WHAT EVERY MAN SHOULD UNDERSTAND
Most people know that the hormone testosterone is essential to the normal development of the male in utero.
Recent research has also shown that this hormone has health benefits that go beyond sex and sexual characteristics like facial hair and male pattern baldness. Testosterone is the most important male hormone, these chemicals known as androgens are made in males in the testicles (gonads)and adrenal glands.
The chemical building blocks for testosterone and all androgens are steroids. Androgens, and specifically testosterone has many important physiological actions in the adult. There are age-related decreases in androgen production in men. For women the age-related changes in hormone production are abrupt, often referred to as climacteric or menopause. For men changes in gonadal function are slow, but progressive with aging. Men don't experience andropause. Men do experience late onset hypogonadism (LOH) or androgen decline in the aging male (ADAM). For many men these changes cause significant symptoms and distress.
The Baltimore longitudinal aging study found that ADAM or LOH affected 9% of men surveyed in the age groups of 50 to 59 years, 34% of men aged 60 to 69 years and 68% of men aged 70 to 79 years. If levels of testosterone are too low, your mood muscular strength, and bones can be badly affected.
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What Does Testosterone Do? |  |
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Normal testosterone production has a daily or diurnal pattern with peak levels in the early morning and lowest levels late in the evening. . Throughout life androgens play an essential role . This diurnal pattern may also change with aging so the highs are not so high and lows not so low.
Loss of erections is rarely due solely to low testosterone. Erectile dysfunction (ED) is more commonly related to changes in blood flow to the penis-changes which are negatively affected by age, high blood pressure, diabetes, atherosclerosis, smoking elevated cholesterol, and medications. Nevertheless low levels of testosterone, and for some men falling or borderline low levels of testosterone can impact: sexual interest, natural performance, and responses to drugs like Cialis, Levitra and Viagra. Sometimes testosterone therapy is necessary, and this may be particularly important for men who take drugs for erectile dysfunction, and for men experiencing other symptoms of ADAM.
ABOUT TESTOSTERONE
As you know, testosterone is the major male hormone. You begin making it before you're born, and you make your highest levels during adolescence early adulthood. These are just some of the things that happen because of testosterone. As you can see some of these actions are easily recognized changes with aging, some are clearly beneficial and others are not so desirable. The production and release of testosterone is a complicated process that starts in the brain, of all places. A part of the brain called the hypothalamus makes a hormone called gonadotrpin-releasing hormone, or GnRH (a gonadotropin is another term for sex hormone). When GnRH reaches the nearby pituitary gland, the pituitary releases another hormone, called eternizing hormone, or LH. When LH levels in the blood reach a high enough level, they stimulate special cells in the testes to produce testosterone.
LOW TESTOSTERONE
It's no surprise that testosterone levels begin to rise fast at about the time of puberty, which accounts for all of the physical changes and rapid growth that boys experience at this age. Testosterone levels remain high until about age 50 years, when they begin to drop gradually. By the time a man is 80 years old he has only about 20% to 50% of the testosterone he did when levels were at their highest, in early adulthood. Age is not the only factor that lowers testosterone levels. Some medical studies suggest that conditions such as obesity and diabetes may lead to lower testosterone levels. Sometimes, problems in the hypothalamus and/or pituitary glands lead to decreased levels of GnRH or LH. Eventually, low testosterone levels may result.
Other possible causes of low testosterone include chemotherapy, infections, radiation, and trauma to the testes or brain. Infection with human immunodeficiency virus, the virus that causes acquired immunodeficiency syndrome, may cause low testosterone levels by its direct effects on the testes or by its effects on the pituitary or hypothalamus. Certain drugs, such as morphine and prednisone may stop the pituitary gland from producing LH, which in turn slows testosterone production by the testes.
Anabolic steroids taken to enhance athletic performance may activate a negative effect on the natural production of sex hormones like testosterone.
On rare occasions, boys are born with problems that cause low testosterone. These include an absence of the testes and failure of the testes to drop from the first year of life, 3% of males are born with an undescended testicle. Both testes should be visible in the scrotum of men and pediatric doctors generally refer male babies with an empty scrotum on one or both sides to see a urologist.
SYMPTOMS OF LOW TESTOSTERONE
Some symptoms are more or less common depending on when the shortage occurs. If the deficiency occurs during puberty, a boy might not grow as tall or as muscular as his friends, and he might not grow pubic or body hair. In a few, the breast tissue might begin to develop, a condition called gynecomastia.
In adult men, the picture looks a bit different because they previously had normal levels that have declined or are declining relative to what was normal for them at a younger age. As a result, they may experience none, some or all of the following symptoms:
- Lower libido (sex drive)
- Erectile dysfunction
- Poor concentration
- Fatigue
- Increased body fat
- Muscle weakness
- Osteoporosis (weakness of the bones)
- Loss of body hair (including softening or loss of the beard)
- Depression
- Hot flashes
- Other mood problems
WORRIED ABOUT LOW TESTOSTERONE?
