Testosterone is a vital hormone (a chemical messenger) in maintaining sexual and general wellbeing in men. Normal levels are responsible for the development of men’s sexual characteristics and function including sexual drive and erections. Testosterone helps to maintain energy levels and a positive mood. As men age, their testosterone level decreases, however in some men it can decrease to such a level as to cause significant signs and symptoms. Sexual, physical and mental health can all be affected by abnormally low testosterone.
There are several types of testosterone deficiency, but this article discusses specifically testosterone deficiency occurring in men over 50 years of age. Around eight percent of men between the ages of 50-79 have low testosterone and its symptoms. In the UK, that equates to approximately 790,000 men.
Testosterone deficiency can be associated with other diseases, such as Type 2 diabetes, where it can occur in 40-50 percent of men. Other chronic diseases and—significantly heart disease—are also linked to low levels of testosterone.
Medications, most commonly long term use of opiates for pain relief, as well as anti-depressants, and cholesterol-lowering treatments (statins) can also lead to low testosterone and its symptoms.
See also: Tackling Testosterone Deficiency
Osteoporosis, or thinning of the bones, is another potential presentation in men often overlooked by the physician. This disease is more commonly associated with women, but in an ever-increasing elderly population it needs to be considered in men also. Low testosterone has been linked to 20 percent of men with fractures of the wrist and up to 50 percent of men with hip fractures.
Testosterone deficiency usually presents with sexual symptoms such as a reduced interest in sex and problems getting and maintaining an erection. Symptoms of low testosterone also include depression, lack of motivation, low self-esteem, weight gain and tiredness. Men may notice that they lack concentration, experience hot flushes, have reduced muscle mass resulting in weakness, and increased fat around their abdomens. They may also notice a reduction in body hair. Of course other illnesses may cause these symptoms and these need to be excluded by the physician with careful investigation.
How is testosterone deficiency diagnosed?
Diagnosis is made if patients have any of the above-mentioned symptoms combined with an early morning blood test. The blood test looks at testosterone levels in the body. Other blood tests are usually carried out at the same time to look for other diseases including those associated with testosterone deficiency, low testosterone levels and its symptoms.
See also: Men’s Biggest Health Concerns
Treatment
Testosterone replacement therapy has been used effectively for over half a century.
Initially patients are advised to improve lifestyle and diet in an attempt to increase testosterone levels, however this intervention alone is often not enough, so the use of replacement therapy is then recommended.
Replacement therapy comes most commonly in the form of a gel or an injection. Men will need monitoring during treatment, which is considered to be life long in those that respond positively.
Benefits of treatment for low testosterone can be a restored sense of well-being and sex drive, with improved sexual performance. Weight reduction is commonly reported with improved muscle mass and less fat around the abdomen. This in turn leads to less risk of developing diabetes and potentially heart disease.
See also: Treatment for Peyronie’s Disease
Lack of awareness about low testosterone, symptoms and treatment
Testosterone deficiency is often underdiagnosed and undertreated. In a recent online survey, we noticed that men waited between two and 24 months to seek help for symptoms with 35 percent of men waiting more than two years. The top reasons for this delay were that they ‘didn’t think that it was a serious problem’, they ‘thought it was just part of life’ or assumed, ‘it was just part of growing older’. The survey revealed that it was more often than not the man’s partner who influenced treatment seeking.
Men don’t tend to present to the doctor on a regular basis. Women have reasons to present, be it with screening—for example breast and cervical, or with pregnancy related issues—or when the children are unwell. Women are therefore more frequent attenders for a variety of reasons; hence they are generally more health-aware and exposed to healthcare facilities and health promotion. Therefore, women play an important role in identifying health issues in their partners and encouraging them to seek help—even for conditions such as low testosterone and its symptoms. Successful identification and management of testosterone deficiency and low testosterone can return a man’s vitality, improve overall health and restore energy levels so that once again a fulfilling sex life can be established.
For more information visit low-testosterone.uk and/or pctag.uk
Dr Janine David, GP with a special interest in men’s health
MB BCh DRCOG DFFP MRCGP FECSM
This article on low testosterone, symptoms and treatment was funded by Besins Healthcare (UK), the company was consulted on the scientific accuracy of the article and conducted a review for compliance purposes.
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