Testosterone
Testosterone is the primary male sex hormone (androgen), produced mainly in the testes under the direction of the brain. It plays an essential role in maintaining energy levels, muscle mass, bone density, mood, libido, and sexual function. Testosterone production is within the testes and the signal for production comes from the brain and pituitary gland.
Symptoms and signs of low testosterone could include:
- Fatigue and low energy
- Reduced libido (sex drive)
- Erectile dysfunction
- Low mood, irritability, or depressive symptoms
- Difficulty concentrating or ‘brain fog’
- Reduced muscle mass and increased body fat
- Decreased body and facial hair
- Reduced bone density (osteopaenia or osteoporosis)
- Hot flushes
- Reduced morning erections
Low testosterone levels are confirmed with two 2 separate fasting morning blood tests.
Testsoterone deficiency could be due to the testicles not functioning optimally and this is called primary hypogonadism.This could be genetic, or due to testicular trauma, previous chemotherapy or operations or mumps infections. Secondary hypogonadism is where the underlying issue is related to reduced pituitary signal to the testes. This could be caused by genetic condition or pituitary gland disease processes.
There are several situations where testosterone could be low without ptiutitary or testicular disease and this includes – but is not limited to – low mood/depression, sleep deprivation, obstructive sleep apnoea, excess alcohol, diabetes, obesity.
The role of the endocrinologist is to conduct a thorough assessment and correlate with objective measures (blood tests) and address underlying medical conditions that could be causative or contributing to the low testosterone.
The treatment options include transdermal (skin) preparations and injections with varying administration time frames. Blood tests are required for the monitoring of treatment effectivess and safety.
Testosterone therapy is not prescribed solely on the basis of symptoms and treatment is only considered where there is clear clinical and biochemical evidence of testosterone deficiency after appropriate assessment.
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