What is testosterone?
Testosterone is the primary male sex hormone, responsible for a wide range of functioning in the body. This includes regulating mood and energy levels, managing muscle mass, bone density, as well as libido and sexual function.
As men age, testosterone levels naturally begin to decline. If the decline is too fast, this can lead to symptoms that significantly affect their quality of life. This can sometimes be called Andropause or the ‘Male Menopause’.
What is normal?
Testosterone peaks in early adulthood, and then gradually decreases after the age of 30. If levels drop too quickly, this can lead to various symptoms mentioned below.
A “normal” level can vary between people, but a total testosterone level <12nmol/l in a morning sample is generally regarded as being low.
What causes low testosterone?
There are multiple factors that can cause male menopause, so it is important to see a doctor to take a full history and examination to identify the cause. Factors include:
- Medical conditions (diabetes, obesity, stress)
- Injury or infection affecting the testicles
- Medications
- Genetic factors
The commonest cause of low testosterone however is simply aging.
Signs of low testosterone?
Low testosterone can cause a range of symptoms with differing severity. Common signs include:
- Fatigue – significant drop in energy levels and tiredness
- Reduced libido – decreased sexual desire and performance
- Mood changes – depression, anxiety and irritability
- Loss in muscle mass
- Increased body fat – especially around the tummy
- Brain fog – poor concentration and memory
- Infertility
If you suffer from any of the above, it is worth having a testosterone test.
An ADAMs questionnaire is a useful screening tool for low testosterone.
https://www.issam.ch/AMS_English.pdf
How is it tested?
A simple blood test is needed to check total testosterone levels.
The best time for an accurate test to be taken is before 10am and ideally fasting.
If the first level is low, then a further sample should be taken at a later date (4-6 weeks) for confirmation before replacement is started. This further test should also include some other screening blood tests to check for other causes of low testosterone. A ‘Free Testosterone’ level is also calculated at this time.
How is it treated?
It is important to have a full review with a medical professional to ascertain any reversible secondary causes first.
The next step for treatment is testosterone replacement which varies from person to person. Options are:
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- Topical gels and creams (Testogel, Tostran, Testavan)
Generally first line treatment option due to ease of use and provides a steady absorption of testosterone and consistent levels.
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- Testosterone injections (Nebido, Sustanon)
Normally used either every 12 weeks (Nebido) or 2-3 injections a week (sustanon).
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- Pellets
Inserted by minor op under the skin.
It is also important to look at other lifestyle measures to increase testosterone, including regular exercise, diet, weight loss, alcohol intake and stress.
Conclusion
Testosterone replacement therapy can be life changing for men suffering with low testosterone, but should also coincide with lifestyle changes to have the most benefit. There are certain risks and side effects, so it is important to be under the right team and have appropriate monitoring while being treated.
If you are suffering with any of the issues mentioned before, book an appointment to be tested and discuss your options.
