Low testosterone, or hypogonadism, is common and occurs due to a number of different causes. A man’s testosterone normally declines with age, roughly 1 percent per year starting around the age of 40. This is due to age-related changes in the pituitary gland as well as the testes. However other conditions can exacerbate this including obesity and chronic alcohol consumption. Fortunately, these are reversible.
The number of men affected by low testosterone is not known for certain as there is debate over what lab value indicates hypogonadism, particularly in light of the fact that this is a normal aspect of aging to a degree. I define hypogonadism as lab demonstrated low testosterone with signs and symptoms of hypogonadism. These include:
- Feeling depressed
- Low sex drive
- Erectile dysfunction
- Difficulty concentrating.
Signs of low testosterone include:
- Loss of muscle mass
- Increased fat
In addition, low testosterone appears to be linked to heart disease with shortened life expectancy, as well as metabolic syndrome. Metabolic syndrome is a group of conditions including high blood pressure, high blood sugar and high cholesterol/triglycerides. Studies are ongoing so it is not clear if low testosterone is the cause of heart disease and metabolic syndrome or coincidental. This is important when considering testosterone replacement to prevent these conditions.
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Testosterone replacement therapy
Testosterone replacement is very easy and comes in various forms. It can be delivered as an intramuscular injection every 3 to 10 weeks depending on the formulation. Implantable pellets can last up to six months. You can apply it to the skin as a patch or more commonly, a daily application of testosterone gel. Except in rare cases, you should not replace testosterone if you have prostate cancer.
Side effects of replacement include acne, blood clots, symptoms of prostate enlargement with difficulty urinating, sleep apnea, decreased tthe esticular size, increased hemoglobin, and decreased sperm count or infertility. Because your body senses it has enough testosterone, your testicles reduce production; these changes may be permanent, increasing the likelihood that you would need to stay on replacement therapy.
There is a study linking testosterone replacement with increased risk of heart attack and stroke. This is not clear, as low testosterone is linked with increased risk of heart attack. More study is needed. Because of these risks, ra eplacement must be considered with caution and patients on replacement must be monitored.
Speak with your healthcare provider if you think you have symptoms of low testosterone. A blood test can screen for this. As mentioned above, there is variability in the normal values of testosterone. Because testosterone levels peak in the morning, you should have your blood drawn around 8 -10 a.m. These results, as well as the presence of any signs or symptoms of low testosterone, can help you and your healthcare provider decide if replacement is indicated.