Testosterone deficiency and hormonal imbalance in men | DIAGNOSTICS

Between the ages of 30 and 70, men lose testosterone at a rate of 1% to 3% per year. This decrease can have a number of detrimental physical, sexual and psychological effects. 

Many men unknowingly suffer from testosterone deficiency, and some may believe that the symptoms they’re experiencing are just a normal part of aging.

As an experienced private urologist, Dr. Carlos Marois is able to provide you with accurate information about this condition that affects the health and well-being of so many men. It’s worth noting that men with diabetes who are 45 and older are twice as likely to have low testosterone. Excessive body fat is an additional risk factor for testosterone deficiencies.

What is testosterone?

Testosterone is a sex hormone produced by the body. Most of the testosterone present in men is made in the testicles. This hormone is responsible for developing and maintaining men’s reproductive systems.

Why do testosterone levels decrease with age?

It’s estimated that approximately 1.7 million Canadian men over the age of 45 have a testosterone deficiency.

Testosterone levels decrease with age mainly due to a growing imbalance between the proteins SHBG and albumin. SHBG levels increase with age, while levels of albumin, which binds to testosterone, decrease.

What are the primary symptoms of low testosterone and hormonal imbalance in men?

  • Decreased sex drive
  • Difficulty getting or maintaining an erection (erectile dysfunction)
  • Decrease in muscle mass
  • Fatigue
  • Hot flashes or night sweats
  • Reduction in facial, body and/or pubic hair
  • Increased fat tissue
  • Sleep apnea
  • Irritability, sadness or depression
  • Difficulty concentrating
  • Weakened memory

What are the risk factors for testosterone deficiency in men?

  • Age: Testosterone deficiency is more prevalent in older men.
  • Family history: Low testosterone can be hereditary.
  • Comorbidities: Diabetes, obesity, hypertension and HIV can cause the body to produce less testosterone.
  • Medications: A number of drugs can lower testosterone levels, including certain opioid pain relievers, non-steroidal anti-inflammatory drugs (NSAIDs), antifungal medications, anticonvulsants, anti-androgens and prednisone.

How is testosterone deficiency diagnosed at Cliniques Marois?

We use the following methods to diagnose low testosterone:
  • Diagnostic questionnaires: The patient fills out various diagnostic questionnaires, including the quantitative ADAM questionnaire.
  • Physical examination: Dr. Marois examines physical markers including hair, muscle mass and testicle size.
  • Blood sample: Levels of bioavailable testosterone and total testosterone are measured (ideally in the morning, when testosterone levels tend to be highest).
Total testosterone is the main indicator for androgen levels. However, it’s a poor indicator of androgen activity in the tissues.

Monitoring free testosterone levels is an inadequate method for treating symptoms, and at Cliniques Marois, our focus is on improving symptoms.

What are the effects of low testosterone?

  • Sex drive diminishes: Low testosterone correlates with a lower sex drive, erectile dysfunction and low rates of sexual activity.
  • Cardiovascular issues: In older men, low levels of testosterone correspond to higher overall mortality rates and an increase in occurrences of cardiovascular disease.
  • Bone disease: A deficiency in this sex hormone gradually weakens bones and can lead to osteoporosis (loss of bone mass).
  • Sleep difficulties: It’s been shown that testosterone both relaxes and revitalizes the body and acts a sleep regulator. Individuals with low testosterone levels may feel a frequent desire to nap, as a deficiency in this hormone generally results in shallow and uneven sleep.
  • Mood problems: Testosterone plays an important role in the bodily systems that regulate emotion. Low testosterone correlates with depression, anxiety, mood swings and a decrease in motivation.
  • Muscle atrophy: By stimulating muscle and tissue growth, testosterone plays a key role in increasing and maintaining muscle mass and strength. A testosterone deficiency generally results in weaker, smaller muscles.
  • Metabolic issues: A decrease in testosterone can cause a corresponding spike in cholesterol levels, leading to cardiovascular problems such as high blood pressure and arteriosclerosis. It can also result in lower overall cardiovascular fitness and poorer heart health.
  • Cognitive impairment: Testosterone plays a key role in synaptic and neural plasticity and memory function. A testosterone deficiency can lead to serious problems with concentration and memory.

What are the long-term consequences of low testosterone in men?

Over time, a testosterone deficiency will result in an increased risk of Alzheimer’s disease, cardiovascular disease, osteoporosis-related fractures, diabetes, sarcopenia and prostate cancer.

What are the benefits of testosterone replacement therapy?

Testosterone deficiency treatments for men are designed to improve their overall vitality and well-being. Testosterone replacement therapy (TRT) prioritizes making improvements to the patient’s sex life, energy levels, bone density, muscle mass, sleep quality, mood and cognitive functioning (concentration and memory). The degree of improvement varies between patients, and success depends on individual factors.

What are the relevant studies?

Shores MM Matsumoto Am Sloan KL et AL; Arch intern Med 2006; 166 Low testosterone and mortality in male veterans

Khan KT, Dorset M, Folkerd et al Circulation 2007; Dec. 4; 116(22) 2694-2701; Endogenous testosterone and mortality due to all causes, cardiovascular disease and cancer in men: European prospective Investigation into cancer in Norfolk

What treatments are available for low testosterone?

  • Testosterone replacement therapy

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