Struggling with diagnosis

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It can be difficult for men with testosterone deficiency to pinpoint what's causing their symptoms. They can experience issues with libido (sex drive), or with sexual performance, and often experience other symptoms. These can make it harder for hypogonadal men to go about their day-to-day lives.

Hypogonadism (testosterone deficiency)

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What is testosterone deficiency?

Testosterone deficiency (the medical term is hypogonadism) simply means having a very low testosterone level. Testosterone is responsible for typical male sexual characteristics and is required by all men for a healthy life physically and psychologically.

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It can be difficult for men with testosterone deficiency to pinpoint what's causing their symptoms. They can experience issues with libido (sex drive), or with sexual performance, and often experience other symptoms. These can make it harder for hypogonadal men to go about their day-to-day lives.

Frequently asked questions (FAQs) about hypogonadism

For quick reference we have provided answers to the most commonly asked questions on testosterone deficiency. From diagnosis through to treatment options, you should find the answers to your questions here.

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Glossary

View the glossary for definitions of all of the commonly used terms associated with testosterone deficiency.

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What is low testosterone?

As you get older, you will likely experience typical aging-related physical and mental changes. You may gain weight and belly fat, lose muscle, and start noticing a gradual loss of vigour and sex drive, and get the feeling that you have passed your peak. But what if this isn’t just because of aging?

Aging is accompanied by gradual deterioration in general measures of health and well-being, which may be related to low testosterone levels.1 Low testosterone, also called testosterone deficiency or hypogonadism, is a medical condition in which the testes (testicles, the male reproductive glands) do not produce enough testosterone (the male sex hormone).2-5 While it is common for testosterone levels to progressively decline in men as they get older,6 low testosterone can occur even in young men, especially if they have developed a belly or have an excess amount of total body fat.7 Other causes of low testosterone in younger men is life/work stress8,9 and use of medications, such as opioids,10 selective serotonin reuptake inhibitors (SSRIs)11 and statins.12 Therefore, low testosterone is not just an “old man’s problem”. Less common causes of low testosterone in young men include testicular trauma, concussion and congenital (present at birth) disease caused by chromosomal abnormalities or gene mutations.

So why is testosterone important? Testosterone not only gives you sexual desire (libido) and enables you to have an erection,13 it also provides a wide range of health benefits, such as improvement in wellbeing/quality of life, blood sugar control, cholesterol profile, body composition (reduced body fat and increased muscle mass) and bone density, that might be expected to reduce long-term sickness and prevent premature death.14,15 In fact, it is well documented that men with low testosterone have increased risk of the metabolic syndrome, diabetes, heart disease and death.14-16

Talking to your doctor


CONCERNED ABOUT TALKING TO YOUR DOCTOR? Read our tips on talking to your doctor about your symptoms

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Do you have TD symptoms?


Find out if you may have symptoms of TD by completing our SYMPTOM CHECKER...

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What are the signs of & symptoms of low testosterone?

Signs & symptoms

Symptoms and signs of testosterone deficiency (hypogonadism) occur as a result of low testosterone levels.1-6 Due to the multiple effects of testosterone, the health consequences of hypogonadism are wide-ranging with signs and symptoms affecting sexual, physical, metabolic and psychological functions (Figure).

Figure: Common symptoms and signs of hypogonadism (low testosterone) in men.1,3-6

Metabolic
symptoms / signs


  • Obesity (BMI 30 or higher)
  • Abdominal (belly) obesity (waist circumference 94-102 cm or higher)
  • Metabolic syndrome
  • Insulin resistance, prediabetes or type 2 diabetes

Sexual symptoms


  • Decreased sexual desire and activity
  • Decreased frequency of sexual thoughts
  • Erectile dysfunction
  • Delayed ejaculation
  • Decreased volume of ejaculate
  • Decreased frequency or absent morning or night-time erections
  • Small testes
  • Infertility
Marek on his own

Psychological symptoms


  • Depressed mood
  • Loss of energy
  • Reduced motivation
  • Poor concentration
  • Decreased well-being and/or poor self-rated health
  • Irritability
  • Sadness
  • Impaired memory
  • Decreased cognitive function (including impaired concentration, verbal memory, and spatial performance)

Physical symptoms


  • Decreased muscle mass and strength
  • Reduced physical performance
  • Hot flushes or sweats
  • Sleep disturbances
  • Fatigue
  • Reduced bone mineral density, osteoporosis,
    low trauma fractures
  • Decreased body hair
  • Gynecomastia (enlarged breasts)

However, these symptoms are not just bothersome. If you also have low testosterone, these symptoms may signal that your overall health is at risk. Men who have both bothersome symptoms and low testosterone also commonly have “invisible symptoms” - such as elevated blood sugar levels, cholesterol abnormalities and high blood pressure - which are important risk factors that can lead to metabolic syndrome, type 2 diabetes and heart disease if left unchecked.19-21 Therefore, if you experience bothersome symptoms it is important that you get your testosterone level checked.

