Testosterone Deficiency & Proper Use of Hormone Replacement Therapy
Testosterone production declines naturally with age, and has been often observed in patients starting around age 35. Testosterone deficiency (TD) may result from disease or damage to the hypothalamus, pituitary gland, or testicles that inhibits hormone secretion and testosterone production, and is also known as hypogonadism. Depending on age, insufficient testosterone production can lead to abnormalities in muscle and bone development, depression, underdeveloped genitalia, and diminished libido & virility.
Testosterone is the androgenic hormone primarily responsible for normal growth and development of male sex and reproductive organs, including the penis, testicles, scrotum, prostate, and seminal vesicles. It facilitates the development of secondary male sex characteristics such as musculature, bone mass, fat distribution, hair patterns, laryngeal enlargement, and vocal chord thickening. Additionally, normal testosterone levels maintain energy level, healthy mood, fertility, and sexual desire.
The testes produce testosterone regulated by a complex chain of signals that begins in the brain. This chain is called the hypothalamic-pituitary-gonadal axis. The hypothalamus secretes gonadotropin-releasing hormone (GnRH) to the pituitary gland in carefully timed pulses (bursts), which triggers the secretion of leutenizing hormone (LH) from the pituitary gland. Leutenizing hormone stimulates the Leydig cells of the testes to produce testosterone. Normally, the testes produce 4–7 milligrams (mg) of testosterone daily.
Incidence and Prevalence
Testosterone production increases rapidly at the onset of puberty and decreases rapidly after age 40 (to 20–50% of peak level by age 80). Recent estimates show that approximately 13 million men in the United States experience testosterone deficiency and less than 10% receive treatment for the condition. Patients have been as young as 18.
At times, the presentation is confusing and has lead to misdiagnosis and dismissal by medical professionals.
Symptoms can appear similar to depression, passivity, apathy, adiposity around the pectorals, and lack of physical musculature. Studies also have shown that men with obesity, diabetes, or hypertension may be twice as likely to have low testosterone levels.
Common Types and Causes
Testosterone deficiency (hypogonadism) may be present at birth (congenital) or may develop later (acquired). It is classified by the location of its cause along the hypothalamic-pituitary-gonadal axis:
Primary, disruption in the testicles
Secondary, disruption in the pituitary
Tertiary, disruption in the hypothalamus
The most common congenital cause is Klinefelter's syndrome. This condition, which is caused by an extra X chromosome, results in infertility, sparse facial and body hair, abnormal breast enlargement (gynecomastia), and small testes.
Congenital hormonal disorders such as leutenizing hormone-releasing hormone (LHRH) deficiency and gonadotropin-releasing hormone (GnRH) deficiency (e.g., Kallmann's syndrome) also may cause testosterone deficiency.
Other congenital causes include absence of the testes (anorchism; also may be acquired) and failure of the testicles to descend into the scrotum (cryptorchidism).
Acquired causes of testosterone deficiency include the following:
Damage occurring during surgery involving the pituitary gland, hypothalamus, or testes
Head trauma that affects the hypothalamus
Infection (e.g., meningitis, syphilis, mumps)
Isolated LH deficiency (e.g., fertile eunuch syndrome)
Tumors of the pituitary gland, hypothalamus, or testicles
Features and Symptoms
Signs depend on the age of onset and the duration of hormonal deficiency. Congenital testosterone deficiency is generally characterized by underdeveloped genitalia (testes that do not descend into the scrotum) and, occasionally, undeterminable genitalia. Acquired testosterone deficiency that develops near puberty can result in enlargement of breast tissue (gynecomastia), sparse or absent pubic and body hair, and underdeveloped penis, testes, and muscle. Adult men may experience diminished libido, erectile dysfunction, muscle weakness, loss of body hair, depression, and other mood disorders.
Testosterone deficiency has been linked to muscle weakness and osteoporosis. In one study, proximal and distal muscle weakness was detected in 68% of men with primary or secondary hypogonadism. Spinal, trabecular, and radial cortical bone density may also be significantly reduced in testosterone-deficient men. Thirty percent of men with spinal osteoporosis have long-standing testosterone deficiency, and one-third of men have subnormal bone density that puts them at risk for fracture.
Treatment for hypo-gonadism is sensible and can be relatively low in risks, if used intelligently.
Today, the condition is more commonly referred to as Andropause, as it is a common affliction for middle aged men. Scientists are agreeing that this condition is a symptom of age and should be treated like any other medical condition. While there are many people who prefer to associate hormone replacement therapy on the same level as anabolic steroids, it is observed in medical and scientific research that HRT for men will not only improve quality of life but may prevent the onset of age related diseases and conditions. Comparing it to the menopause and HRT for women would be reasonable, based on the data and noteworthy results from thousands of male patients. It is only a matter of time before it is a common medical intervention.
Treatment is a combination of endocrine hormones that replace the missing hormones and stabilize the relationship of all the endocrine hormones in one's system. There are 7 hormones that are of concern. From a comprehensive blood draw and medical evaluation, a reliable assessment of what is too low can be attained. The goal is to replace the low hormones to a level more suitable for the individual. A synergistic effect will occur with proper replacement. In some cases, the physiology that supports hormone production needs to be repaired or supported medically. The calibration effect which occurs from accurate manipulation will render results that dramatically change the patient.
Because there are different characteristics with the various types of hormones, the selection of which hormone to use is important. A 'one size fits all' is an outdated notion that should be abandoned by doctors. It is important to know which type of testosterone, HGH, estrogen blocker, etc, should be selected. This is a specialty that very few practitioners acquire because of the bias within the medical arena. It is simply not embraced in medical school. Even medical specialists are often confused about how to evaluate the condition of their patients. For example, very few endocrinologists understand the nature of the various types of testosterone and how to use them in an effective manner. In one actual case, a 19 year old male had been suffering with exceptionally low testosterone for years and three different physicians in the Santa Barbara area, including one endocrinologist, suggested that his features were psycho-somatic and each practitioner refused to do a comprehensive blood study for this young man. His parents were skeptical and went with the attitudes of the physicians. Ultimately, the evidence was obtained that he had extraordinarily low testosterone as well as IGF 1 (insulin growth factor). Within 2-3 weeks, most of his symptoms vanished and he was able to lead a normal life.
Adequate evaluations and proper use of medicines or naturopathic supplements can virtually reverse many of the conditions associated with andropause. At the same time, knowing what not to use remains as important as what to use. A good solution for proceeding with treatment is to seek out a qualified anti-aging specialist with a track record of success.
Like all medications and programs, there can be risks that dependant on the patient's personal circumstances and reactions to medicine. The most common risks associated with hormone replacement therapy can include high blood pressure, edema, sleeplessness, emotional magnification, acne, testicular atrophy, and estrogenic over-load. These features are most commonly reported by patients who have not used medical management effectively and have used hormones over many years. Overall, it appears from research and review of real patients who have been on HRT for ten years or more, symptoms have not been significant or caused serious illness. This report lines up with modest and prudent use of hormones, medical management, and effective use of proper diet, exercise, and stress reduction. It might be fair to say that there are significantly less side effects for men than in comparison to what women have experienced from HRT.