Testosterone Deficiency Syndrome (Hypogonadism)

Testosterone Deficiency Syndrome, or Hypogonadism, is a disorder in which a man's body does not make sufficient testosterone, the primary male hormone. This condition usually affects older men, but younger individuals 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 key part in a man's sex drive, muscle mass, and mental and physical energy.

Symptoms

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

• Reduced sex drive
• Trouble 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 work performance
• Unfavorable changes in cholesterol profile

Causes

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

In most people, though, no cause for testosterone deficiency can be found. In these circumstances, testosterone replacement therapy is generally 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, elevated insulin levels, excess belly fat and abnormal cholesterol levels
• Strong association with diabetes
• Strong association with atherosclerotic disease of the aorta
• Greater occurrence of prostate cancer
• Association with more aggressive variants of cancer

Diagnosis

Testosterone deficiency is typically diagnosed with a basic 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 instance, medication or surgery may be used to fix the underlying problem.

In cases where no particular 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 defined amount of testosterone daily but have to be replaced each day.
• Testosterone gels work in much the same way as testosterone patches, needing daily application.
• Intramuscular testosterone supplementation is an injection that is given every one to four weeks.
• Testosterone "pellets" are implanted under 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 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 a lot of 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 know 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 increase a patient'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 Rancho Santa Fe, California, please visit our website at MarkStengler.com or give us a call at (760) 274-2377