Low Testosterone Issues?
August 24, 2012
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There has been a lot of discussion and research of menopause in women, however, not until recently has there been a spotlight on Low Testosterone (aka Low T) in men. Some have called this “Andropause”.
In our practice, we have noticed a significant increase in men coming in to see us for signs and symptoms of Low T. This may partly be because of advertising, but lately there has been a considerable increase in awareness in general about low T. As a generation, we are not wanting to “grow old!” Instead, we are increasingly asking our bodies to do more, despite the ability of our natural physiology to keep up.
Increasingly, people are mentally, physically, and sexually active much later in life than our parents or grandparents.
At the Austin Urology Institute, we approach Low T from a true medical standpoint. We are not an “injection or shot clinic”. Instead, we will perform a critical evaluation on each patient that includes screening for low T, low thyroid hormones, diabetes, high cholesterol, low B 12 levels, anemia, and other issues such as sleep disorders, as necessary. Although many people may find that Low T is their primary issue, many others will still find that other issues, some medical, and some non-medical (work or life stressors) may be a significant source of their issues.
Many cases of hypogonadism or low T may be overlooked because of patient embarrassment, feeling that the symptoms are part of the natural aging process, or the diagnosis is overlooked secondary to lack of clinical awareness on the part of the physician.
Although the most well recognized symptom of low T is reduced or loss of libido, hypogonadism can also lead to a significant reduction in quality of life, the loss of livelihood, and a reduction in the quality of relationships and marriages. Low T can also result in a loss of self esteem and confidence.
It is also important to know that a fall in libido can also be commonly associated with other medical conditions, such as depression, anxiety, and other disease states.
What exactly is a Low T level? Check on the internet, or any lab guideline, and you’ll see a significant range of what is normal. Interestingly, guidelines vary between international and national societies. Normal ranges used in clinical labs are based on normal ranges of healthy young men. Ranges can also vary between countries and labs.
Typically, I like to see a range between 350-650 as a normal range for most men. Having said that, years of clinical experience has taught me that different men will need a different T level to feel well. For example, I see many ‘normal’ men with a T level in the high 200s; I also see many men who have signs and symptoms of low T, but might find their T in the 400-500 range. This reinforces the idea that low T may not be the only factor in low energy, libido, and other signs of low T.
By the age of 40, T levels begin to slowly fall, on the order of 1-2% per year.
T is released in a normal circadian (up and down) rhythm that peaks between 6-8am, and drops to its lowest between 6-8pm. Interestingly, overall T levels are the highest in summer/late autumn, and lowest in the winter/early spring.
Testosterone has predominantly been regarded as a sex hormone; having said that, it also has important biologic effects on metabolism, bone, muscle integrity, the cardiovascular system, and the brain.
Low T can be associated with a reduction in strength of erections and loss of early morning erections. Vascular disease, hypertension, different medications for the heart and or blood pressure can all cause ED in addition to coexisting with low T.
Low T and Osteoporosis have been linked. Approximately 15% of men by the age of 50 may be at risk for developing bone fractures later in life. This can increase to 25% by the age of 60. In the US, men account for approximately 150,000 hip fractures a year.
Fatigue can be a common symptom of hypogonadism. As the day progresses, you can feel more and more tired and lethargic. Additionally, there can be a reduced ability to undertake physical tasks that require endurance such as gardening, or distance walking.
Mood disturbance is another important symptom. Depression, irritable behavior, poor concentration, and mood swings can be seen.
T is critical in maintaining normal penile architecture and vascular flow. Restoration of normal T levels can convert over half of patients who initially did not respond to Viagra, into patients that respond well to Viagra.
T supplementation does not cause prostate cancer. However, if prostate cancer is present, T supplementation can cause the cancer to accelerate. Routine monitoring of PSA and prostate cancer screening is recommended. Notify Dr. Shaw if you or a family member has a history of prostate cancer.
Low Testosterone Questionnaire
(3+ Yes answers may suggest low T)
Do you have a decrease in libido/sex drive?
Do you have a lack of energy?
Do you have a decrease in strength/endurance?
Have you lost height?
Have you noticed a decreased enjoyment of life?
Are you sad or grumpy more often?
Are your erections less strong?
Have you noticed a recent deterioration in your ability to play sports or other activities?
Are you falling asleep after dinner?
Has there been a recent deterioration in your work performance?
Dr. Shaw will first assess your panel of labs that were ordered on your initial visit. If there are any issues with labs other than Testosterone (Diabetes, Thyroid disease, etc) we may refer you to a Primary Care physician for further evaluation and treatment
Dr. Shaw will look at your Total Testosterone, as well as Free Testosterone levels. Although your Total T levels are important, your Free Testosterone is what is actually “bioavailable” to your body and cells. We will want to make sure your levels are in an acceptable range.
If appropriate, Dr. Shaw will place you on a 3-month trial of Testosterone supplementation as a trial, and reassess you to check your labs and see how you are symptomatically doing after the initial trial.
Some patients ask about T injections. Initially, testosterone was delivered by intramuscular injections. This led to super-therapeutic doses right after injection, sometimes over the 1000-range, followed by major lows right before the next injection. This can lead to many problems, including major mood swings, increases in Red Blood Cell counts, and other side effects associated with this type of treatment.
Dr. Shaw predominantly utilizes topical testosterone gels. 3 major products work well, and are similar to the “hand-sanitizer gels” available these days. The Gel is simply applied after showering, depending on the brand, either on the chest, the underarms, or upper thigh area. Each has its pros and cons. Gels allow for replacement therapy to mimic the natural circadian rhythm of T, i.e, Testosterone peaks every morning, followed by a natural dip in the evening hours.
Thanks for reading, and we hope this is a start towards feeling better!
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