TALK TO DR ELIST
MAYBE YOU HAVE NOTICED THAT YOUR SEX DRIVE HAS NOT BEEN STRONG LATELY. OR MAYBE YOU HAVE HAD TROUBLE GETTING OR KEEPING AN ERECTION. MAYBE THE CIALIS, LEVITRA OR VIAGRA PRESCRIBED BY YOUR PHYSICIAN IS NOT WORKING. DOES THAT MEAN YOU HAVE LOW TESTOSTERONE? MAYBE NOT.
Many illnesses can cause these symptoms, and stress and depression can also cause some of these problems. The important thing is to discuss your suspicions with DR ELIST, who will know how to sort though them to find the cause of your symptoms. In addition to a thorough physical exam, DR ELISTmay do some blood tests for testosterone, other androgens or regulating hormones from the brain. Depending on the severity of your symptoms and lab results, he may suggest that you see an endocrinologist, a physician who specializes in hormone problems. DR ELIST may suggest other specialized diagnostic tests: computed topography, magnetic resonance imaging, semen analysis for fertility or genetic studies. If osteoporosis is suspected, your doctor may do bone mineral density studies. In very rare cases where fertility is also an issue your doctor may suggest biopsy of the testicles.
TYPES OF TESTOSTERONE
DR ELIST may talk about different types of testosterone, and you should know a bit about these if you're going to be tested. In healthy men, about 2% of testosterone in the blood is free (unbound to proteins), 30% is bound to sex hormone binding globulin and the remainder is bound to albumin. Both free and albumin bound testosterone make up what is referred to in scientific language as bioavailble testosterone. There is some evidence that as we age, more testosterone is bound in this inactive form with sex hormone binding globulin. The organs and cells of your body respond to levels of bioavailable testosterone.
IS TREATMENT NECESSARY?
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| HYPOGONADISM, OR LOW TESTOSTERONE, CAN HAVE SERIOUS CONSEQUENCES, ON FERTILITY, SEX DRIVE, ENERGY LEVELS, MUSCLE MASS, CONCENTRATION, DEPRESSION AND BONE STRENGTH. | ||
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In addition, cosmetic problems like decreased beard, loss of body hair, and enlarged male breasts also may occur. These are important health issues, and treatment is usually recommended. Some doctors believe that men with ED are also candidates for testosterone therapy. These men may take a drug like Cialis, Levitra, or Viagra but not get the response they hoped for. If these men have a testosterone deficiency that is related to their older age, there is some evidence that taking testosterone treatments in addition to a drug for ED may improve the quality and duration of their erections. If you're taking a drug to improve your erectile function but want more help, ask your doctor if testosterone might be useful. Androgens are contraindicated in men with carcinoma of the breast or known or suspected carcinoma of the prostate.
IS TREATMENT NECESSARY?
If DR ELIST determines that testosterone therapy is the best course of action to treat your problem, he will recommend one of the several available delivery methods. These include the following:
INJECTION: Taken every 2 to 4 weeks, injections of testosterone are given directly into the muscle and are considered safe and effective. One disadvantage of injections is that the testosterone level may vary up and down by a large amount between shots, possibly causing mood swings. Testosterone is a controlled substance, and is generally administered in a doctor's office by physician, physician assistant, or nurse.
Patches: A testosterone-containing gel can also deliver the hormone right through your skin. Every day you pick a different site: the lower abdomen, upper arm, or shoulder. You need to avoid swimming or showering for a few hours after application, and you should take care to avoid getting the gel on your partner. Gels seem to cause fewer skin irritation problems than testosterone patches.
GUM AND CHEEK DELIVERY: Testosterone can also be delivered to your system with a small piece of a substance that may remind you of chewing gum. You simply hold this material above your top teeth between your gum and upper lip. This way, the testosterone gets directly into your bloodstream. Headaches or gum irritation or leave a bitter taste in your mouth. These side effects tend to disappear within two weeks.
Although a pill form of testosterone is also available in other countries, most doctors don't recommend this formulation. Several problems have been associated with the pill form of testosterone, including increases in cholesterol and higher risk for blood clots and disorders of the heart and liver.
Possible risks of testosterone therapy
You should understand that testosterone is a medication for a disorder, not a substance that can be used to enhance your lifestyle, as some people think. Taking testosterone may aggravate sleep disorders, stimulate enlargement of the prostate gland and trigger urinating problems, and other problems. Also, if you have prostate cancer already, testosterone may make the tumor grow faster. Testosterone therapies whether by injection, patch, gel or mouth require periodic medical monitoring, so talk with your doctor about what benefits you can expect and when you should visit again or have blood testing.
