Hypogonadism/Low Testosterone

Low testosterone is one of the most frequently talked about topics among men. This is because of several reasons.

There is increasing awareness of testosterone and its many benefits, previously it was thought to be mainly related to sexual activity. Now we know it is essential not just for libido, but many other benefits. Some of the important benefits include:

  • Strong bones (avoiding osteoporosis)
  • Increased muscle mass
  • Improved mental function
  • Improved energy
  • Weight loss
  • Improved diabetic control
  • Improving depression symptoms
  • Improved sexual function

Testosterone is highest at about age 20, from then it slowly decreases over a man’s life span. In some men the level of testosterone decreases faster than expected.

Studies have shown 38 percent of men over 45 have low testosterone. This is worse in certain conditions.

Prevalence of low testosterone in certain diseases:

Chronic Opioid Use 74%
Obesity 52%
Diabetes 50%
Hypertension 42%
Erectile Dysfunction 36%

A questionnaire was put together called the ADAM questionnaire. This is used to alert patients to the possibility of low testosterone.

Answer YES or NO to each of the following questions:

  1. Do you have a decrease in libido (sex drive)?
  2. Do you have a lack of energy?
  3. Do you have a decrease in strength and/or endurance?
  4. Have you lost height?
  5. Have you noticed a decreased “enjoyment of life?”
  6. Are you sad and/or grumpy?
  7. Are your erections less strong?
  8. Have you noticed a recent deterioration in your ability to play sports?
  9. Are you falling asleep after dinner?
  10. Has there been a recent deterioration in your work performance?

If you answered YES to questions 1 or 7 or any 3 other questions, you may be experiencing androgen deficiency (low testosterone level).

Source: http://www.prostatehealthnaturally.com/downloads/ADAM_Questionnaire.pdf

Another reason why testosterone is much talked about now is because there are multiple options available for treatment.

Depo-Testosterone – This has been available for the longest time. It is an injection given by the patient to himself generally every two weeks. The problem with this is a rapid increase the first week and a rapid decrease the second week resulting in a roller coaster serum level of testosterone.

Testosterone Gels – There are several of these brands available, none of which are generic. Insurance coverage will depend on your prescription policy. They work well but they have to be applied daily at about the same time. Some patients do not absorb the gels well.

Testosterone Pellets – These are inserted under the skin in the office. The procedure takes about 3 or 4 minutes. Some local anesthesia is injected under the skin. A needle is then passed and through this the pellets are inserted. No suturing is needed, the pellets last about 3 to 4 months. Prior to doing the procedure, your insurance is checked by our office for coverage.

Points to Remember

Only 5% of men with low testosterone are receiving treatment. This is mainly from lack of awareness.

If you are receiving testosterone supplements, you need to be monitored with blood tests periodically. This is to make sure you are reaching the correct levels of testosterone, also to make sure your PSA remains stable. In addition, CBC (complete blood count) is done occasionally to monitor your blood count.

Fear of prostate cancer? Much of the confusion has been clarified by work and research by Dr. Morgentaler from Harvard. It is now clear testosterone does not cause prostate cancer however, if you do have prostate cancer, it can wake it up in the early part of testosterone treatment. It doesn’t mean you should not consider testosterone treatment because living with low testosterone and all the side effects can be worse. It does mean you need to be monitored with appropriate blood tests.

Checking testosterone levels and treating it if needed is all about wellness and living to your maximum capacity. We are not destined to live forever, but we should be careful not to blame everything on aging.

If you are concerned about your testosterone levels because you want to stay well, you should also eat correctly and exercise regularly, it is all about doing what you can to help yourself stay well.