Testosterone Deficiency Syndrome (Hypogonadism)

Testosterone Deficiency Syndrome, or Hypogonadism, is a condition in which a man's body does not produce sufficient testosterone, the primary male hormone. This problem typically affects older men, but younger patients can also be affected for a variety of reasons.

While the term "andropause" is occasionally used for this condition, it is inaccurate. Unlike menopause, testosterone deficiency syndrome is not an inevitable result of aging.

Testosterone plays a major role in a man's libido, muscle mass, along with mental and physical energy.

Symptoms

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

• Reduced sex drive
• Difficulty obtaining or maintaining an erection
• Trouble 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 circumstances, 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 beginning or worsening of various illnesses:

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

Diagnosis

Testosterone deficiency is usually diagnosed with a simple blood test.

Treatment

When a specific cause for testosterone deficiency can be determined, treatment can be focused on that cause. In the case of excess pituitary secretion of hormones, for example, medicine or surgery may be used to correct the underlying problem.

In cases where no specific cause can be identified, testosterone replacement therapy is the most common treatment option.

Testosterone replacement therapy increases the body's testosterone levels through regular administration of testosterone. This therapy can take several forms:

• Testosterone patches provide a specified amount of testosterone daily but must be replaced every day.
• Testosterone gels work in much the same way as testosterone patches, requiring 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 stable level of testosterone for 4-6 months.

There are two other types of testosterone therapy that are either not available in the U.S. or not recommended:

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

Risks

Before starting testosterone therapy, individuals should recognize that it is a life-long commitment. Testosterone supplementation leads to a reduction 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, as shown in a test called the hematocrit. As a result, careful tracking of hematocrit levels is essential.

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