Lackluster drive
could point to Low T
The Endocrine Society de nes low testosterone, or low T (male hypogonadism), as the condition where the testes fail to produce adequate testosterone levels for normal male function. After about age 30, most men begin to experience a gradual decline in testosterone levels due to normal aging. But the decline may sometimes be precipitous, and it can happen at any age. According to the American Urological Association low-T affects roughly 39 percent of men over the age of 45, and that percentage increases with age. The National Institutes of Health estimates that about ve million men suffer from this condition.
Dr. Loren J. Smith, a urologist at Willis- Knighton Pierremont, said that he is seeing an increasing number of men, young and old, seeking treatment for low testosterone, or low T. “I used to see one to two men every quarter and now we see two or more weekly. It is being recognized as a signi cant medical issue, and as it gets more discussion and attention, more men seek treatment. T declines with age for reasons which are not completely clear, but low T affects both elderly and young men. I have seen it at all ages. Men should listen to their spouses when they complain about tiredness and lack of libido, as we often do not recognize the changes seen by our family and friends.”
The National Institutes of Health describes testosterone as the most important hormone in male sexuality for development of male sexual characteristics, as well as the driving force behind the male sex drive and sperm production. According to the NIH, levels of testosterone can decrease due to disruptions to functioning of the hypothalamus, pituitary, or gonads (the GPH axis) potentially resulting from tumors, cysts, trauma or infection.
Smith said that low T is associated with a number of diseases/conditions:
• Testis trauma
• Infections
• Diabetes
• Obesity
• Infertility
• Testis cancer
• Treatments for testis cancer, and
• Hormone imbalances.
“In order to diagnose low T, we perform a thorough evaluation starting with a discussion of his symptoms and then completing a complete physical exam. We test the blood for the T level, usually with an early morning test when the level should be highest.”
Smith said that he thinks the diagnosis of low T requires a combination of symptoms and a low testosterone level. He listed some of the symptoms as:
• Depression
• Low or decreasing libido
• Tiredness
• Lack of energy
• Loss of interest in activities the sufferer used to enjoy
• Weakness, and
• Weight gain.
Smith added, “Remember that libido is the desire for intercourse not the ability to achieve erection. Low T is seldom the reason men have trouble achieving erections when they want to have intercourse. T is produced by the testicles. The level considered normal is about 250 to 1,000 nanograms per deciliter. The “normal range” is obviously pretty wide so sometimes men with normal levels may have symptoms while men with low levels may not have any symptoms. When the level gets below 200, men usually do have symptoms.”
“Low T is primarily treated with replacement testosterone,” said Smith. “The most common form is a topical gel or cream which is effective and well tolerated. Sometimes injectable T is a better answer if we need to achieve higher levels or the patient is concerned about the cream rubbing off on family members, which we do not want to happen. A newer form of treatment is an implantable pellet, which slowly releases testosterone. If we replace the T and achieve a normal level but symptoms persist, it may be reasonable to stop therapy. However, increasing the level may help keep bones stronger and increase muscle mass even if other symptoms do not improve.” The NIH warns, however, that testosterone replacement therapy is contraindicated for men diagnosed with breast cancer or bladder obstruction caused by severe prostate enlargement.
Finally, Smith said that there is newly emerging data suggesting a link between low T and prostate cancer. “When men have a low T, I am careful to obtain a PSA level also [Prostate-Speci c Antigen, a test for prostate cancer]. If the patient has a low T and a borderline PSA level, I am more likely to recommend a biopsy to evaluate for prostate cancer ... there has been a lot of discussion in the press about PSA lately and there are good arguments both for and against routine PSA screening for prostate cancer. I strongly encourage all men to have a discussion with their primary physicians or urologists regarding the bene ts and risks of PSA screening.
– Michael Stone
