Testosterone deficiency or hypogonadism occurs if the body cannot produce enough testosterone to function normally. Men are likely to end up with hypogonadism as part of aging, usually those between the age of 50 and 79.
Role of testosterone
Testosterone is an essential sex hormone among men. The body starts the production of testosterone during puberty and vital for the development and upkeep of the male physique. The hormone also influences sexual function and most vital organs including the kidneys, brain, bone, skin, and muscles.
A drop in the level of testosterone increases the risk for diseases of the heart and blood vessels, thus increasing the risk for death. The low testosterone in the body can also significantly reduce the quality of life in most men.
Should I worry about low testosterone?
The level of testosterone generally fluctuates throughout the day, peaking in the morning and significantly drops in the evening. The “normal” level of hormone in the body depends on your age since the level normally declines as part of the aging process.
During the phase of puberty, the testosterone level is high. The high level allows changes to the male physique such as deepening of the voice, muscle development and the transition of sexual characteristics from “boy” to “man”. After reaching 30 years old, the level steadily drops along with symptoms such as weight gain, fatigue, depression, poor muscle mass, and poor libido.
If you suspect that you have low testosterone, the first move is to think if it is normal for your age. For those over 80 years old with muscle loss, it is relatively normal. However, if you are over 30 years old or younger with the above symptoms, consult a doctor.
The doctor will perform a history check and physical examination to determine the possible causes of the symptoms. Blood tests are also part of the assessment to take a close look at your hormones, vitamin and mineral levels, electrolytes and the blood count. This aims to check for other causes of fatigue such as low iron, low thyroid hormone or low vitamin D.
Remember that the normal testosterone level in the blood is generally above 300 nanograms per deciliter (ng/dL). If the level is lower than this, the doctor requires a repeat test in the morning, usually, around 8 am where the level is at its peak. If the result of the second test is less than 300, it is a sign that you have “low T” in the body.
What are the causes?
The production of testosterone is under control by both the brain and testes. Among younger men, deficiency in testosterone typically stems from an issue in one of these areas.
Around 30 years old, the testosterone level starts to decline naturally. However, the production of the hormone does not stop altogether, and some men have higher levels than others as they age. The condition is known as “late-onset hypogonadism” which is only linked with older age.
Generally, older men face a higher risk of developing hypogonadism if obese or have a diagnosis of diabetes, metabolic syndrome, chronic obstructive pulmonary disease (COPD), kidney disease or inflammatory arthritis. It is also likely to occur if under androgen deprivation therapy for prostate cancer, using opiate drugs long-term, has prostate cancer or excessively drinking alcoholic beverages.
What are the indications?
If hypogonadism is likely, there are no specific symptoms. One might lose their nightly erections, has difficulty achieving or maintaining an erection, low libido and feel tired or depressed.
Some notice a loss in muscle mass, becoming weak or gaining weight. Other symptoms that might be present include hair loss from the armpit, face or pubic region as well as hot flushes and difficulty sleeping.
Diagnosis
Hypogonadism is often identified after consulting a doctor about poor libido or erectile dysfunction.
When diagnosing hypogonadism that requires treatment, the doctor considers the symptoms and the level of testosterone in the body. Men with diabetes, erectile dysfunction, and potential hypogonadism must undergo testing of the testosterone level. Men who do not respond to phosphodiesterase inhibitors such as Viagra must also undergo testing.
When measuring the testosterone level, a blood test is necessary which is done in the morning and usually repeated on another day.
Hypogonadism might not be diagnosed if men simply ignore the symptoms or consider other possible causes such as aging.
Should I undergo treatment?
If hypogonadism is present and requires treatment, the doctor will suggest testosterone replacement therapy. When using the gel form, rub directly into the skin daily. If the doctor uses the long-acting injections, the administration is every 6-12 weeks depending on the response of the individual.
Testosterone replacement therapy can provide a variety of benefits among men with hypogonadism. Some of these benefits include improvement in cardiovascular health, libido, mood, and sexual function as well as a reduction in body fat and enhancement with muscular mass. These benefits are likely to improve the overall quality of life.
If erectile dysfunction is likely, testosterone replacement therapy might provide an additional benefit of improving the effects of drugs such as Viagra. This is vital among men who have type 2 diabetes since most do not achieve good results with these drugs.
Nevertheless, testosterone replacement therapy has its share of risks and your doctor should discuss these with you. If you are considering the therapy as a treatment, you must be certain that the benefits outweigh any potential risks. Remember that this form of treatment might not be suitable for men with prostate cancer.
After starting testosterone replacement therapy, regular appointments with the doctor is part of the routine to ensure effectiveness and ensure that there are no undesirable issues. If one is at high risk for heart issues and the level of testosterone is stable, a blood test is necessary every 6-12 months.
