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Do I have low testosterone?

by Chris Steidle, MD

Low testosterone levels affect many men as they age. All men should know the symptoms of low testosterone and be familiar with the causes of low testosterone so they can see their doctors if and when they develop. Low testosterone levels and the symptoms they cause can be remedied through testosterone replacement therapy.

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In the past, a discussion of treatment with testosterone conjured up an image of a weight lifter or body builder, which usually carries negative connotations. Consequently, physicians have been taught that testosterone should be used only in severe cases where the patient cannot function in normal society.

In the last several years, and, more specifically, with the development of testosterone in a form that simplifies administration and dose, our understanding of low testosterone in men has changed. The medical profession has generally believed that, as men age, many of the changes they experience are due to the aging process rather than to hormonal changes such as are seen in women during menopause. 

Millions of American women have taken hormones to reduce the negative effects of low estrogen levels during and after menopause. Only recently, we’ve begun to recognize a similar syndrome in men and have called it andropause.  The difference in the way men and women experience this change is that it is a much slower process in men so it is often not as obvious. 

Symptoms of low testosterone

In men, mid-life hormone changes usually begin without notice, especially after the age of forty. Unfortunately, the only obvious result may be the gradual assumption of the appearance of an old man. Andropause, a condition in which the testosterone level slowly declines with age, also decreases a man’s ability to enjoy sex. In addition to experiencing a decrease in sexual desire and erectile function, men with a lowered testosterone level may also notice changes in mood and emotions, a decrease in body mass and strength due to loss of muscle tissue, and an increase in body fat. Finally, the worst outcome may be alterations in bone mineral density, a condition called osteoporosis, which can lead to severe bone changes and even to fractures.

After the age of thirty, a man may lose up to two percent of testicular function each year. We know that twenty to fifty percent of healthy men between the ages of 50 and 70 have lower than normal levels of testosterone. This statistic indicates that up to five percent of all men are at risk for low testosterone states, a staggering number if you think about it.  However, the reported incidence is extremely low, due, at least in part, to the fact that it’s difficult to diagnose a condition that you don’t know about. Until recently, we haven’t known much about low testosterone or testosterone replacement in men. 

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The Low Testosterone Quiz is taken from the Androgen Deficiency in Aging Male Questionnaire, which is a series of questions that can reliably lead clinicians to the possible diagnosis of low testosterone. If the answers to this quiz indicate that a low testosterone level is a possibility, the next step is to have a blood test to measure the testosterone level in the morning. If this test indicates a lower than normal testosterone level, a visit to your physician for evaluation and diagnosis is indicated.  

Men are living longer and we are beginning to understand more about their aging process. As this knowledge becomes more available, men will demand treatment for low testosterone so they can maintain or improve their relationships and alleviate other symptoms of low testosterone, including osteoporosis, sexual dysfunction and mood disturbances - many of the same problems that occur in aging women.

Do I have low testosterone? Take the quiz and find out.

References

Brawer, Michael K., MD. Androgen Supplementation and Prostate Cancer Risk: Strategies for Pretherapy Assessment and Monitoring. Rev.Urol. 2003;5 (suppl 1):S29-S33.

Caruthers, Malcolm, MD. The Testosterone Revolution. London: Thorsons; 2001

Heaton, Jeremy, P.W., MD. Hormone Treatments and Preventive Strategies in the Aging Male: Whom and When to Treat? Rev.Urol. 2003;5(suppl 1):S16-S21.

Matsumoto, Alvin M., MD. Fundamental Aspects of Hypogonadism in the Aging Male. Rev.Urol. 2003;5(suppl 1):S3-S10.

McCulloch, Andrew, MD. Case Scenarios in Androgen Deficiency. Rev.Urol. 2003;5(suppl 1):S41-S48.

Nieschlag, E., Behre, H.M., Nieschlag, S. Testosterone: Action, Deficiency, Substitution. Berlin: 1998.

Steidle, Christopher P., MD. New Advances in the Treatment of Hypogonadism in the Aging Male. Rev.Urol. 2003;5(suppl 1):S34-S40.

Notes

1. Matsumoto, Alvin M. Fundamental Aspects of Hypogonadism in the Aging Male. Urology. Vol. 5, Supplement 1. 2003;S3-10.

2. Morley, JE. J Gend Specif Med. 2001;4:49-53.

Posted February 2004
Last updated: March 2013

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