What is Testosterone Deficiency (TD)?
Testosterone deficiency (TD), or hypogonadism, is a constellation of symptoms resulting from a progressive decline in serum (blood) testosterone levels to an abnormally low level.
Testosterone is the essential hormone in men for sexual desire and sexual function, but it also has important quality of life effects on energy, muscle, bone, cardiovascular health and brain function.
Testosterone levels decline with some medical conditions (like diabetes and obesity), and/or the use of medications (like opioid pain medication). Since testosterone levels can also decline after age 30 or 40 at a rate of approximately 1- 2 % per year, some men may notice symptoms of low testosterone as early as their 40’s or 50’s.
It has been researched that 20% of men over 60 and up to 50% of men over the age of 80 suffer from the clinical diagnosis of TD.
What Are the Signs and Symptoms of Testosterone Deficiency?
Signs and symptoms associated with testosterone deficiency include:
Sexual Signs and Symptoms
- Reduced sex drive
- Reduced erectile function
Physical Signs and Symptoms
- Reduced energy
- Reduced endurance
- Diminished work performance
- Diminished physical performance
- Loss of body hair
- Reduced beard growth
- Reduced lean muscle mass
- Change in sleep pattern
Cognitive Signs and Symptoms
- Depressive symptoms
- Cognitive dysfunction
- Reduced motivation
- Poor concentration
- Poor memory
What Are the Causes of Testosterone Deficiency?
Causes of testosterone deficiency (TD) are numerous and are traditionally divided into two main categories: Primary causes and Secondary causes.
In primary hypogonadism, either a congenital (born with it) or acquired (mumps, trauma, radiation) testicular problem exist such that the testes cannot produce enough testosterone.
Secondary hypogonadism accounts for the majority of low testosterone cases. In this type, testosterone level is low as a result of complex physiological and behavioural factors that interfere with the testosterone production in the otherwise normally formed testicles. Common examples of these conditions are obesity, diabetes, head trauma, etc.
How to screen for testosterone deficiency?
There are multiple screening tools employed to screen for testosterone deficiency (TD). ADAM Screening is one of the most widely used questionnaires for this purpose.
Below is a copy of the ADAM test to review:
Adam Test – If you answer yes to multiple questions you may have low testosterone.
- Have you experienced a decrease in your sex drive (libido)?
- Do you lack energy or feel weak?
- Has your strength or endurance decreased?
- Have you lost height?
- Have you noticed yourself enjoying life less?
- Are you frequently sad or particularly irritable?
- Are your erections less strong?
- Have you noticed a recent deterioration in your athletic ability?
- Do you find yourself falling asleep after dinner?
- Has there been a recent deterioration in your work performance?
You can Take the ADAM Test Now.
How is the diagnosis of Testosterone Deficiency confirmed?
Men who have signs and symptoms of Testosterone Deficiency (TD) and have had abnormal ADAM Screening will undergo blood tests to determine their testosterone level.
The diagnosis of Testosterone Deficiency will be confirmed once a man has low total testosterone blood levels on two separate morning laboratory tests along with symptoms of testosterone deficiency (positive ADAM Screening).
Testosterone Replacement Therapy
When the body no longer produces sufficient amounts of testosterone, replacement therapy (TRT) is usually required to help men improve sexual function, support overall health and energy levels, as well as mood and overall mental function.
While testosterone replacement therapy alone may not reverse erectile dysfunction (ED), it can be an invaluable part of an ED program since abnormal testosterone levels contribute to poor erectile quality. Testosterone replacement may also improve the efficacy of some ED treatments.
In addition to testosterone replacement therapy, other lifestyle modifications including diet, exercise, weight loss, reduction in stress levels and improvements in sleep duration and quality have also been shown to improve testosterone levels.
At Pollock Clinics we present a series of options for your consideration, including but not limited to topical gel, intranasal spray, and intramuscular injection. The delivery method will be selected together by the physician and patient to best meet the needs of the patient.
Is Testosterone Replacement Therapy safe?
Testosterone replacement therapy is generally a safe treatment modality. However, there are both benefits and risks associated with treating low testosterone. The figure below provides information on TRT’s impact on various health conditions that could be impacted by your course of treatment.
Figure source: Canadian Medical Association Journal: Diagnosis and management of testosterone deficiency syndrome in men: clinical practice guideline. 2015.
Benefits of Testosterone Replacement Therapy
The ideal outcome from TRT is to improve sexual function, libido, and energy level.
Some men experience a strong change. Others get limited benefits.
Many men report improvement in energy level, sex drive, and quality of erections.
Testosterone also increases bone density, muscle mass, and insulin sensitivity in some men.
Men also often report an improvement in mood from testosterone replacement.
They may be able to focus better and see improvements in memory and cognitive skills.
Testosterone Replacement Therapy Risks
Testosterone replacement therapy can raise a man’s risk for urinary symptoms, relating to enlarged prostate, increased PSA levels, blood clots and stroke. Uncommon side effects include sleep apnea, acne, and breast enlargement.
Men who use a testosterone gel should wash their hands thoroughly after applying a dose and make sure that no one else touches the spots where they medicate. If a woman or child comes into contact with testosterone gels, it can cause side effects in them.
To continue to benefit, a man with low testosterone must remain on it. Research over the past few decades has shown little evidence of a link between testosterone replacement therapy and prostate cancer.
Testosterone Replacement Therapy at Pollock Clinics in Vancouver
At Pollock Clinics our goal is to carefully diagnose and treat those patients who have signs and symptoms of low testosterone through detailed history taking, focused physical examination, and proper biochemical laboratory testing.
Our clinic provides testosterone replacement therapy to patients who have signs/symptoms and biochemical evidence of hypogonadism (low testosterone) and only after we have validated that they can have testosterone therapy safely.
Circumstances where it may not be safe will be determined by the treating physician through the assessment process. Please contact us anytime for more information.
Scientific Studies on Testosterone Replacement Therapy
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