What Is Testosterone Deficiency in Men?
Testosterone deficiency (TD), also known as hypogonadism, is a condition where the body doesn't produce enough testosterone, a crucial hormone in men. Testosterone plays a key role in maintaining muscle mass, bone density, fat distribution, red blood cell production, and sexual and reproductive functions.
Why Does Testosterone Deficiency Happen?
Testosterone deficiency can occur for several reasons:
- Primary TD: Problems with the testes themselves, known as hypergonadotropic hypogonadism.
- Secondary TD: Issues with the hypothalamus or pituitary gland, referred to as hypogonadotropic hypogonadism.
- Combined TD: A combination of problems in both the testes and the brain's control centres.
- Impaired Testosterone Action: Situations where the body cannot effectively use testosterone.
What Are the Common Symptoms of Low Testosterone?
Men with testosterone deficiency may experience a variety of symptoms that affect their physical, sexual, and psychological well-being. These include:
Sexual Symptoms of Low Testosterone:
- Reduced sexual desire and activity
- Erectile dysfunction (ED): Difficulty achieving or maintaining an erection
- Loss of early morning erections
- Decreased frequency of sexual thoughts
Physical Symptoms of Testosterone Deficiency:
- Fatigue and low energy
- Decreased muscle mass and strength
- Hot flushes and sweating
- Osteoporosis: Weakening of bones, which can lead to fractures
Psychological Symptoms of Low Testosterone:
- Changes in mood: Such as irritability, sadness, or depression
- Decreased cognitive function: Difficulty concentrating, remembering things, or performing tasks
Cardiometabolic Symptoms of Testosterone Deficiency:
- Increased body weight: Especially around the abdomen (visceral obesity)
- Metabolic syndrome: A group of conditions that increase the risk of heart disease and diabetes
- Insulin resistance: Leading to type 2 diabetes
Who Should Be Screened for Testosterone Deficiency?
Screening for testosterone deficiency is recommended for:
- Men with multiple symptoms of TD
- Men presenting with ED, loss of spontaneous erections, or low sexual desire
- Men with type 2 diabetes or obesity (BMI >30 kg/m²)
- Men on long-term opiate, antipsychotic, or anticonvulsant medication
How Is Testosterone Deficiency Diagnosed?
Diagnosing testosterone deficiency involves a combination of history taking, physical examination, and laboratory tests:
History Taking:
- Discuss symptoms, medical history, and current medications.
Physical Examination:
- Checking height, weight, BMI, body hair, and prostate health.
Laboratory Tests:
- Measure testosterone levels in the blood, usually between 7–11 am when levels are highest. If levels are low or borderline, additional tests may be conducted to assess other hormones like LH (luteinising hormone) and FSH (follicle-stimulating hormone).
What Are the Treatment Options for Testosterone Deficiency?
Treatment for testosterone deficiency is often tailored to the individual, with Testosterone Therapy (T Therapy) being a common approach. This therapy can help alleviate symptoms and improve overall quality of life. Here are some options:
Types of Testosterone Therapy:
- Transdermal Gel: Applied daily to the skin, offering steady testosterone levels throughout the day.
- Intramuscular Injections: Administered every few weeks to maintain adequate testosterone levels.
- Alternative Treatments: For men who wish to maintain fertility, options like human chorionic gonadotropin (HCG), selective oestrogen receptor modulators (SERMs), or aromatase inhibitors (AIs) may be considered.
Benefits of Testosterone Therapy:
- Improvement in sexual function, including erectile function
- Increased muscle mass and strength
- Enhanced mood and cognitive function
- Reduction in fat mass and improved metabolic health
Considerations and Monitoring:
Before starting T Therapy, it’s crucial to discuss the potential benefits and side effects with your doctor. Regular follow-ups will be necessary to monitor testosterone levels, prostate health, and overall well-being.
Who Should Avoid Testosterone Therapy? Key Contraindications
Testosterone therapy may not be suitable for everyone. It is generally avoided in:
- Men with prostate or breast cancer
- Men with high haematocrit (a blood condition) or severe heart failure
- Men actively trying to have children
When to Stop Testosterone Therapy: Signs and Guidelines
If there’s no improvement in symptoms after six months, or if side effects outweigh the benefits, testosterone therapy might be discontinued. In such cases, other potential causes of symptoms should be investigated.
