Male Hypogonadism (Low Testosterone)
Male hypogonadism or low testosterone is a serious condition in males. In this condition, the testes (testicles, the male reproductive glands) are not able to produce enough testosterone (a male sex hormone).
In men, testosterone helps develop and maintain:
- Sexual features
- Muscle mass
- Adequate amount of red blood cells
- Bone density
- Sense of well-being
- Reproductive and sexual function
How Common Is hypogonadism?
Low testosterone is a common problem that affects almost 40% of men who are 45 years and older. It’s not an easy task to define a normal testosterone level in males as its levels vary throughout the day. Testosterone levels are affected by multiple factors such as nutrition, body mass index (BMI), certain medications, alcohol consumption, age and illness.
Symptoms And Causes
What Causes hypogonadism?
The amount of testosterone decreases with the increasing age of males. It’s a natural procedure in which about 1% of the testosterone decreases every year after the age of 30 and the process continues throughout his life.
It’s not only the age that affects the testosterone level but many other potential factors are also responsible for the hypogonadism level, including the following:
- Orchitis (infection of the testes) or an injury (trauma, interrupted blood supply to the testes)
- Chemotherapy for cancer
- Metabolic disorders such as too much iron in the body known as hemochromatosis
- Tumors or dysfunction of the pituitary gland
- Medications, including steroids (such as prednisone), opioids, and hormones used for the treatment of prostate cancer
- Short-term (acute) or long-term (chronic) illness
- Alcohol abuse
- Cirrhosis of the liver
- Kidney failure
- Inflammatory conditions such as sarcoidosis cause inflammation of the lungs and other organs
- Abnormal development of the hypothalamus known as Kallman syndrome
- A genetic disorder in which a male has an extra copy of the X chromosome is known as Klinefelter syndrome.
- High levels of prolactin, the milk-producing hormone
- Extreme weight loss or obesity
- Uncontrolled type 2 diabetes mellitus
- Congenital defect (present at birth)
- Obstructive sleep apnea
- Excess of estrogen which is normally from an environmental or external source
- Past anabolic steroid abuse
- Severe primary hypothyroidism
- Pubertal delay
- Trauma (head injury)
- Prior surgery of the brain or radiation exposure
What Are The Symptoms of Low Testosterone?
Symptoms regarding low testosterone level depend on the age of the person and include the following:
- Erectile dysfunction
- Low sex drive
- Decreased sense of well-being
- Depressed mood
- Difficulties with memory and concentration
- Irritability and moodiness
- Loss of muscular strength
There are some other changes also that can occur with hypogonadism including:
- Mild anemia and a decrease in hemoglobin
- Reduction in body hair
- Osteoporosis or thinning of the bones
- Increased body fat
- Gynecomastia or breast development
Diagnosis And Tests
How Is hypogonadism Diagnosed?
A blood test is needed to diagnose the hypogonadism level by measuring the amount of testosterone present in the blood. As we already know that the level of testosterone in the body changes throughout the day, so it may take several tests and measurements to know if a patient has low testosterone. It’s the morning time around 8 AM that the testosterone level is the highest. This is why it is the most preferred time for doctors to measure testosterone levels.
Management And Treatment
How Is Low Testosterone Treated?
The treatment of hypogonadism is done with the help of testosterone replacement therapy which can be done in many different ways:
- Intramuscular injections are usually given every 10 to 14 days.
- Testosterone patches can be used daily and are applied to various parts of the body such as arms, buttocks, abdomen and back.
- Testosterone gels are applied daily to the clean dry skin of the arms and upper back (the gels need the care to make sure that the hormone is not mistakenly transferred to another person).
- Pellets are implanted under the skin after every two months.
- There is an option of oral testosterone also but it is not approved in many countries.
Benefits of Testosterone Replacement Therapy?
Some lonely benefits of testosterone replacement therapy may include:
- In boys, avoiding conditions related to delayed puberty
- Loss of fat
- Protection against osteoporosis due to increased bone density
- Better mood and sense of well-being
- Much better sexual function
- Improved mental sharpness
- Greater physical performance and muscle strength
Side effects of Testosterone Replacement Therapy?
Given below are the side effects of testosterone replacement therapy:
- Oily or acne skin
- Mild fluid retention that causes swelling in the ankles
- Boosting of the prostate, which can lead to urination symptoms such as problems in urinating
- Breast tenderness or enlargement
- Worsening of sleep apnea
- Smaller testicles
- Skin irritation
Some laboratory abnormalities can also occur with testosterone replacement and they are as follows:
- Enhancement in prostate-specific antigen (PSA).
- Improvement in red blood cell count.
- Reduction in sperm count, creating infertility (inability to have children), is specifically significant in younger men who desire fertility.
- If you are undergoing hormone replacement therapy, do remember to have regular follow-up appointments with your physician as it is really important.
Doctors should calculate prostate cancer risk before beginning testosterone treatment, and 3 to 12 months after starting testosterone:
- PSA levels must be checked at 3, 6, and 12 months in the first year, and after that once a year.
- A digital rectal examination of the prostate is needed at 3-6 months and also 1 year after beginning the therapy, and then every year after that.
- This examination is even recommended for men who have not taken testosterone replacement therapy. It is helpful in age-related prostate cancer screening. The normal screening age starts at 50.
- Hematocrit levels are also examined before beginning testosterone therapy, and after that regularly to check if red blood cell levels remain normal.
Who Shouldn’t Take Testosterone Replacement Therapy?
Testosterone replacement therapy may lead to the growth of the prostate. If someone has early prostate cancer, there are chances that testosterone may encourage cancer growth. Hence, men who are suffering from prostate cancer should not undergo testosterone replacement therapy. Before starting this therapy make sure to undergo prostate screening as it is very important.
There are some other men too who should not take testosterone replacement therapy for example:
- An expanded prostate leading to urinary symptoms
- A mass on their prostate that was left undiagnosed
- A PSA measurement above 4
- Breast cancer
- An increased hematocrit level
- Serious congestive heart failure
- Obstructive sleep apnea that has been left untreated
Can hypogonadism Be Prevented?
As of now, there are no known procedures to avert low testosterone that is the result of any genetic conditions or damage to the pituitary gland or testes.
But some ways to help keep your testosterone levels normal such as a healthy lifestyle that includes exercise, weight management, good nutrition, and avoiding excessive use of drugs and alcohol.