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 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, and 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 libido
• Difficulty getting 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 job performance
• Unfavorable changes in cholesterol profile

Causes

In some cases, a particular cause for testosterone deficiency may be identified. An example would be excess secretion of one or more pituitary hormones that then interfere with testosterone production or availability.

In most people, though, no cause for testosterone deficiency can be identified. In these circumstances, testosterone replacement therapy is usually 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 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 variations 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. When it comes to the excess pituitary secretion of hormones, for instance, medicine or surgery may be used to fix the underlying problem.

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

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

• Testosterone patches provide a specified amount of testosterone daily but have to 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, giving a steady 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 has to be taken twice daily and causes gum irritation in many individuals.
• 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 beginning testosterone therapy, patients should recognize that it is a life-long commitment. Testosterone supplementation results in a reduction in the amount of testosterone that is naturally produced by the body.

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

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