Testosterone Deficiency Syndrome

Testosterone Deficiency Syndrome

Men’s Clinic in Singapore (Caring & Treating Since 2005)

What is Testosterone Deficiency Syndrome?

Testosterone Deficiency Syndrome (also known as hypogonadism) is a condition that occurs in men as they advance in age. It is also often defined as the biochemical deficiency of testosterone and sperm production, both of which are the major function of the testes.

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These abnormalities usually result from disease of the testes – primary hypogonadism, the disease of the pituitary or hypothalamus (glad in the brain) – secondary hypogonadism, or, more rarely, a defect in the ability to respond to testosterone

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What are the Leading Symptom of Testosterone Deficiency Syndrome?

The leading symptom experienced by men is the loss of Libido. Other sexually related symptoms also include difficulty in initiating or maintaining an erection. Furthermore, low testosterone levels also cause depression and obesity resulting in the worsening of metabolic disease.

However, the manifestations of testosterone deficiency can be nonspecific and variable in severity and onset.

Do I have Testosterone Deficiency?

ADAM Questionnaire about Symptoms of Low Testosterone (Androgen Deficiency in Aging Male)

Take this simple questionnaire to determine whether you may have a deficiency or not

ADAM Questionnaire about Symptoms of Low Testosterone (Androgen Deficiency in Aging Male)

1.) Do you have a decrease in libido (sex drive)? Yes No
2.) Do you have a lack of energy?Yes No
3.) Do you have a decrease in strength and/or enduance? Yes No
4.) Have you lost height? Yes No
5.) Have you noticed a decreased “enjoyment of life” Yes No
6.) Are you sad and/or grumpy? Yes No
7.) Are your erections less strong? Yes No
8.) Have you noticed a recent deterioration in your ability to play sports? Yes No
9.) Are you falling asleep after dinner? Yes No
10.) Has there been a recent deterioration in your work performance? Yes No

If you Anser “Yes” to number 1 or 7, or if you answer “Yes” to more than 3 questions, you may have low Testosterone.

However, there are a host of other medical conditions which can also mimic testosterone deficiency syndrome.

These are summarized in the following table:

Type 2 Diabetes Osteoporosis
Metabolic Syndrome End Stage renal disease
HIV weight loss COPD (lung disease)
Opiod, Glucocorticoid Infertility
Alcohol or Drug abuse Hyperprolactinemia
Liver disease Brain tumour or trauma
(iron accumulation in liver)
Testes cancer treatment

Doctor how then do we diagnose testosterone deficiency (TDS)?

Ruling out the above conditions through a detailed series of questions and tests, we would then measure your testosterone levels in the morning between 7am and 11am, or within 3 hours of waking.

As a guide, if total testosterone levels are normal (greater than 12), you would then, not be diagnosed with (TDS). If the values are borderline below 12, a repeat testosterone level can be performed for confirmation. However, this numbers serve as a guide and should still be explored as a whole with our doctors given your clinical contextand symptoms experienced. If your total testosterone values fall below 12, further comprehensive tests would also be undertaken

These include FSH, TSH, LH, Prolactin– (hormones produced by the pituitary gland), a complete blood count, SHBG, cFT or cBAT, Ferritin (iron capacity in the blood), PSA (prostate specific antigen) for prostate disease.

Depending on the results of the comprehensive tests, one would then be given a diagnosis of primary hypogonadism or secondary hypogonadism

Primary Hypogonadism:

  • Low testosterone + High LH/FSH
  • More likely associated with decrease in sperm production than testosterone production
  • More likely associated with gynaecomastia (breast development)
  • Due to congenital abnormalities, acquired disease OR idiopathic (unknown cause)

Secondary Hypogonadism

  • Low testosterone + normal LH/FSH

Testosterone in the body is bound to carrier proteins (transport proteins that bind to other substances for transport through the blood around the body). These carrier proteins are sex hormone binding globulin (SHBG) and albumin.

44% of testosterone in the blood binds tightly to SHBG. This proportion of testosterone cannot bind to cells in the body which use testosterone and is known as unavailable testosterone, as it is unavailable to the body’s cells.

Further 54% of testosterone in the blood binds loosely to albumin, but remains available to the body’s cells. This is also known as calculated bio-available testosterone (cBAT).

The remaining 2% of testosterone in the blood remains unbound and is also available to testosterone-using cells in the body. It is referred to as calculated free testosterone (cFT).

Testosterone levels can be measured in terms of total, bio-available or free testosterone and there are various tests which can be used to measure levels of each type of testosterone.

What do I do after my diagnosis?

Are there any Follow up

Whilst low testosterone could be the reason behind the symptoms you experience, there are also many other medical reasons which could contribute to your symptoms.

It will be important for us to care for you holistically and uncover any other conditions which may mimic the symptoms you experience with low testosterone.

Subsequently, you could explore with our team of doctors the possibility of Testosterone Replacement Therapy.

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If you are experiencing any symptoms, or have any concerns or questions about Andropause, please call or visit any of our Men’s Health Clinics or drop us an email at hello@dtapclinic.com.sg for an appointment.

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