Testosterone Deficiency Syndrome (Hypogonadism)

Testosterone Deficiency Syndrome, or Hypogonadism, is a condition in which a man's body does not make enough testosterone, the primary male hormone. This condition generally affects older men, but younger people can also be affected for a variety of reasons. While the term "andropause" is sometimes 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 several 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 job performance
• Negative changes in cholesterol profile

Causes

In some cases, a specific 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 the majority of people, though, no cause for testosterone deficiency can be identified. 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 cardiovascular disease.
• Increased risk of death from a cardiovascular event.
• Increased risk of metabolic syndrome: high blood pressure, elevated insulin levels, excess stomach 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 variations of cancer.

Diagnosis

Testosterone deficiency is typically diagnosed with a simple blood test.

Treatment

When a specific cause for testosterone deficiency can be identified, 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 specific cause can be determined, testosterone replacement therapy is the most common treatment option.

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

• Testosterone patches give a specified amount of testosterone daily but must 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 beneath 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 starting testosterone therapy, patients need to recognize that it is a life-long commitment. Testosterone supplementation causes 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, shown in a test called the hematocrit. As a result, careful tracking of hematocrit levels is important.

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