Having low levels of testosterone or Testosterone Deficiency Syndrome is common and can occur in about 1 in every 200 men under the age of 60 and 1 in 10 men over the age of 60. Commonly the symptoms may be subtle and thus can be easily overlooked as “Oh, it’s just part of aging.”
As men age, levels of testosterone drop by about 1-1.5% each year after age of 30 but not all males experience the drop in levels. It is known from studies that the more overweight you are, the faster the decline in the levels of testosterone. In addition, it has been shown in studies that low testosterone levels are associated with cardiovascular risks like coronary arterial disease and metabolic syndrome including type 2 diabetes.
Effects of having low testosterone:
- Regression of some features of male sexual characteristics
- Low mood or irritability
- Poor concentration
- Low energy, feeling tired
- Hot flushes and sweats
- Decreased libido
- Reduced beard or body hair growth
- Low semen volume
- Reduced muscle strength
- Fracture (osteoporosis)
- Erectile dysfunction
It has been shown in some studies that supplementation of testosterone in those with low testosterone levels can increase their libido.
Causes of low testosterone
Generally the causes of low testosterone can be classified into testicular (Primary) and Hypothalomo-pituitary (Secondary) causes.
- Age-Related Testosterone Deficiency
- Chromosomal: Klinefelter syndrome – Congenital;
- Undescended testes
- Surgery: bilateral orchiectomy
- Infection: mumps orchitis
- Radiotherapy/chemotherapy/drugs (spironolactone, ketoconazole)
- Idiopathic hypogonadotropic hypogonadism
- Pituitary microadenoma (<1 cm) or macroadenoma (>1 cm)
- Functional or non-functional: in men typically macroprolactinoma
- Other causes of hypothalamic pituitary damage: surgery, radiotherapy, trauma, infiltrative disease such as haemochromatosis
Lifestyle modifications – diet and exercise
It has been shown in studies that resistance weight training can increase levels of testosterone. Reducing body fat has also been shown to increase levels of testosterone. There are some studies show high-intensity interval training (HIIT) is more effective in reducing body fat than steady-state cardio.
Medications: Testosterone Replacement
There are several formulations available for replacing testosterone. The choice of which formulation to use is largely patient preference.
- Slow releasing formulation injections – generally given every 10-12 weeks as an intramuscular injection. Some people prefer that as they only need to get 1 injection once every 3 months or so rather than to take medication daily.
- Short acting formulation injections – these injections are given once every 1 to 3 weeks. Most of the time, patients learn to inject themselves.
- Gels or capsules – generally capsules are taken twice daily and gels are applied once daily. Gels are preferred by some as it is only used once daily and also in some cases, those who used the injectable form experience swings in their symptoms especially when it approaches the time for the next dose. But as the gel is applied daily, the levels of testosterone remain relatively stable and thus avoid the swing. However, gels may not be suitable for a person with an active lifestyle as the testosterone in the gel may not have enough time to be absorbed before they commence their exercise or when they shower after the exercise.
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