low testosterone levels in men

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by Chris Steidle, MD.

Low testosterone in men can create problems for many as they age. Our current understanding of the causes and symptoms of low testosterone in aging men, often referred to as andropause or male menopause, is that through treatment to increase testosterone levels, we can relieve many symptoms previously believed to be part of the aging process. These include irritability, weight gain in the wrong places, loss of muscle tone, inadequate erections and poor sexual performance. An additional list of symptoms of low testosterone includes:

• Erectile dysfunction (problems with erections)
• loss of libido (low sex drive)
• Mood disturbances, including depression, irritability and feeling tired
• Loss of muscle size and strength
• Osteoporosis (bone thinning)
• Increased body fat
• Difficulty with concentration and memory loss
• Sleep difficulties

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. 

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 and to develop good quality erections. In addition to experiencing a decrease in sexual desire and erectile dysfunction, 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.

Low testosterone is often the result of lost testicular function

After the age of thirty, a man may lose up to two percent of testicular function each year and a corresponding decrease in testosterone level. 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. 

Low testosterone quiz to help you describe your symptoms

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 the aging process. As this knowledge becomes more available, men will demand treatment for low testosterone to maintain or improve their relationships, have better sex without Viagra and alleviate other symptoms, including osteoporosis and mood disturbances - many of the same problems that occur in aging women.

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 modified: December 2008