men getting fatigue all the time and sex drive is not performing well. I recommended to visit Dr. Pugach for a consultation. Thank you.


Eric N.


Just as women go through menopause as they age, men go through andropause. Men’s testosterone levels peak between the ages of 25 and 35. From that point on, three is a gradual decline of approximately 1% to 3% per year. By age 40, estimates are that as many as 15% of men may have a testosterone deficiency! That number increases year after year.


The principal cause of Low T levels is a decrease in the number of functioning Leydig cells in the testicles. These cells are responsible for testosterone production. Simply stated, the testicles gradually burn out. That’s why many advertised remedies that claim to boost testosterone production don’t work – there aren’t enough Leydig cells to stimulate as men get older.

Other causes include disorders of the hypothalamus, the pituitary gland and certain brain tumors. In some men, dilated veins in the scrotum cause low testosterone levels and these can often be corrected with a short, outpatient surgical procedure.

Another cause of Low T symptoms is a decline is bioavailable, or “free”, testosterone. Most of a man’s circulating testosterone can’t be metabolized. Only testosterone that is not tightly bound to proteins in the blood stream is available. One circulating hormone, called SHBG (or Sex Hormone Binding Globulin) binds testosterone tightly so it can’t be utilized. For reasons not clearly understood, SHBG levels increase as men get older so the percentage of free, useable testosterone declines.

How much does it decline? Part of that depends upon when a man’s testosterone level peaks. As noted previously, that’s usually between the ages of 25 to 35. From then on, testosterone levels drop by 1% to 3% per year. By age 40, 15% of men have Low T; by age 55, 40% of men have Low T. Testosterone levels continue to decline every year.

Whether you call the condition Low T, andropause, male menopause or hypogonadism, the significance of decreasing testosterone levels can’t be overstated. Testosterone is important for a number of reasons. Read below to learn about some of them.


Testosterone is an anabolic steroid hormone that is actually made from cholesterol. In men the vast majority of testosterone comes from the testicles. In women a very small amount of testosterone is made by her ovaries. The adrenal glands also contribute a small amount. The normal value of total testosterone in males varies considerably during a 24 hour period. It peaks in the early morning hours and declines by approximately 35% as the day goes on. That’s why it’s important to have an experienced professional like Dr. Robert Pugach evaluate your testosterone blood levels to determine what replacement therapy may be right for you.


In men, testosterone is important for many functions, including:

  • Development and maintenance of reproductive tissues
  • Promotion of secondary sexual characteristics like a deep voice and hair distribution
  • Stimulation of sperm production
  • Creation of sexual desire (libido)
  • Prevention of mood swings and depression
  • Development and increases in muscle mass and strength
  • The ability to multi task and maintain good memory
  • Maintenance of bone strength and prevention of bone thinning (osteoporosis)
  • Prevention of diabetes
  • Maintenance of good cardiac (heart) function
  • Preservation of good eyesight


In adult men low testosterone has been linked to the following symptoms:

Decline in sexual function. This can take many forms including a reduction in sexual interest and desire (libido), erectile dysfunction(ED), or a decline in fertility (infertility).
Changes in body and physical characteristics. Muscle mass may decline and body fat my increase. Specifically, abdominal fat may become more prominent and noticeable and be difficult to lose. Loss of hair may also occur.

Change in energy level. Some men report a decrease in energy levels and may fatigue easily, especially in the afternoon and early evening hours. Being exhausted at the end of a work day or taking afternoon of after dinner naps are common symptoms.

Change in sense of well being and mental ability. Low T is a cause of male depression, irritability, mood swings and loss of confidence.
Disruption in sleep patterns. Low testosterone has been reported as one of the causes of sleep disturbances, including insomnia.
Changes in concentration and memory. Low testosterone may contribute to changes and declines in memory, concentration and the ability to multi-task. In some cases, it can actually be mistaken for dementia or Alzheimer’s disease.


Decreased testosterone levels have also been implicated in a number of serious health conditions such as:

  • Bone Diseases such as thinning bones (osteopenia) or brittle bones (osteoporosis)
  • Diabetes
  • Congestive Heart Failure
  • Visual problems
  • Coronary Artery Disease


Because of the staggering number of men who suffer from Low T, a number of products have come to the marketplace for treatment. Some of these can be very beneficial while some are a waste of money despite aggressive marketing campaigns. At the Male Health and Hormone Center of Excellence we understand that we have a very important role – to advise and guide you through the confusing number of treatments to find the one that’s best for you. Some of the available treatments are:

  • Custom compounded creams
  • Gels
  • Injections given in the office or in your home
  • Pellets that require replacement every 3 to 4 months
  • Nasal sprays


Before beginning any type testosterone therapy, an appropriate examination must be made to ensure that there are no more serious causes of Low T such as testicular growths, abnormalities of the pituitary gland or a part of the brain called the hypothalamus, and some other medical conditions, as indicated in the aforementioned sections.

Despite the many television commercials and magazine ads for various types of over-the-counter gels and pills for Low T, Dr. Robert Pugach strongly advises men to consult with a physician before beginning any type of testosterone replacement therapy. It is important that blood tests are done to determine the levels of both total and free testosterone. At Pacific Coast Urology’s Male Health & Hormone Center of Excellence, we provide a thorough evaluation including a medical history, thorough medical exam and appropriate blood tests. We use only reputable laboratories for your testing to ensure that we get the most accurate results possible. In addition, we screen patients for prostate cancer. This must be done because there may be a link between testosterone administration and prostate cancer in later years.

A lot of research and work has been done to develop new, easier and safer treatments for Low T. However, before you begin treatment for low testosterone schedule an appointment with Dr. Robert Pugach to obtain a proper medical evaluation, accurate diagnosis, an individualized treatment plan and follow-up visits to monitor your testosterone levels. (See Low T Treatment Options for more information)


If you think you have low testosterone and are suffering from the symptoms described above, call the Male Health & Hormone Center for a confidential appointment. There‘s no need to suffer from Low T anymore! At Pacific Coast Urology Medical Center we’re proud to have a Center of Excellence for Male Health & Hormone diagnosis and treatment.   CALL: 888-735-4336 or Email us via our Contact Us form for your consultation.