low testosterone

by Chris Steidle, MD

Historically, a discussion of treatment with testosterone conjures up an image of a weight lifter or body builder, which usually carries negative connotations. Consequently, physicians have been taught that testosterone should be used only in severe cases where the patient cannot function in normal society.

In the last several years, and, more specifically, with the development of testosterone in a form that simplifies administration and dose, our understanding of low testosterone in men has changed. The medical profession has generally believed that, as men age, many of the changes they experience are due to the aging process rather than to hormonal changes such as are seen in women during menopause.

Currently, millions of American women take hormones to reduce the negative effects of low estrogen levels during and after menopause. Only recently, we've begun to recognize a similar syndrome in men and have called it "andropause." The difference in the way men and women experience this change is that it is a much slower process in men so it is often not as obvious.

In men, mid-life hormone changes usually begin without notice, especially after the age of forty. Unfortunately, the only obvious result may be the gradual assumption of the appearance of "an old man." Andropause, a condition in which the testosterone level slowly declines with age, also decreases a man's ability to enjoy sex. In addition to experiencing a decrease in sexual desire and erectile function, men with a lowered testosterone level may also notice changes in mood and emotions, a decrease in body mass and strength due to loss of muscle tissue, and an increase in body fat. Finally, the worst outcome may be alterations in bone mineral density, a condition called osteoporosis, which can lead to severe bone changes and even to fractures.

After the age of thirty, a man may lose up to two percent of testicular function each year. We know that twenty to fifty percent of healthy men between the ages of 50 and 70 have lower than normal levels of testosterone. This statistic indicates that up to five percent of all men are at risk for low testosterone states, a staggering number if you think about it. However, the reported incidence is extremely low, due, at least in part, to the fact that it is difficult to diagnose a condition that you don't know about. Until recently, we haven't known much about low testosterone or testosterone replacement in men.

The ADAM Questionnaire (Androgen Deficiency in Aging Male) is a series of questions that can reliably lead you and your doctor to the possible diagnosis of low testosterone. If the answers to this quiz indicate that a low testosterone level is a possibility, the next step is to have a blood test to measure your testosterone level in the morning. If this test indicates a lower than normal level, a visit to your physician for evaluation and diagnosis is indicated.

Men are living longer and we are beginning to understand more about the aging process. As this knowledge becomes more available, men will demand treatment for low testosterone to maintain or improve their relationships and alleviate other symptoms, including osteoporosis, sexual dysfunction and mood disturbances - many of the same problems that occur in aging women.

References

Steidle, CP. The Impotence Sourcebook. Lowell House. 1998.

Posted January 2002
Updated May 2005