Andropause or Low Testosterone

You may have heard of menopause that happens in women after the age of 45 years; do men also suffer similar condition? Andropause is very common but not routinely diagnosed or treated as there is no great awareness regarding this condition.

What are the signs of low testosterone in Men?

There are many signs and symptoms of Low Testosterone. Some are more closely related to Low-T levels (specific signs and symptoms). Others may not necessarily be linked (non-specific signs and symptoms). Your doctor will help you make sense of your own situation.

Specific Signs/Symptoms of Testosterone Deficiency (TD)

Specific symptoms are those more likely or directly linked to TD such as:

  • Reduced sex drive
  • Reduced erectile function
  • Loss of body hair 
  • Less beard growth 
  • Loss of lean muscle mass
  • Feeling very tired all the time (fatigue)
  • Obesity (being overweight)
  • Symptoms of depression

Non-specific Signs/Symptoms of Testosterone Deficiency (TD)

Non-specific symptoms are those that may or may not be linked to TD such as:

  • Lower energy level, endurance and physical strength
  • Poor memory 
  • Difficulty with finding words to say
  • Poor focus
  • Not doing well at work

Having any one of the specific or non-specific symptoms may not mean that you have TD. But if you have a mix of symptoms, for instance, if you start to feel very tired and sad over a period of time and this is a change for you, you may want to check for TD.

Low sexual desire alone may not mean that you have TD. But if you have a combination of low sexual desire, reduced erectile function, and feelings of sadness and tiredness, you should talk to your doctor.

What causes Testosterone Deficiency (TD)?

Some persons are born with conditions that cause Testosterone Deficiency (TD). Luckily these are not common and are easy to diagnose. Few examples:

  • Klinefelter syndrome 
  • Noonan syndrome
  • Ambiguous genitalia (when the sex organs develop in ways that are not typical looking)
  • Some men may develop Low-T because of conditions like these:
  • Damage to testicles by accident
  • Removal of testicles because of cancer
  • Chemotherapy or radiation
  • Pituitary gland disease leading to hormone deficiency

Basically, if your testicles keep making less testosterone than normal, your blood levels of testosterone will fall. Many men who develop TD have Low-T levels linked to:

  • Aging
  • Obesity
  • Metabolic syndrome (high blood pressure, high blood sugar, unhealthy cholesterol levels, and belly fat). This is a very important cause and steadily increasing in Indian population.
  • Use of medications such as antidepressants and narcotic pain medications
  • Men with certain health problems also tend to have low testosterone. Some of these are:
    • HIV (about 30 out of 100 also have low testosterone)
    • AIDS (about 50 out of 100 also have low testosterone)

How is Low Testosterone Diagnosed?

Although many symptoms may be tied to Low Testosterone (Low-T), total blood testosterone level is the most important measure of testosterone deficiency. To make a diagnosis, your doctor will use other specific signs and symptoms in addition to your testosterone blood level.

Your doctor may ask you about:

  • Headache, visual field change (possible symptoms of brain mass such as a pituitary tumor) 
  • How you developed at puberty 
  • History of head trauma 
  • Brain (head) surgery/brain tumor or cranial irradiation 
  • Anosmia (loss of ability to smell) 
  • History of infection in your testicles 
  • Injury to your testicles
  • Mumps after puberty (painful swelling of testes
  • Past or present use of anabolic steroids 
  • History of chemotherapy or irradiation 
  • Family history of diseases linked to Low-T
  • History of stroke or heart attack
  • History of unexplained anemia 

Your doctor will check for the following:

  • BMI or waist circumference for obesity 
  • Metabolic syndrome. These are symptoms (seen together) of increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels 
  • Hair pattern, amount, and location 
  • Gynecomastia (enlarged breasts) 
  • Whether testicles are present and their size 
  • Prostate size and any abnormalities 

Your doctor may order these blood tests:

  • Total testosterone level. This test should be done at two different times on samples taken before noon. Testosterone levels are lower later in the day.
  • Luteinizing hormone (LH). This test is done to help find the cause of a Low-T level. This hormone controls how you make testosterone. Abnormal levels may mean a pituitary gland problem.
  • Blood prolactin level. If your prolactin level is high, your doctor may repeat the blood test to make sure there is no error. High prolactin levels also may be a sign of pituitary problems or tumors.
  • Blood hemoglobin or Hgb. Before doing this test, your doctor will look for other reasons for low Hgb such as climate level (like climate altitude), sleep apnea, or tobacco smoking.

The following also may be done to help with further diagnosis:

  • Follicle stimulating hormone (FSH). This test is to check for sperm-making function if you want to have children. You may also need to have semen tests. These tests will be done before any hormone therapy.
  • Estradiol hormone test is done if there are breast symptoms.
  • HbA1C blood test may be done for diabetes.
  • MRI (magnetic resonance imaging) of the pituitary gland  Bone density tests.
  • Karyotype (Chromosome tests).

Treatment

Testosterone Therapy (TT)

In recent years, the media has reported more about Testosterone Therapy (TT), and more men between the ages of 40 and 64 have been tested and given TT. It is recommended that TT be prescribed only to men who meet the clinical and laboratory definition of testosterone deficiency (Testosterone level of less than 300 ng/dL).

Treatment of andropause is possible but needs to be done under proper medical supervision and care. Health changes such as losing weight and getting more physical activity will likely raise your testosterone levels. 

How Do I Take Testosterone?

There are generally five different ways to take testosterone. They are: transdermal (through the skin), injection, oral/buccal (by mouth), intranasal (through the nose), and by pellets under the skin. No method is better than another. While you are taking TT, your doctor will test your blood to determine testosterone levels.

Are There Side Effects of TT?

There are some side effects of TT. Some side effects are mild while others are more serious. You should ask your doctor about these side effects and watch for them while you are taking TT.

Here are some things you should know:

  • There is no evidence linking TT to prostate cancer.
  • There is no strong evidence linking TT to increase in vein clots.
  • At this time, there is no strong evidence that TT either increases or decreases the risk of cardiovascular events. However, while you are on TT, you should call your doctor right away if you have signs or symptoms of stroke or heart attack.

What Can I Expect after Treatment?

Remember that each person is unique, and each body responds differently to treatment. TT may help erectile function, low sex drive, bone marrow density, anemia, lean body mass, and/or symptoms of depression. However, there is no strong evidence that TT will help memory recall, measures of diabetes, energy, tiredness, lipid profiles, or quality of life.

You will need routine checkups to see that your testosterone level stays normal. In patients who are stable on TT, total testosterone and certain other lab tests should be checked every 6-12 months.

If you are overweight, try to work on keeping your weight within recommended ranges. Increasing physical activity may help you lose weight and also may help increase testosterone levels.

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