Testosterone Deficiency (Hypogonadism)


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Hypogonadism is a term used to describe lower-than-normal levels of the male sex hormone testosterone.

It’s estimated that more than 15 million men in the United States have a testosterone deficiency, also referred to as hypogonadism. It’s a condition that’s often treated with testosterone replacement therapy. In addition to playing a role in sexual functions, the testosterone hormone affects:

  • Muscle development
  • Bone growth
  • Red blood cell production
  • Cognitive function
  • Vitality
  • Cardiovascular health
  • Metabolic health
  • Overall health

What Causes Testosterone Deficiency?

Testosterone production primarily occurs in Leydig cells in the testicles. As men age, testosterone production in these cells naturally begins to decline. Levels may become abnormally low for many reasons, including underlying health conditions such as diabetes. Obesity and higher than normal levels of cholesterol may also contribute to testosterone deficiency. The problem has also been associated with the use of certain opiate medications (narcotics), multiple instances of head trauma, alcoholism, chronic illness, stress, and gene abnormalities, amongst other conditions.


Symptoms of Testosterone Deficiency

Depression and a loss in sex drive are some of the more common symptoms associated with testosterone deficiency. Some men may also experience erectile dysfunction or a general decrease in their sense of well-being. Should testosterone levels remain consistently low, men might notice:

  • A decrease in muscle mass
  • Weight gain
  • Mild anemia
  • Decreased bone density and osteoporosis
  • A reduction in body hair
  • Decreased cognitive function and ability to focus
  • Increased risks of cardiovascular issues

How It’s Diagnosed

A blood test is the only way to positively diagnose testosterone deficiency. Since levels of this hormone vary throughout the day, it is preferred to collect a blood sample in the morning since this is when testosterone levels tend to be higher.

How Does Testosterone Replacement Therapy Help?

Testosterone replacement therapy (TRT) is an often-suggested treatment option for men with a deficiency that’s affecting overall health and sexual performance. One option may involve transdermal (TD) applications in the form of a gel or path that is applied to skin daily. Another option is intramuscular TRT that is injected every 1-2 weeks. Testosterone pellets (Testopel) may also be placed under local anesthesia in the clinic and provide consistent stable results for 3-4 months. Some men will see noticeable improvements with libido and muscle mass within a few weeks. Other benefits include weight loss, increased muscle mass, improved bone density, and improved diabetic control, amongst others. Patients will need to be periodically monitored, which includes blood tests to track testosterone levels. Adjustments to dosing recommendations will be made based on the results of subsequent testing to minimize the risk of potential side effects.

Who Shouldn’t Use TRT?

Testosterone replacement therapy generally isn’t recommended for everyone and you should consult with a trained urologist prior to initiating therapy. Prior to giving the go-ahead to try TRT, a urologist may perform a further hormonal blood testing, a rectal exam, and a prostate specific antigen (PSA) test. Risks and side effects of TRT include development of acne, water retention (edema), increasing blood concentration, and increasing PSA, amongst others.

Testosterone deficiency is caused by many different factors, including genetic ones, making it something that’s not entirely preventable. Paying attention to lifestyle habits involving weight management, dietary choices, and exercise routines, however, may help maintain sufficient levels of testosterone. For men using TRT, lifestyle adjustments could also improve results. More thorough evaluations by a urologist can be beneficial as well, especially for men at risk.

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