Testosterone deficiency

Both men and women experience changes in hormone production as they grow older. In men, testosterone – a hormone produced in the testicles – tends to decrease with age.

Testosterone has a number of functions, playing a role in:

• Sexual drive and function
• Sperm production
• Bone growth and density
• Muscle strength and mass
• Body fat levels and distribution
• Red blood cell production
• Emotional well-being

Unlike female menopause, the male hormonal change happens very gradually. Testosterone levels vary between individuals, but peak in adolescence and young adulthood, decreasing on average about 1 percent a year after age 30. While this decline is often considered a natural part of ageing, it can be exacerbated by poor health and lifestyle.

Abnormally low testosterone levels, a condition called hypogonadism, can also be caused by various underlying disorders. While more common in older men, hypogonadism can occur in men of any age, and may result in serious health and quality-of-life issues.

Causes
Testosterone deficiency occurs because of loss of function in the hormonal system and the testes. In hypogonadism, the dysfunction may be due to a range of conditions:

• Damage to, or loss of, the testicles
• Cancer treatment
• Obesity
• Genetic factors
• High iron levels
• Pituitary gland dysfunction
• Inflammatory diseases
• Chronic (long-term) illness
• Kidney failure
• Alcoholism and cirrhosis of the liver
• Use of hormone-containing medications
• Steroid or opiate abuse
• Stress

Men with diabetes, hypertension, rheumatoid arthritis, hyperlipidaemia or osteoporosis also have a higher incidence of testosterone deficiency.

Symptoms
Some men have no or mild symptoms. For others, testosterone deficiency may cause:

• Loss of libido (sex drive), erectile dysfunction and general loss of sexual function
• Lowered physical energy
• Depressed mood, irritability
• Sleep disturbance
• Loss of muscle tone
• Increased body fat, especially belly fat (a risk factor for cardiovascular disease)
• Mild anaemia
• Osteoporosis
• Changes in cholesterol levels
• Abnormal sperm production
• Shrinking testes
• Flushes and sweating
• Pain in the breasts
• Loss of body hair
• Poor concentration and memory
  
  

These symptoms can be subtle and gradual, and may not be noticed or recognised at once. Some are a normal part of ageing, or may be the signs of other unrelated disorders.

If you suspect that you have low testosterone, see your doctor for a blood test. Because testosterone levels fluctuate, several samples may be needed. Often the blood will be taken in the morning, when testosterone levels are highest.

Treatment
Where the deficiency is causing distress or health problems, testosterone replacement therapy may be effective. (Note that no herbal supplements have been shown to help – and some might be dangerous.)

Testosterone can be introduced into the body in a number of different ways. Your doctor will advise you on which of these treatments, if any, is best for you:

• A topical gel
• Patches on the scrotum or elsewhere on the body
• Injections every few weeks
• Pellets implanted under the skin
• Oral tablets
• A roll-on stick
• Material applied to the gums
  
  

This therapy is relatively safe. However, there may be some side effects:

• Worsening of sleep apnoea (a sleep disorder)
• Skin problems: acne or oiliness
• Fluid retention
• Prostate growth, possibly causing problems with urination
• Breast enlargement
• Shrinking testicles
• Changed cholesterol levels
• High red blood cell count, which can increase the risk of heart disease
• Low sperm count
• Mood swings
  
  

Note: Men with prostate or breast cancer should not take testosterone replacement therapy, and all patients should first be screened for this. While testosterone doesn’t cause prostate cancer, it can speed up its spread.

It’s not clear that testosterone therapy has any benefit in the case of healthy older men whose testosterone is naturally declining. Given the risks, it’s generally not advised.

It will help you to manage the condition if you follow a healthy diet and exercise regularly: this improves muscle strength, energy levels and sleep patterns. It’s also advisable to seek help for any mood problems such as depression, which may be related to low testosterone or its effects. Note that drinking excessively can be a sign of depression.

- (Health24, October 2013)

(Source: Dandona, P and Rosenberg, M.T., 'A practical guide to male hypogonadism in the primary care setting', International Journal of Clinical Practice, May 2010)