Saturday, April 19, 2014

Low Testosterone

There seems to be an epidemic of low testosterone. I've been seeing more and more male patients with decreased testosterone levels, a condition known as male hypogonadism. When testosterone levels are low, men can have symptoms like erectile dysfunction, decreased libido, fatigue, depression and hot flashes. Many men, however, have very subtle symptoms or no symptoms at all. Many men with lower testosterone feel tired and depressed but don't have erectile dysfunction, so they are never checked for low testosterone.

Even if you have normal erectile function, you can still have hypogonadism. In fact, I have seen that many of my patients do not complain of erectile dysfunction, but have profound fatigue or depression which is caused by lower testosterone. When they take testosterone replacement, the symptoms tend to get better.

There are many causes for hypogonadism, and finding the cause is as important as getting treated. The hypothalamus (part of the brain) and the pituitary gland control testosterone production from by the testicles, so problems with the brain or pituitary gland can be the main source of problems.

In order to get an accurate diagnosis, doctors usually perform two rounds of testing. The first test will be to measure your testosterone level, which should be done in the morning. Testosterone levels naturally fall in the afternoon, so a level that is reported as "low" may actually be normal if it was taken in the afternoon. Pituitary hormones, LH and FSH are measured in the second round of testing to determine if the cause is central (meaning central nervous system, hypothalamus or pituitary gland) or primary (meaning testicular failure). A second morning testosterone level should also be taken to confirm the diagnosis. Other tests are also done including the hormone prolactin and ferritin, a test for excess iron. Iron overload, a condition known as hemochromatosis occurs in one in 500 men and is a common cause of lower testosterone.

Obesity and excess fat is a cause of low testosterone and is one of the main reasons why there is a growing epidemic. Excess fat produces hormones like leptin and inflammation chemicals, known as cytokines, which work to lower testosterone levels. Having diabetes is also a risk for having low testosterone, but careful studies have shown that the link is through fat, not through elevated blood sugar. Inflammation chemicals have a suppressive effect on the hypothalamus and pituitary gland, muting the hormones they produce, subsequently lowering testosterone levels. Many men with declining testosterone who are overweight complain of swelling of the breasts, known as gynecomastia. The problem is that testosterone treatment can also cause breast swelling, so it can sometimes be a no win situation. However, not everyone with hypogonadism from excess weight needs to take testosterone. In fact, being healthier and losing weight can help naturally boost testosterone without the need for hormone replacement therapy.

There are many other causes of declining testosterone, including testicular failure or other testicular problems and exposure to toxic substances. Alcohol is a known toxin to the testicle. BPA, a chemical found in plastic can cause low testosterone because it is an endocrine disruptor that imitates the female hormone estrogen.

If you have symptoms of hypogonadism, see your doctor right away to get tested.

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