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See if you should have your testosterone level checked

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What causes low testosterone?

Many people think that the main cause of low testosterone is aging. This is wrong. The most common and strongest risk factor for low testosterone, more so than aging itself, is actually obesity.6,22,23

This means that by living a healthy lifestyle with regular exercise and healthy food habits, you can maintain your testosterone level in the healthy range even as you get older. In other words, low testosterone – while common - is not inevitable in men as they get older, as menopause is in women.

Other common causes of low testosterone are the metabolic syndrome24-26 and type 2 diabetes.27-30 Chronic diseases, such as high blood pressure, heart disease, liver disease, kidney disease, arthritis, stroke, emphysema, rheumatoid arthritis and depression may also be risk factors for low testosterone.1,28,31

Which men are most at risk of TD?

Men with...
Obesity


Up to 80% of men with obesity have low testosterone.32,33 Medical guidelines state that all men who have an increased waist circumference - 94 cm (37 inches) or higher - or who have obesity (BMI 30 or higher) should be checked for low testosterone by having testosterone levels measured.34

Men with...
Erectile dysfunction


Among men with erectile dysfunction, over one third (36%) have low testosterone levels.9 Low testosterone can cause erectile dysfunction and/or non-responsiveness to treatment with PDE5i (phosphodiesterase 5 inhibitors) such as Viagra. Therefore, according to medical guidelines is it mandatory that men with erectile dysfunction have testosterone levels measured.38,39 This is particularly important if your erectile dysfunction treatment doesn’t appear to be working well.

Men who...
Take medications


Certain medications, especially opioids,10 selective serotonin reuptake inhibitors (SSRIs)11 and statins,12 can reduce your testosterone level.

Men with...
Type 2 diabetes


Half of men with type 2 diabetes have low testosterone.35 Obesity is common among men with type 2 diabetes,36 but even non-obese men with type 2 diabetes commonly have low testosterone.35 The frequent occurrence of low testosterone in men with type 2 diabetes prompted medical guidelines to recommend that testosterone levels are measured in men with type 2 diabetes who have symptoms.37

Men with...
Heart disease


Nearly one in four (24%) men with heart disease have low testosterone.40 Men with heart disease who also have low testosterone have a higher risk of death compared to men with heart disease who have healthy testosterone levels.40

Men with...
High life/work stress


Nearly half of men who report having a high degree of life/work stress have low testosterone.9

How are men affected by low testosterone?

The essential role of testosterone in the health and well-being of males is well established. Testosterone is responsible for typical male sexual characteristics and is required for a healthy life physically and psychologically, enabling and maintaining erectile function, libido, and overall sexual satisfaction. Testosterone also helps to maintain body composition and bone mass, positive mood, and physical energy. Accordingly, the health consequences of hypogonadism can be quite wide-ranging, and include fatigue, depression, erectile dysfunction, loss of libido, loss of facial and body hair, decrease in muscle mass, development of gynecomastia, and osteoporosis.

 

Low testosterone can be diagnosed by an assessment of symptoms and a blood test  to measure testosterone levels. If tests confirm hypogonadism, a range of different testosterone replacement therapies and formulations are available to normalize testosterone levels.

Low testosterone?

Think you’ve got low testosterone?

Regardless of age, if you’re rarely in the mood for sex and perhaps have difficulties getting an erection, often feel tired/lethargic and have a depressed mood, you may be experiencing symptoms of low testosterone.

If you are concerned that you may have low testosterone, COMPLETE OUR SYMPTOM CHECKER AND TALK TO YOUR DOCTOR. With a simple blood test, it is possible to find out your testosterone level and establish whether or not you have the diagnosis of testosterone deficiency (hypogonadism).

Check your symptoms

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References

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