Testosterone Deficiency Syndrome (Hypogonadism)

Testosterone Deficiency Syndrome, or Hypogonadism, is a condition in which a man's body does not make enough testosterone, the main male hormone. This condition usually 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 key part in a man's sex drive, muscle mass, as well as 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 getting or keeping 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
• Negative 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, however, no cause for testosterone deficiency can be identified. 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 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
• Greater incidence of prostate cancer
• Association with more aggressive variants of cancer

Diagnosis

Testosterone deficiency is usually diagnosed with a basic blood test.

Treatment

When a specific cause for testosterone deficiency can be identified, treatment can be focused on that cause. When it comes to excess pituitary secretion of hormones, for instance, medication 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 with regular administration of testosterone. This therapy can take several forms:

• Testosterone patches deliver a specified amount of testosterone daily but must be replaced daily.
• Testosterone gels work in much the same way as testosterone patches, requiring 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 stable 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 must be taken twice each day and causes gum irritation in a lot of patients.
• A long-lasting oral preparation of testosterone is currently available outside the United States, however it has not yet been approved by the FDA for sale in this country.

Risks

Before beginning testosterone therapy, individuals should know that it is a life-long commitment. Testosterone supplementation causes 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, shown 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 Mesa, California, please visit our website at MarkStengler.com or give us a call at (760) 274-2377.

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