Testosterone Deficiency Syndrome (Hypogonadism)

Testosterone Deficiency Syndrome, or Hypogonadism, is a disorder in which a man's body does not produce enough testosterone, the primary male hormone. This problem generally affects older men, but younger people 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 major part in a man's libido, muscle mass, along with mental and physical energy.

Symptoms

There are several symptoms that are associated with a deficiency in testosterone in men:

• Reduced libido
• Difficulty obtaining 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
• Depression
• Poor work performance
• Negative changes in cholesterol profile

Causes

Sometimes, a specific cause for testosterone deficiency may be identified. An example would be excess secretion of one or more pituitary hormones that then disrupt testosterone production or availability.

In most people, however, no cause for testosterone deficiency can be found. In these situations, testosterone replacement therapy is often an effective treatment.

Effects

Beyond the symptoms that a lot of men experience, testosterone deficiency syndrome can also contribute to the onset or worsening of various diseases.

• Increased risk of cardiovascular disease.
• Increased risk of death from a cardiovascular event.
• Increased risk of metabolic syndrome: high blood pressure, elevated insulin levels, excess belly fat and abnormal cholesterol levels.
• Strong association with diabetes.
• Strong association with atherosclerotic disease of the aorta.
• Higher occurrence of prostate cancer.
• Association with more aggressive variations of cancer.

Diagnosis

Testosterone deficiency is usually diagnosed with a simple blood test.

Treatment

When a specific cause for testosterone deficiency can be identified, treatment can be focused on that cause. When it comes to the excess pituitary secretion of hormones, for instance, medication or surgery might be used to correct 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 deliver a defined amount of testosterone every day but must be replaced every day.
• Testosterone gels work in much the same way as testosterone patches, needing a daily application.
• Intramuscular testosterone supplementation is an injection that is given every one to four weeks.
• Testosterone "pellets" are implanted beneath 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 United States or not recommended:

• The testosterone wafer dissolves between the lip and the gum. It is not commonly used because it has to be taken twice daily and causes gum irritation in many patients.
• A long-lasting oral preparation of testosterone is currently available outside the U.S., however, it has not yet been approved by the FDA for sale in this country.

Risks

Before beginning testosterone therapy, patients need to recognize that it is a life-long commitment. Testosterone supplementation results in a drop in the amount of testosterone that is naturally produced by the body.

Testosterone replacement therapy can also increase an individual's red blood cell mass, reflected in a test called the hematocrit. As a result, careful tracking of hematocrit levels is necessary.

For further information about Dr. Stengler’s practice and his clinic in La Jolla, California, please visit our website at MarkStengler.com or give us a call at (760) 274-2377