What is the role of testosterone in men’s health?
Testosterone is the most important sex hormone that men have. It is responsible for the typical male characteristics and helps maintain sex drive; sperm production; facial, pubic, and body hair; muscle; and bone. The brain and pituitary gland (a small gland at the base of the brain) control the production of testosterone by the testes. In the short term, low testosterone (also called hypogonadism) can cause:
• A drop in sex drive
• Poor erections
• Low sperm count
• Enlarged breasts
Over time, low testosterone may cause a man to lose body hair; lose muscle bulk and strength; accumulate body fat; and have weaker bones (osteoporosis), mood changes, less energy, and smaller testes. Symptoms vary from person to person.
What causes low testosterone?
Low testosterone can be caused by testicular injury (trauma, castration, radiation or chemotherapy) or infection, hormonal disorders (pituitary tumors or diseases, high levels of prolactin), or other systemic diseases (HIV/AIDS, chronic liver and kidney disease, obesity, and type 2 diabetes). Some medications and several genetic conditions (Klinefelter syndrome, hemochromatosis, Kallmann syndrome, Prader- Willi syndrome, and mytonic dystrophy) also can cause low testosterone.
Many older men have low testosterone levels and, in many cases, the cause is not known.
How is low testosterone diagnosed?
During a physical exam, your doctor will examine body hair, breast size, size and consistency of the testes, scrotum, penis size, and loss of side vision (which could indicate a pituitary tumor, a rare cause of low testosterone). Your doctor will also use blood tests to see if your total testosterone level is low. The normal range is generally 300 to 1,000 ng/dL but this depends on the laboratory that conducts the test. To diagnose low testosterone you may need more than one early morning (7–10 AM) blood test and, sometimes, other tests of pituitary gland hormones.
How is low testosterone treated?
Testosterone replacement therapy can improve sexual interest, erectile function, mood and energy, body hair growth, bone density, and muscle mass. There are several ways to replace testosterone:
• Injections
• Patches
• Gel
• Tablets (stick to the gums)
• Pellets or pills
The best method will depend on the patient’s preference and tolerance, and cost.
There are risks with long-term use of testosterone. African American men, men over 40 years of age who have close relatives with prostate cancer, and all men over 50 years of age should be monitored for prostate cancer during testosterone treatment. Men with breast cancer or known or suspected prostate cancer should not receive testosterone therapy.
What should you do with this information?
If you have symptoms of low testosterone, talk to your doctor. He or she can help determine the cause. Be open with your doctor about your medical history, all prescription and non-prescription drugs you are now taking, sexual problems, and any major changes in your life.
What are the possible risks of testosterone treatment?
• A high red blood cell count
• Acne
• Breast enlargement
• An increase in prostate enlargement or prostate cancer growth
• Occasional stopping of breathing during sleep, called sleep apnea (rarely)
• Fluid build-up in ankles, feet and legs, called edema (rarely)
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