Testosterone Deficiency Syndrome (Hypogonadism)

Testosterone Deficiency Syndrome, or Hypogonadism, is a condition in which a man's body does not make sufficient testosterone, the main male hormone. This disorder 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 key role in a man's libido, muscle mass, as well as mental and physical energy.

Symptoms

There are a number of symptoms that are linked to a deficiency in testosterone in men:

• Reduced libido
• Trouble obtaining or keeping 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 job performance
• Unfavorable changes in cholesterol profile

Causes

Sometimes, a certain 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 individuals, however, no cause for testosterone deficiency can be found. In these circumstances, testosterone replacement therapy is generally an effective treatment.

Effects

Beyond the symptoms that many 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 stomach fat and unusual cholesterol levels.
• Strong association with diabetes.
• Strong association with atherosclerotic disease of the aorta.
• Higher incidence of prostate cancer.
• Association with more aggressive variants of cancer.

Diagnosis

Testosterone deficiency is normally 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, 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 increases the body's testosterone levels with regular administration of testosterone. This therapy can take several forms:

• Testosterone patches give a specified amount of testosterone daily but must be replaced every 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 beneath the skin, providing a steady level of testosterone for 4-6 months.

There are two other types 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 each day and causes gum irritation in many 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 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 a patient's red blood cell mass, reflected in a test called the hematocrit. As a result, careful monitoring of hematocrit levels is essential.

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