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Testosterone Replacement Therapy

Low testosterone is referred to by many different names such as hypogonadism, andropause and androgen deficiency in the aging male (A.D.A.M.). These terms are oftentimes used interchangeably and create confusion even amongst healthcare professionals. All of these terms refer to a condition of low testosterone that is associated with other symptoms. Some of these symptoms include a decreased sex drive, fatigue, erectile dysfunction, falling asleep after dinner, memory and concentrating difficulties, bone density loss and diminished work performance which are all associated with low testosterone levels. Oftentimes these symptoms are overlooked or attributed to some other condition such as normal ageing. Effective therapy for low testosterone levels exists.

Why is my testosterone level low?

It is a well known fact that a man's testosterone level begins to decline as early as the age of thirty (30). In fact, large longitudinal population studies have shown that a man's tetsosterone decreases by approximately 1% per year after the age of 30. By the time a man reaches the age of 60, there is a 30% chance that he will have a low testosterone level. Most often the decrease in testosterone is associated with aging. Similar to when a woman goes through menopause, men go through andropause but at a much slower rate. Consequently, many of the symptoms associated with this condition can be insidious.

What are some other conditions associated with Hypogonadism?

Certain common conditions are frequently associated with low testosterone. The table on the right lists some of these conditions.

 
Aging
Metabolic Syndrome
COPD/Sleep Apnea
Obesity
Kidney Disease
Stress
Diabetes Mellitus
HIV/AIDS
Chronic Infections
Chronic Opiod Use
Sickle cell disease
Medications

Alerting your physician to any of the symptoms associated with low testosterone is important. A health inventory questionnaire called the A.D.A.M questionnaire was designed to identify patients who potentially might have low testosterone levels. If you answer yes to any three questions or to any single sexual question, there is a strong possibility that you have a low testosterone level. Your physician will order confirmatory lab tests prior to commencing any therapy.

What types of treatment options are available for men with low testosterone levels?

There are a variety of treatment options available for the man with low testosterone levels. Currently, there are oral, buccal, transdermal gels, patches, intramuscular injections and subcutaneous pellets available to treat hypogonadism. Each form of therapy has specific advantages and disadvantages associated with it. You can discuss with your physician which form of therapy is right for you.

What are the risks of testosterone replacement therapy?

In general, testosterone replacement therapy is very safe. People oftentimes confuse the difference between replacing testosterone in the body to return it to normal physiologic levels with taking testosterone to achieve "super-physiologic" levels for performance enhancement. These are clearly two different situations. The biggest concerns are related to prostate health and the development of prostate cancer. Many hypogonadal men might notice a slight worsening of their urinary symptoms or increase in their PSA. This occurs because the prostate and PSA are directly controlled by testosterone. Replacing testosterone into the normal range only increases urinary symptoms and PSA into the range where they would be if the testosterone level was not low in the first place. Men with testosterone levels in the normal range (300-1000 ng/dl) are at no greater risk of developing prostate cancer than their hypogonadal counterparts. Hypogonadism is not only not protective against prostate cancer, there is some evidence to suggest that hypogonadal men might develop a more aggressive form of prostate cancer. Men on testosterone replacement therapy appear to have improved angina-free exercise periods and better cholesterol profiles than their hypogonadal counterparts. The risks of osteoporosis and fractures are reduced in men on testosterone replacement therapy.

What are some of the other resources available to better understand my condition?

For a more detailed discussion about hypogonadism and testosterone replacement therapy, read Dr Karpman's article:
The Therapeutic Challenges of Hypogonadism and Its Comorbidities

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