Testosterone—Are You Running On Empty?
5 million American men have testosterone deficiency. Could you or someone you know be one of them?
Nearly 40% of American men have testosterone deficiency, or hypogonadism. Could you or someone you know be one of them?
Testosterone, the predominately male sex hormone (women have some too) is produced in the testicles and to a much lesser extent in the adrenal glands (small organs that sit atop the kidneys). A man’s production peaks at adolescence and declines slowly throughout aging. Unlike women, there is no “male menopause” where testosterone production abruptly declines. Testosterone has many functions: stimulating a healthy sex drive, muscle mass, energy level, and bone health, just to name a few. Without testosterone men have trouble concentrating, feel depressed, lack energy and sex drive, and gradually whither away. Men need testosterone to be men!
There are several well-recognized causes of hypogonadism. A rare type of benign brain tumor in the pituitary gland, called a prolactinoma, can cause decreases in testosterone production. Obesity, and alcohol or marijuana abuse, as well as certain prescription drugs, can cause the available testosterone in the bloodstream to decline. Diabetic men, and those with HIV or being treated for chronic pain all have a greater risk of lower testosterone levels. Surgical removal of the testicles, and certain treatments of advanced prostate cancer affect testosterone production. And as previously mentioned, aging results in a gradual decline in testosterone production. That said, only 10% of men with hypogonadism are being treated for their problem, according to a recent large study.
The average male doesn’t want to admit anything is wrong with him. We are bred to believe we are indestructible! Fortunately, many of us have significant others that care about us, and encourage (and occasionally force) us to seek medical attention when things aren’t quite right. An astute physician will recognize signs of hypogonadism and order a testosterone blood test. This test should be performed in the early morning when our circadian rhythm cause testosterone levels to be at their peak. If low, a normal prolactin level will reassure us that no brain tumor is to blame for hypogonadism.
There is no pill currently available that safely and reliably increases one’s testosterone. Testosterone replacement therapy is available in the US in the form of shots, patches, implantable pellets, and gels. Although least expensive, shots cause severe peaks and valleys in the testosterone level, and this is associated with bothersome mood swings as well as enhancement of other side effects. The patches, pellets, and gels provide the most physiologic form of replacement, and are covered by most commercial insurers. All forms of testosterone replacement have risk associated. Testosterone replacement can cause fluid retention resulting in ankle swelling and worsening of a condition called sleep apnea (a potentially life-threatening problem, usually seen in overweight men with a snoring problem); also thickening of the blood, polycythemia, which can increase one’s risk of blood clots, and acceleration of prostate enlargement with associated voiding difficulties can result from addition of testosterone to a hormonally-deficient man. Testosterone does not cause prostate cancer, but can accelerate its growth. Testosterone can also cause infertility. Careful monitoring is required once on testosterone replacement to ensure that no significant side effects occur.
On the upside, the return of sex drive and overall energy, as well as ability to concentrate and physical strength are enormous benefits to an otherwise run-down individual. Seek medical attention if you think you have hypogonadism, and carefully weigh the risks and benefits to testosterone replacement.
After completing his education at the UCLA School of Medicine and the University of Kentucky, Dr. Gange entered the US Army as a urologist, where he was twice awarded the military medal of meritorious service.
Now at the Western Urological Clinic, Dr. Gange works to advance the field of urology and serve the community. He researches prostate cancer, BPH, prostatitis and more and is widely published.
Locally, Dr. Gange is president of the Utah Healthy Living Foundation, which works to improve Utah's health through education and screenings. He is the former chair of the Prostate Cancer Task Force in Salt Lake, and former chief of surgery at St. Mark's. Dr. Gange lectures to physicians and lay audiences nationally.