Testosterone Deficiency

Testosterone deficiency is more common among older men as it often comes with ageing. It may also occur at a younger age when certain factors affect the pituitary gland or the testicles. Depending on the underlying cause of the deficiency, a replacement therapy may be suggested or other treatment to address the underlying cause may be recommended.

What is testosterone deficiency?

Some men are unable to produce sufficient levels of the hormone to lead a normal and healthy life. This is also called hypogonadism. Testosterone production is controlled by the brain and the testicles. The production starts when a boy hits puberty and after 30 years of age it normally tends to decline. This is the single most important sex hormone in men.

Testosterone features:

• essential for developing and sustaining male characteristics
• Directly affects sexual function
• Low levels of testosterone raises the risk of heart diseases in men
• Low testosterone level may affect a man’s quality of life.

What causes testosterone deficiency?

• Most common cause is normal ageing
• It could be a genetic condition that runs in the family
• It could be deficient at birth or develop subsequently
• Obesity may also cause men to be deficient in testosterone
• Physical illness or emotional stress may cause temporary deficiency of the hormone

Primary testosterone deficiency

Primary testosterone deficiency is caused when the testicles fail to produce the required levels of the hormone. Common causes are:

• Klinefelter’s syndrome- this occurs when two or more X chromosomes and a Y chromosome are present instead of the normal combination of one X and one Y chromosome each
• Testicles have been injured
• Testicles are undescended
• Mumps orchitis.
• Haemochromatosis.
• Treatment for cancer such as radiotherapy and chemotherapy are known to affect sperm production

Secondary testosterone deficiency

Secondary testosterone deficiency is the condition when the hypothalamus or the pituitary gland in the brain fail to stimulate the production of the hormone in the testicles. Often, the testicles are normal but their function is affected by the lack of trigger from the brain.
Some common causes:

• Poorly functioning pituitary gland or any abnormality of the gland
• Underlying conditions that make the immune system weak – like HIV/AIDS
• Occasionally hormone supplements or opium based painkillers may affect the production of testosterone

How common is testosterone deficiency?

The condition is more prevalent among men as they get older. Obese or overweight men tend to develop the deficiency more than men who generally are fit and keep good health.
A European study revealed that 2% of the men between 40 and 79 years of age were deficient in the hormone and the figure increased to 5% among those in the 70-79 age group.

What are the symptoms of testosterone deficiency?

The symptoms will depend on when the condition develops.Extremely low production of testosterone in unborn male babies hinder the proper development of the testicles. The baby may be born with either:

• Female genitals.
• Ambiguous genitals that are neither clearly male nor female or
• Poorly developed male genitals.

Testosterone deficiency in adult males may lead to:

• Infertility
• ED or Erectile dysfunction.
• Lower levels of body hair and beard.
• Reduced muscle mass.
• Growth of breast tissue – a condition called gynaecomastia
• Osteoporosis or loss of bone density.

If the deficiency occurs before the person hits puberty, it may also lead to:

• Onset of puberty maybe delayed
• The voice may lack depth and sound
• Development of the testicles and penis may be impaired
• Arms and legs may experience excessive growth as compared to the body

Symptoms of lowered testosterone levels in men as they get older are(similar to menopause in women)- fatigue or feeling excessively tiredness, low sex drive or libido, poor concentration and hot flushes.

What are the tests for testosterone deficiency?

Testosterone deficiency frequently goes undiagnosed as the symptoms are general problems that develop with natural ageing. If you go to the doctor to get checked out about a low sex drive or erectile dysfunction, he is likely to have you tested for testosterone deficiency. Men that are getting treatment for ED but do not respond to the treatment must have their blood testosterone tested. If it turns out that testosterone levels are indeed low, further testing needs to be done to find out the underlying cause.

• Checking the blood levels of other hormones as the pituitary gland is responsible for producing more than one hormone
• Analysis of a semen sample
• A CT or an MRI scan of the pituitary gland.
• Genetic tests.
• Biopsy of the testicles.

The importance of detecting Testosterone deficiency:

Early detection and treatment in boys

• Prevents delayed puberty
• Ensures correct development of male characteristics
• helps increased muscle mass
• helps beard and hair growth
• helps proper development of the penis and testicles

Early diagnosis and treatment in adult men

• Prevents heart diseases
• Better protection against osteoporosis
• May also rectify ED and improve sex drive
• Improve general well-being and improve tiredness.

The underlying cause of the testosterone deficiency can determine the course of treatment.

How do we treat Testosterone Deficiency?

Testosterone replacement

This can be administered in different ways:

• In the form of a gel
• long-acting injections
• using an adhesive patch that is applied to your skin.

You must follow up with your doctor for regular check-ups to ensure there are no adverse side effects of problems resulting from this treatment.

Other treatments

• If the pituitary gland is causing the problem, pituitary hormone supplements may help stimulate testosterone production and improve fertility.
• If a tumour in the gland is causing the deficiency, surgical removal, radiotherapy or chemotherapy may be required along with replacement therapy.
• Occasionally, infertility treatments may be helpful, although there is no actual treatment to repair potency in a man who has the deficiency because of underdeveloped testes

What is the outlook?

The prognosis mainly depends on the underlying cause of the deficiency. In older men that are deficient in testosterone, without an apparent underlying cause, replacement therapy has proved to be effective.

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