Low testosterone | Andrology Australia

What are androgens?

Hormones are chemical messengers madeby glands in the body that are carried inthe blood to act on other organs in thebody. Hormones are needed for growth,reproduction and well-being.

Androgens are male sex hormones thatincrease at puberty and are needed for aboy to develop into a sexually mature adultwho can reproduce. The most importantandrogen is testosterone.

Testosterone is the most important androgen (male sex hormone) in men and it is needed for normal reproductive and sexual function. Testosterone is important for the physical changes that happen during male puberty, such as development of the penis and testes, and for the features typical of adult men such as facial and body hair and a masculine physique. Testosterone also acts on cells in the testes to make sperm.

Testosterone is also important for overall good health. It helps the growth of bones and muscles, and affects mood and libido (sex drive). Some testosterone is changed into oestrogen, the female sex hormone, and this is important for bone health in men.

Testosterone is mainly made in the testes. A small amount of testosterone is also made by the adrenal glands, which are walnut-sized glands that sit on top of the kidneys.

The pituitary gland and the hypothalamus,located at the base of the brain, controlthe production of male hormones andsperm. Luteinizing hormone (LH) andfollicle stimulating hormone (FSH) arethe two important messenger hormonesmade by the pituitary gland that act onthe testes.

LH is needed for the Leydig cells in thetestes to make testosterone, the male sexhormone. Testosterone and FSH from thepituitary gland then act together on theseminiferous tubules (sperm-producingtubes) in the testes to make sperm.

Androgen, or testosterone, deficiency iswhen the body is not able to make enoughtestosterone for the body to functionnormally. Although not a life-threateningproblem, androgen deficiency can affectyour quality of life.

Androgen deficiency due to diseases of the testes or hypothalamus-pituitary affects about one in 200 men under 60 years of age. It is likely that androgen deficiency is under-diagnosed and that many men are missing out on the benefits of treatment. About one in 10 older men may have testosterone levels lower than those in young men, but this is usually linked with chronic illness and obesity. The benefits and risks of testosterone treatment for such men are not yet known.

Testosterone levels in men are highestbetween the ages of 20 and 30 years. Asmen age there is a small, gradual drop intestosterone levels; they may drop by up toone third between 30 and 80 years of age.

Some men will have a greater drop intestosterone levels as they age, especiallywhen they are obese or have other chronic(long-term) medical problems. On the otherhand, healthy older men with normal bodyweight may not experience any drop inserum testosterone levels.

There is no such thing as male menopauseor andropause that can be compared tomenopause in women.

Low energy levels, mood swings, irritability,poor concentration, reduced muscle strengthand low sex drive can be symptoms ofandrogen deficiency (low testosterone).Symptoms often overlap with those of otherillnesses. The symptoms of androgen deficiencyare different for men of different ages.

Androgen deficiency can be caused bygenetic disorders, medical problems, ordamage to the testes or pituitary gland.Androgen deficiency happens when thereare problems within the testes or withhormone production in the brain. A commonchromosomal disorder that causes androgendeficiency is Klinefelters syndrome.

A diagnosis of androgen deficiency involveshaving a thorough medical evaluation andat least two blood samples (taken in themorning on different days) to measurehormone levels. Diagnosis should not be simply based on symptoms as these could becaused by other health problems that needdifferent treatment. A diagnosis of androgendeficiency is only confirmed when blood testsshow a lower than normal testosterone level.

A reference range is used as a guide by testing laboratories and doctors to decide whether a persons hormone levels are normal or low, and whether treatment may be needed. Testosterone is measured in units called nanomalor. The normal testosterone reference range for healthy, young adult men is about 8 to 27 nanomolar but these numbers vary between measurement systems.

Androgen deficiency is treated with testosterone therapy; this means giving testosterone in doses that return the testosterone levels in the blood to normal. Testosterone is prescribed for men with androgen deficiency confirmed by blood tests. Once started, testosterone therapy is usually continued for life and the man needs to be checked regularly by a doctor.

In Australia testosterone therapy is available in the form of injections, gels, creams, patches and tablets, and works very well for men with confirmed androgen (testosterone) deficiency. The type of treatment prescribed can depend on patient convenience, familiarity and cost. Commercial testosterone products contain only the natural testosterone molecule that is chemically produced from plant materials.

Side-effects are not expected because testosterone therapy aims to bring a mans testosterone levels back to normal. However, testosterone therapy can increase the growth of the prostate gland which can make the symptoms of benign prostate enlargement (such as needing to urinate more often) worse. In the case of prostate cancer, testosterone therapy is not used because of concerns that it can make the tumour grow. Too high a dose of testosterone can lead to acne, weight gain, gynaecomastia (breast development), male-pattern hair loss and changes in mood. Any side-effects should be managed by a doctor and the testosterone dose lowered.

There are many herbal products marketed, particularly on the Internet, as treatmentsthat can act like testosterone and improve muscle strength and libido (sex drive). However, there are no known herbal products that can replace testosterone in the body and be used to treat androgen deficiency.

Testosterone therapy generally stops the production of the pituitary hormones FSH and LH, which reduces the size of the testes and can lower or stop sperm being made.

Testosterone treatment should not be given to a man wanting to become a father in the foreseeable future. If sperm production was normal before testosterone therapy, it usually recovers after treatment stops but it can take many months to go back to normal.

Testosterone therapy in men with androgen deficiency aims to bring testosterone levels back to normal and to return muscle strength and energy levels back to normal. However, the use of androgens (anabolic steroids) by normal men to improve athletic performance is illegal and has important short-term and long-term health risks.

Men who use anabolic steroids will lower or even turn off their own testosterone and sperm production. It may take many months for testosterone levels and sperm counts to return to normal after stopping anabolic steroids.

There are no known ways to prevent androgen deficiency caused by damage to the testes or pituitary gland. However, if you live a healthier lifestyle and manage other health problems your testosterone levels may improve, if your low testosterone levels are caused by other illness.

Not all men have a drop in testosterone levels with age. A healthy lifestyle may help you to keep testosterone levels normal.

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Low testosterone | Andrology Australia