Low Testosterone

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Low Testosterone and Hormone Replacement in San Antonio. For men and women.

ADAM Questionnaire for Men

  • Do you have a decrease in libido (sex drive)?
  • Do you have a lack of energy?
  • Do you have a decrease in strength and/or endurance? Yes No
  • Have you lost height?
  • Have you noticed a decreased “enjoyment of life”
  • Are you sad and/or grumpy?
  • Are your erections less strong?
  • Have you noticed a recent deterioration in your ability to play sports?
  • Are you falling asleep after dinner?
  • Has there been a recent deterioration in your work performance?

If you Answer Yes to number 1 or 7 or if you answer Yes to more than 3 questions, you may have low Testosterone. Click here to print the Questionnaire.

Hormone Replacment Checklist for Women

Women have similar symptoms. Here are some, which may make you think about hormone replacement.

  • Decreased sex drive or libido.
  • A decreased enjoyment of life.
  • Sleep problems which include falling asleep, staying asleep or waking up exhausted.
  • Migraine headaches
  • Bloating or weight gain
  • Vaginal dryness, hot flashes or night sweats.
  • Dry skin or hair loss
  • Bloating or swelling over the body


Frequently Asked Questions

Low testosterone or “Low T” is not a disease, but rather a natural aging process that can be regulated through proactive awareness. This occurs in men and women Testosterone production, which sustains sexual function and promotes muscular and skeletal health, drops 1% to 2% a year beginning in a man’s 20s. Almost 5% of the adult male population has Low T, but only a small percentage seeks treatment. Testosterone is important for multiple reasons. It helps:

  • maintain normal sexual and reproductive function
  • promote muscle and skeletal growth and maintenance
  • conversion to dihydrotestosterone (DHT), important for facial and body hair growth, acne suppression, and prostate development
  • conversion to estradiol (E2), which plays a role in bone formation and breast tissue development

Women and hormone replacement is nothing new. Dr Timothy Hlavinka is one of most experienced medical doctors in Texas helping women with hormone replacement. He is the only Fellow of the International Society of the Study of Women’s Sexual Health in Texas. Symptoms such as mood swings, hot flashes, depression, decreased sexual drive, migraines and problems losing weight in women may be caused by a hormonal imbalance.

Although testosterone levels naturally decline over time as men age, decline can also be the result of heredity, injury, medications, body fat, or disease. Patients suffering with obesity, diabetes, high blood pressure, high cholesterol, asthma, or COPD are more likely to have low testosterone levels as these conditions affect hormone production and response. Long-term use of some pain medications can also contribute to Low T.

One of the best “at home” tests to help men and women understand whether low testosterone levels might be affecting them is to fill out a questionnaire. For men, it is called the ADAM questionnaire. ADAM stands for Androgen Deficiency in the Aging Male. Answering the questions in the ADAM survey below can be useful for men. A printable version of the ADAM test can be accessed here. For women, there is a similar checklist below. If you note many symptoms or severe symptoms, be sure to get in touch.

Urologists at The Urology Place can confirm whether or not you have lower than normal testosterone levels with an examination and possible blood testing.

If you suspect you have low testosterone, your doctor may suggest you see a specialist such as a urologist or endocrinologist. We are board-certified urologists experienced with multiple forms of treatment.

If testosterone replacement is indicated, there are options:
Shots – Usually inexpensive but also the most painful. Shots are usually given once a week or every two weeks. The levels sharply spike after injection. Levels of testosterone rise above the normal range within the first 48 hours and fall below the normal range in the days prior to the next dose. This supraphysiologic rise and fall can be a matter of concern.

Creams – This is a painless way of applying testosterone. Transdermal testosterone formulations (patches, gels) can have limitations, such as local reactions, poor adhesion, fear of transmission to others, unpleasant odor, and high discontinuation rates.

Pellets- Testosterone pellets are bio-identical. In other words, it is the same type of testosterone as your body makes. Pellets can last for months at a time and have the benefit of holding steady levels. As a result, the erratic swings with other modes of therapy are avoided. The pellets are placed in the physician’s office in a 5-10 minute procedure. The pellets are shaped like large grains of rice and are placed in the upper hips or buttocks. Patients may experience soreness for a couple of days. It is a procedure, so there is a small risk of infection. The procedure itself is usually painless. Pellets are sourced from FDA registered 503B facilities. The sterile pellets are derived from yams, irradiated with E-beams to sterilize, and are in compliance with CGMP, which is the same as large commercial drug manufacturers.




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A San Antonio urologist, Naveen Kella M.D. is the Founder of the Urology Place. He is one of the most experienced surgeons in the country with robotic prostate cancer surgery.


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