The Rarity of Symptomatic Low Testosterone
While almost a quarter of American males are reportedly suffering from low testosterone levels, only about 5.6% experience symptoms of the condition known in medical terms as Androgen Deficiency. In a study by Dr. Andre Araujo and his colleagues from the New England Research Institutes, it was found that not all men with low testosterone exhibit or experience any symptoms. There are fewer men with symptomatic androgen deficiency than there are men with low testosterone levels.
As the most important sex hormone produced in the male body, testosterone or androgen is the hormone that is primarily responsible for producing and maintaining the typical adult male attributes. At puberty, testosterone stimulates the physical changes that characterize the adult male, such as enlargement of the penis and testes, growth of facial and pubic hair, deepening of the voice, an increase in muscle mass and strength, and growth in height. Throughout adult life, testosterone helps maintain sex drive, the production of sperm cells, male hair patterns, muscle mass, and bone mass.
A man's testosterone levels decline naturally with age. However, there is no precipitous drop in a man's sex hormones as there are for women at the time of menopause.
Symptoms of androgen deficiency include:
· Loss of sex drive
· Erectile dysfunction
· Lower sperm count
· Reduced fertility
· Increased breast size
· Bone loss or fracture
· Two or more of what endocrinologists call “non-specific” symptoms: sleep disturbance, depressed mood, lethargy, and diminished physical performance.
Men who suffer from male sexual health problems such as symptomatic androgen deficiency would benefit from treatment if they have no contraindication such as prostate or breast cancer. But treatment guidelines from the Endocrine Society state that symptom-free and age-related declines in testosterone should not be treated.
According to Dr. Robert Davis, a professor of urology at the University of Rochester in NewYork, men with a waistline over 40 inches, high-blood pressure, and signs of insulin resistance, and the so-called metabolic syndrome, are at high risk of androgen deficiency. “These men have an incredibly high rate of androgen deficiency and treating them with testosterone may correct their metabolic syndrome because they may be able to burn energy better with more muscle. Testosterone replacement may allow these men to avoid some of the consequences of metabolic syndrome such as coronary artery disease,” said Davis. Androgen deficiency is an under-diagnosed and under-treated male sexual health problem. “One of the myths is that testosterone supplements will cause a cancer,” he says. Prostate cancer often regresses when testosterone is removed, but there is very little evidence to support the theory that normal testosterone levels increases risk of cancer.
With regards to the men who have low testosterone levels but no symptoms, there is a possibility of bone density loss. According to Dr. Sol Jacobs, an endocrinologist and assistant professor of medicine at Emory University in Atlanta, “Even if you have a man who says, ‘I feel great and don't want testosterone treatment,' at least measure his bone density. But usually the scenario is the patient is symptomatic and wants treatment.”
However, the question of when to offer a patient testosterone replacement is highly controversial. Even the Endocrine Society's expert panel disagreed over the exact testosterone levels at which doctors should offer testosterone replacement therapy.