33. Testosterone Deficiencies
33. Testosterone Deficiencies
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Testosterone Deficiency Syndrome (Hypogonadism)
Testosterone Deficiency Syndrome, or Hypogonadism, is a condition in which a man’s body does not produce sufficient testosterone, the primary male hormone. This condition generally affects older men, but younger patients can also be affected for a variety of reasons.
While the term “andropause” is sometimes used for this condition, it is inaccurate. Unlike menopause, testosterone deficiency syndrome is not an inevitable result of aging.
Testosterone plays a key role in a man’s sex drive, muscle mass, as well as mental and physical energy.
There are several symptoms that are associated with a deficiency in testosterone in men:
• Reduced libido
• Difficulty obtaining or maintaining an erection
• Difficulty concentrating or making decisions
• Poor results from exercise programs
• Increase in body fat
• Loss of lean body (muscle) mass
• Loss of bone density
• Poor work performance
• Unfavorable changes in cholesterol profile
In some cases, a specific cause for testosterone deficiency may be discovered. An example would be excess secretion of one or more pituitary hormones that then interfere with testosterone production or availability.
In most people, though, no cause for testosterone deficiency can be found. In these cases, testosterone replacement therapy is usually an effective treatment.
Beyond the symptoms that many men experience, testosterone deficiency syndrome can also contribute to the onset or worsening of various diseases.
• Increased risk of cardiovascular disease.
• Increased risk of death from a cardiovascular event.
• Increased risk of metabolic syndrome: high blood pressure, elevated insulin levels, excess belly fat and abnormal cholesterol levels.
• Strong association with diabetes.
• Strong association with atherosclerotic disease of the aorta.
• Higher incidence of prostate cancer.
• Association with more aggressive variants of cancer.
Testosterone deficiency is typically diagnosed with a simple blood test.
When a specific cause for testosterone deficiency can be identified, treatment can be focused on that cause. In the case of excess pituitary secretion of hormones, for example, medicine or surgery may be used to correct the underlying problem.
In cases where no specific cause can be identified, testosterone replacement therapy is the most common treatment option.
Testosterone replacement therapy raises the body’s testosterone levels through regular administration of testosterone. This therapy can take several forms:
• Testosterone patches deliver a defined amount of testosterone daily but must be replaced each day.
• Testosterone gels work in much the same way as testosterone patches, requiring daily application.
• Intramuscular testosterone supplementation is an injection that is given every one to four weeks.
• Testosterone “pellets” are implanted beneath the skin, providing a stable level of testosterone for 4-6 months.
There are two other forms of testosterone therapy that are either not available in the U.S. or not recommended:
• The testosterone wafer dissolves between the lip and the gum. It is not commonly used because it must be taken twice each day and causes gum irritation in many patients.
• A long-lasting oral preparation of testosterone is currently available outside the U.S., but it has not yet been approved by the FDA for sale in this country.
Testosterone is a hormone produced by the testicles and is responsible for the proper development of male sexual characteristics. Testosterone is also important for maintaining muscle bulk, adequate levels of red blood cells, bone growth, a sense of well-being, and sexual function.
Inadequate production of testosterone is not a common cause of erectile dysfunction; however, when ED does occur due to decreased testosterone production, testosterone replacement therapy may improve the problem.
What Causes Low Testosterone?
As a man ages, the amount of testosterone in his body naturally gradually declines. This decline starts after age 30 and continues throughout life. Some causes of low testosterone levels are due to:
• Injury, infection, or loss of the testicles
• Chemotherapy or radiation treatment for cancer
• Genetic abnormalities such as Klinefelter’s Syndrome (extra X chromosome)
• Hemochromatosis (too much iron in the body)
• Dysfunction of the pituitary gland (a gland in the brain that produces many important hormones) or hypothalamus
• Inflammatory diseases such as sarcoidosis (a condition that causes inflammation of the lungs)
• Medications, especially hormones used to treat prostate cancer and corticosteroid drugs
• Chronic illness
• Chronic kidney failure
• Cirrhosis of the liver
• Obesity (especially abdominal)
Before starting testosterone therapy, patients should recognize that it is a life-long commitment. Testosterone supplementation results in a reduction in the amount of testosterone that is naturally produced by the body.
Testosterone replacement therapy can also raise a patient’s red blood cell mass, reflected in a test called the hematocrit. As a result, careful monitoring of hematocrit levels is essential.
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