Testosterone Deficiency Syndrome (Hypogonadism)
Testosterone Deficiency Syndrome, or Hypogonadism, is a condition in which a man’s body does not make sufficient testosterone, the main male hormone. This condition usually affects older men, but younger individuals can also be affected for a variety of reasons.
While the term “andropause” is sometimes used for this condition, it is inaccurate. Unlike menopause, testosterone deficiency syndrome is not an inevitable result of aging.
Testosterone plays a key part in a man’s sex drive, muscle mass, and mental and physical energy.
There are a number of symptoms that are associated with a deficiency in testosterone in men:
- Reduced sex drive
- Difficulty getting or maintaining an erection
- Difficulty concentrating or making decisions
- Poor results from exercise programs
- Increase in body fat
- Loss of lean body (muscle) mass
- Loss of bone density
- Poor job performance
- Negative changes in cholesterol profile
Sometimes, a specific cause for testosterone deficiency might be discovered. An example would be excess secretion of one or more pituitary hormones that then disrupt testosterone production or availability.
In most people, though, no cause for testosterone deficiency can be found. In these situations, testosterone replacement therapy is generally an effective treatment.
Beyond the symptoms that many men experience, testosterone deficiency syndrome can also contribute to the beginning or worsening of various illnesses:
- Increased risk of cardiovascular disease.
- Increased risk of death from a cardiovascular event.
- Increased risk of metabolic syndrome: high blood pressure, high insulin levels, excess stomach fat and unusual cholesterol levels.
- Strong association with diabetes.
- Strong association with atherosclerotic disease of the aorta.
- Greater occurrence of prostate cancer.
- Association with more aggressive variants of cancer.
Testosterone deficiency is typically diagnosed with a basic blood test.
When a specific cause for testosterone deficiency can be identified, treatment can be focused on that cause. In the case of excess pituitary secretion of hormones, for example, medicine or surgery might be used to fix the underlying problem.
In cases where no specific cause can be determined, testosterone replacement therapy is the most common treatment option.
Testosterone replacement therapy increases the body’s testosterone levels with regular administration of testosterone. This therapy can take several forms:
- Testosterone patches give a defined amount of testosterone every day but must be replaced daily.
- Testosterone gels work in a similar way as testosterone patches, requiring daily application.
- Intramuscular testosterone supplementation is an injection that is given every one to four weeks.
- Testosterone “pellets” are implanted under the skin, providing a steady level of testosterone for 4-6 months.
There are two other forms of testosterone therapy that are either not available in the U.S. or not recommended:
- The testosterone wafer dissolves between the lip and the gum. It is not commonly used because it must be taken twice each day and causes gum irritation in many individuals.
- A long-lasting oral preparation of testosterone is currently available outside the United States, but it has not yet been approved by the FDA for sale in this country.
Before beginning testosterone therapy, patients need to know that it is a life-long commitment. Testosterone supplementation causes a reduction in the amount of testosterone that is naturally produced by the body.
Testosterone replacement therapy can also increase a patient’s red blood cell mass, as shown in a test called the hematocrit. As a result, careful monitoring of hematocrit levels is important.