Have you lost your bounce?
Low Testosterone or Testosterone Deficiency Syndrome (TDS) is often missed by doctors because patients might not discuss symptoms they may be experiencing. <sup>1, 2</sup> Approximately 20% of men over the age of 50 have lower than normal levels of testosterone. 1
Evidence suggests that only a small percentage of men with TDS are diagnosed and treated. 1
As you get older your body changes. Perhaps you aren’t as lively as you once were, or you might have put on some weight? Sometimes this is a normal part of ageing but not always. You may be experiencing symptoms of low testosterone. 3
What is testosterone?
Testosterone is an androgen hormone, which plays a vital role in male sexual development before birth and during puberty. 3
The functions of testosterone 2,3,4
- Forms and maintains the sexual organs
- Helps produce sperm
- Regulates sex drive (libido)
- Promotes male sex charactereistics such as voice deepening and growth patterns
- Facilitates muscle growth, bone development and maintenance
What are the symptoms of low testosterone?
Low testosterone can be divided into sexual and non-sexual symptoms: 5
Sexual Symptoms 3,5,6,7
- Erectile dysfunction
- Low libido
- Weaker and fewer erections
- Reduced sexual activity
Non-Sexual Symptoms 3,5,6,7
- Decrease in beard and body hair growth
- Loss of muscle bulk
- Thinning of the bones
- Increased body fat
- Decreased energy levels (fatigue)
What are the causes?
There are a number of reasons why testosterone levels may decline. 7 Symptoms may occur quickly or gradually, sometimes taking years to become noticeable.
The decrease in normal testosterone production can be classified as: 3,6,7
- Primary, when the problem is in the testes – not functioning normally or cannot respond to stimulation from the brain.
- Secondary, when the problem is related to the hypothalamus or pituitary – produce insufficient hormone amounts to regulate testosterone levels
Changes in sex hormone binding globulin (SHBG), which binds to testosterone, can also affect the amount of testosterone available. 1
Who is most at risk?
About one third of men with erectile dysfunction (ED) may also have low testosterone levels.8 If you have ED, it could be worth getting your testosterone levels checked. This is particularly important if your ED treatment doesn’t appear to be working very well. 6, 9,10
Studies show there is a link between type 2 diabetes and low testosterone. If you have type 2 diabetes and notice other symptoms, you could also be suffering from low testosterone. Diabetes can also cause ED, 5, 6, 11 and approximately 50% of diabetic patients have low testosterone. 12
It is not yet clear if low testosterone causes or is a result of, heart problems. However, if you have coronary heart disease, hardening of the arteries or high blood pressure, you could be at risk of developing low testosterone. 1, 5, 6
How is low testosterone diagnosed?
Your doctor will inquire about your medical history and you may be asked to complete some questionnaires. The Aging Male Symptoms test doctor an indication of the extent of the symptoms you are experiencing. 1, 2, 3, 13 You will also need to undergo a physical examination and your doctor will call for blood levels of testosterone to be tested. 14 This needs to be done in the morning between 8 and 10 am. 2
Your doctor will also evaluate your prostate health by asking you to complete the International Prostate Symptoms score (IPSS), he will also do a physical examination of your prostate and request a Prostate 2, 15 Depending on the state of your general health, other associated medical conditions related tests like blood sugar and blood cholesterol, might also be called for. 10
How is low testosterone treated?
Along with lifestyle changes, such as healthy eating and regular exercise, there are various treatment options. Discuss these with your doctor to determine the best course of treatment for you. If testosterone therapy is right for you, your doctor may suggest a treatment programme using injections. 14
Restoring testosterone levels may improve your sex drive, energy levels and general sense of health and well-being. 2, 3, 5, 6 If you suffer from ED, you may taking medication to treat it. 6, 9, 10
1. NCamuthers M. Time for international action on treating testosterone deficiency syndrome. The aging Male, March 2009: 12(1): 21-28.
2. Carnegie C. Diagnosis of Hypogonadism: Clinical Assessments and Laboratory Tests. Rev Urol 2004;6(Suppl 6):S3-S8.
3. Dohle GR, Arver S, Bettocchi C, et al. Guidelines on Male Hypogonadism. European Association of Urology 2013. Cited 12 Sept 2013. Available from: http://www.uroweb.org
4. Jockenhövel F, Schubert M. Male hypogonadism. 2nd edition. UNI-MED SCIENCE. ISBN 978-3-89599-859-1.UNIMED, Bremen, Germany 2007: pp12,13,16,19,34,84.
5. Urology Care Foundation. The official foundation of the American Urology Association. Low Testosterone Hypogonadism). c2013. Cited 1 Sept 2013. Available from: http://www.urologyhealth.org
6. Hackett G. The Role of Androgens in Men’s Health. A Guide for Healthcare Professionals. Essex: National Services for Health Improvement; c2008. 80 p.
7. Pantalone KM, Faiman C. Male hypogonadism: More than just a low testosterone. Cleveland Clinic Journal of Medicine 2012:79(10)717-725.
8. Jones T. Testosterone Associations with Erectile Dysfunction, Diabetes, and the Metabolic Syndrome. European Urology Supplements 2007;6:847-857.
9. The National Institute of Diabetes and Digestive and Kidney Diseases Information clearing House (NIDDK). Erectile Dysfunction. NIH Publication No. 09-3923. June 2009.
10. Jackson G, Boon N, Eardley I, Kirby M, Dean J, Hackett G, Montorsi P, Montorsi F, Vlachopoulos C, Kloner R, Sharlip I, Miner M. Erectile dysfunction and coronary artery disease prediction: evidence-based guidance and consensus. Int J Clin Pract, June 2010, 64, 7, 848 -857.
11. Whittaker C. Phospodiesterase tyoe 5 inhibitors and erectile dysfunction. ISA Fam Pract 2010 Vol 52 No 3. P207-211.
12. Grossmann M, Thomas MC, Panagiotopoulos S, Sharpe K, MacIsaac RJ, Clarke D, Zajac JD and Jerums G. Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes. J Clin Endocrinol Metab. May 2008, 93(5):1834 -1840.
13. Mohamed O, Freundlich RE, Dakik HK, Grober ED, Najari B, Lipshultz LI and Khera M. The quantitative ADAM questionnaire: a new tool in Quantifying the severity of hypogonadism. International Journal of Impotence Research (2010) 22, 20 -24.
14. Bhasin S and Matsumoto AM. Patient Guide to Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes J. Clin. Endocrinol. Metab 2010 96: 0.15. Burnett A, Wein A, Benign Prostatic Hyperplasia in Primary Care: What You Need to Know. The Journal of Urology 2006;175:S19-S24.