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What is testosterone deficiency and its symptoms?

While menopause, which sees females experience starkly decreased oestrogen production, is widely known, it has a lesser known male counterpart – testosterone deficiency.

Low testosterone in males can present in multitude of ways. Therefore, it is important to consider checking your testosterone levels if experiencing one, or more, of the symptoms below:

• Fatigue
• Hot flushes
• Mood swings
• Reduced hair growth
• Loss of muscle mass
• Reduced libido or sex drive
• Erectile dysfunction
• Enlarged and/ or tender ‘female-like’ breast tissue (gynaecomastia)

What is the cause of testosterone deficiency?

Testosterone deficiency can be caused by damage within the hypothalamus-pituitary-gonadal axis, which is the body’s interlinked trio of hormonal glands.

Primary hypogonadism is the inability of the testes to produce testosterone. This can be related to trauma to the testes, previous testicular surgery, undescended testes, a previous mumps infection, a genetic condition, or the onset of age (‘male menopause’). Very rarely, this condition is caused by testicular cancer.

Secondary hypogonadism, or hypogonadal hypogonadism, refers to the inability of the pituitary gland, or hypothalamus gland to produce gonadotrophins. This is a hormone which stimulates the testes to produce testosterone. Causes can include a brain injury (including long-standing brain injuries), pituitary or hypothalamic tumours, a genetic condition, or obesity.

How is testosterone deficiency diagnosed?

Fasted 9am blood samples taken on two separate occasions are often required to confirm the diagnosis. The variable nature of testosterone production, means that Endocrinologists tend to base their diagnosis on a minimum of two samples.

Once diagnosed, further tests, such as an ultrasound of the testicle(s), or an MRI of the pituitary gland, might also be necessary.

Why is treatment of testosterone deficiency in males necessary?

A good question.

After all, not all females seek and/ or undergo treatment for menopause. Treatment of low testosterone levels is recommended, due to the hormone’s wide-ranging effects on general well-being, particularly mood, energy, and libido. It should also be noted that early onset testosterone deficiency, whether in males or females, places one at risk of osteoporosis (weakened bones).

In addition, long-term testosterone replacement is thought to improve one’s cardiovascular health, although evidence for this remains inconclusive.

How is testosterone replaced?

The two licensed methods of testosterone replacement in the UK are:

• Daily self-application of testosterone gel to the skin
• Monthly or quarterly intramuscular testosterone injections usually administered at the GP Surgery

There are no discernible benefits of one method over the other in terms of symptom management. They are equally efficacious, and picking one is largely down to personal preference.

The testosterone gel requires application every morning, so would best suit someone able to adhere to a consistent routine. One should also be aware of the risk of residual transfer from one’s hands, or from the application site, to another individual. If you choose this method, it is important to wash your hands thoroughly after gel application, and allow the gel to completely air dry on your skin before going about your day (getting dressed, engaging in sports where another individual may come into contact with the application site etc.). Due to the gel’s shorter half-life (measure of how long it takes for medication to be eliminated from the body), the risk of side effects is lower.

Intramuscular injections can be 4-weekly or 12-weekly, dependent on the brand used. These tend to be administered at the GP Surgery, and once completed, require no further action on your part. Unlike the gel, there is no need for daily applications, or being mindful regarding residual transfer. It should be noted that as the injection is in depot (slow release) form in the body, there may be a higher risk of side effects. This method also requires visiting the GP every 4 to 12 weeks, which some may not prefer.

Overall, the side effects of testosterone replacement are rare. Some patients may experience issues with acne, increased sebum production (‘oily skin’) and behavioural changes, much like going through puberty again. Other possible side effects include prostate enlargement, increased blood viscosity (thickness) leading to increased risk of heart attack or stroke, and liver derangement (abnormal liver function). Patients on testosterone replacement are closely monitored for side effects, usually through regular
blood tests and follow-up appointments.

What can we offer for individuals with low testosterone levels?

If you are experiencing any of the symptoms above, and wondering if you have low testosterone, please get in touch. We can arrange blood tests for you through BMI Bath Clinic, prior to your confirmed appointment with Dr Tan.

During the appointment, Dr Tan will review your test results, evaluate the need for further investigations, discuss the pros and cons of testosterone replacement, and in collaboration with yourself, choose an option best suited to your needs. Should you embark on testosterone replacement treatment, Dr Tan will be closely monitoring your condition for potential side effects, and to ensure optimal replacement levels are achieved.