Low Testosterone (Hypogonadism)
Low serum testosterone, also known as hypogonadism or Andropause, affects roughly 39% of men over the age of 45. The prevalence of low testosterone increases with age. Researcher have found that the incidence of low testosterone increases from approximately 20% of men over 60, to 30% of men over 70 and 50% of men over 80 years of age.
What are the signs of low testosterone in men?
There are both sexual and non-sexual signs and symptoms associated with low testosterone. Sexual symptoms include poor erectile function, low libido (desire for sex), weaker and fewer erections, and reduced sexual activity. Nonsexual symptoms include increased body fat, decreased energy and fatigue, reduced muscle mass, and depression.
Roughly 40% of men with high blood pressure and 40% of men with high cholesterol levels will have low testosterone levels. Additionally, approximately 50% of men with diabetes and 50% of obese men will have low testosterone. And we know that 30% of men with HIV and 50% of men with AIDS will have low testosterone. Surprisingly, almost 75% of men with a history of chronic opioid use will have low testosterone levels.
What are the treatment options for men with hypogonadism?
There are many treatment options for symptomatic low testosterone. Testosterone replacement therapy may be in the form of skin gel, injections, long acting pellets, patches or oral inserts. The most common type of therapy is gel therapy, which is used by approximately 70% of patients. Men simply rub a gel onto their shoulders or upper arms after taking a shower. Roughly 17% of patients are using testosterone injections and 10% of men are using testosterone patches. Approximately 3% of patients are using other forms of testosterone, such as oral testosterone or implantable testosterone pellets.
What to expect after treatment
Testosterone replacement has been shown to improve a man's energy, libido (sex drive), muscle mass, sleep, erections, energy level, and depressed mood. Testosterone replacement has been shown to also decrease body fat in men. There is data now to support that giving testosterone to a patient with low testosterone may increase their bone mineral density and decrease their risk for a bone fracture. It is important to realize that testosterone treatment is considered lifelong therapy, just like in other chronic conditions. Stopping testosterone replacement will result in a decline in a man's testosterone level.
Frequently Asked Questions:
How is low testosterone diagnosed?
Low testosterone is diagnosed by a blood test. In order to treat a man for low testosterone, he should also have the signs and symptoms of low testosterone. Physicians will also likely check a PSA (a screening test for prostate cancer) and a hematocrit (a measurement of red blood cells in your body). A PSA is checked to make sure that the patient does not have prostate cancer and a hematocrit is checked because men receiving testosterone may experience an increase in their red blood cell count.
What important safety information do you need to understand when using testosterone?
Testosterone should not be used in men with known breast cancer or known or suspected prostate cancer.
Men treated with testosterone may be at an increased risk for the development or worsening of urinary (benign prostatic hyperplasia or BPH) symptoms.
Patients with kidney, liver, or heart problems may be at an increased risk of developing edema, or water retention. Testosterone replacement may result in worsening of sleep apnea. Finally, long-term treatment with testosterone may impair a man's fertility.
What about the relationship between testosterone and prostate cancer?
A common question among patients has been does testosterone replacement therapy cause prostate cancer or more rapid prostate cancer growth.
All studies thus far have found no greater prostate cancer risk among men who receive testosterone compared to men who receive placebo or no testosterone at all. However, this remains an issue that warrants further research.
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Reviewed: January 2011
Last updated: April 2013
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