Diagnostics

Low testosterone

Low testosterone, also referred to as a testosterone deficiency, frequently occurs among men aged 45 and older. This problem can have a range of adverse physical, sexual and psychological effects. Many men who suffer from low testosterone remain unaware of the problem, as they mistakenly associate their symptoms with the aging.

What are the symptoms of low testosterone?
The most common low testosterone symptoms are :

A decrease in sex drive

Difficulty getting or maintaining an erection (erectile dysfunction)

A decrease in muscle mass

Chronic fatigue

Hot flashes or night sweats

Loss of facial, body or pubic hair

Increase in body fat (adipose tissue)

Sleep apnea

Irritability, sadness or depression


Concentration or memory problems
What are the risk factors for testosterone deficiency?
The following risk factors are associated with low testosterone:Age. The condition is more prevalent among older men.

Family history. The condition can be hereditary.

Comorbidities. Conditions such as diabetes, obesity, hypertension and HIV can influence the amount of testosterone the body produces.

Medications. Certain medications can lower testosterone levels, notably opioid pain relievers, nonsteroidal anti-inflammatory drugs (NSAIDs), certain antifungal and anticonvulsant drugs, prednisone and antiandrogens.
How is low testosterone diagnosed?
There are three procedures used to diagnose a testosterone deficiency, which are:1) A medical questionnaire. The patient completes various medical questionnaires, including the quantitative ADAM questionnaire.

2) A physical examination. The doctor examines the patient’s physical features, such as hair, muscle mass and testicle size.

3) A blood test. Total and bioavailable testosterone levels are checked using a blood test. The blood should be taken in the morning, as this is the time of day when testosterone levels are highest.
What are the effects of having low testosterone levels?
Low testosterone in men can have a number of adverse effects, including the following:Unsatisfactory sex life :
Low testosterone is associated with erectile dysfunction (ED), a decreased sex drive and a lower frequency of sexual activity.

Bone disease :
Low testosterone levels gradually cause bones to weaken, in some cases leading to osteoporosis (loss of bone strength).

Sleep problems :
Testosterone is a hormone that soothes and revitalizes and it functions as a sleep regulator. Men with low testosterone levels constantly feel like they need a nap, as a deficiency in this hormone leads to shallow and irregular sleep.

Mood problems :
Testosterone affects mood regulation. Men with low testosterone are more prone to depression and anxiety. In addition, they may experience mood swings and feel a general lack of motivation.

Physical effects :
Testosterone is essential for muscle growth. It helps men to build muscles and maintain their bodily strength. Low testosterone is associated with decreased muscle strength.

Metabolic and muscular effects :
Low testosterone can increase cholesterol to an unhealthy level. This, in turn, can lead to cardiovascular problems such as high blood pressure and arteriosclerosis. A lack of testosterone can also degrade cardiac function, causing the heart to lose muscular strength.

Effects on the brain :
Testosterone plays an important role in promoting synaptic and neuronal plasticity and thereby improving one’s memory. Testosterone deficiency can lead to problems with memory and concentration.
What treatment is available for low testosterone?
Testosterone replacement therapy can be used to treat adult males whose bodies produce little or no testosterone (the medical term for this condition is hypogonadism).

The testosterone can be administered intramuscularly, subcutaneously, transdermally, nasally or orally. The patient and doctor should jointly decide which form of testosterone replacement therapy is most appropriate.
Which testosterone replacement therapy is administered through the nose?
Natesto is an intranasal gel (5.5 mg of testosterone) that is administered in each nostril twice a day, at intervals of at least six hours.
Which testosterone replacement therapies can be applied directly to the skin?
Androgel is a gel packet that should be applied daily, preferably in the morning. It must be placed on dry skin, either on the shoulders, arms or abdomen.

Testim (a gel with 1% testosterone) is a tube filled with 50 mg of testosterone gel. It should be applied in the morning to clean, dry skin on the shoulders or arms.

After using Androgel and Testim, it’s important to wash your hands immediately with soap and water.
Which testosterone replacement therapy is administered through a skin patch?
Androderm is a transdermal patch applied in the evening (at around 10 p.m.) on clean and dry skin on the back, abdomen, arms or thighs. Either a single patch with 5 mg of testosterone is used or two patches with 2.5 mg of testosterone each.

It’s important that the patient rotates between application sites to avoid irritation. He should wait at least seven days before applying a patch to the same zone again.
Which testosterone replacement therapy involves injections?
Delastestryl (200 mg/mL of testosterone enanthate) is an injection of 100 mg to 400 mg administered every 1 to 4 weeks.

Depo-testosterone (100 mg/mL of testosterone cypionate) is usually prescribed as a 200 mg injection administered every 2 weeks.
Which testosterone replacement drug is taken orally?
Andriol (testosterone undecanoate) is a 40 mg capsule that’s taken daily in two doses with food.
What are the possible adverse side effects of testosterone replacement therapy?
  • Acne
  • Aggression or aggressive behaviour
  • Breast enlargement and chest pain
  • Mood swings, depression
  • Prostate enlargement
  • Headaches, dizziness
  • Hypertension
  • Increased or irregular heart rate
  • Increased levels of prostate-specific antigen
  • Increased risk of blood clots
  • Higher erythrocyte count
  • Hair loss and baldness
  • Prolonged or painful erection
  • Irritation, redness or rash at the application site
  • Sleep disturbances caused by respiratory problems
  • Weight gain
  • Cough
  • Natesto only: Metal taste and nasal problems (abnormal or unpleasant smell, continuous nasal discharge, congestion, sneezing, nosebleeds, discomfort in the nose, scabbing, dryness)
What are the potential benefits of testosterone replacement therapy?
The main goal of testosterone replacement therapy is to improve the patient’s overall vitality. In many cases, the treatment improves the patient’s sex life, sex drive, daily energy, bone density, muscle mass and sleep quality. Mood and cognitive functions such as concentration and memory are also typically enhanced. These improvements may vary between patients.
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