Testosterone deficiency and hormonal imbalance in men

Men lose 1 to 3% of their testosterone per year, between the ages of 30 to 70. It can have physical, sexual and psychological effects.

Many men suffer from testosterone deficiency without being aware of the problem, since they consider that its consequences are part of the normal aging process.

Dr. Carlos Marois, urologist in private practice, shares crucial information about this condition, which greatly affects the quality of life and the health of men. For instance, men aged 45 or older with diabetes are twice as likely to have testosterone deficiency. In addition, increased body fat is often associated with testosterone deficiency.

What is testosterone?
Testosterone is a hormone that is secreted by the body, more specifically in the testes. It is the principle sex hormone responsible for the development of reproductive function in male vertebrates. Testosterone is one of the hormones referred to as androgens, which are also known of as anabolic steroids.
Why a drop in testosterone as men get get older?
In Canada, there are an estimated 1.7 million men over the age of 45, who may have testosterone deficiency. Above all, there is a significant change between SHBG balance and albumin. As SHBG increases with age, albumin, related to testosterone, decreases.
What are the common symptoms of testosterone deficiency and hormonal imbalance in men?
  • Drop in libido
  • Difficulty getting or maintaining an erection (erectile dysfunction)
  • Decreased muscle mass
  • Constant fatigue
  • Hot flashes or night sweats
  • Decrease in facial, body or pubic hair
  • Increase in adipose tissue
  • Sleep apnea
  • Moodiness, sadness or depressive disorder
  • Concentration or memory disorders
  • What are the risk factors for a testosterone deficiency in men?
    Age: the prevalence of testosterone deficiency increases with age. Family history: hereditary. Concomitant diseases: diabetes, obesity, hypertension and HIV infection can alter the amount of testosterone produced by the body. Drugs: opioid analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), certain antifungals and anticonvulsants, prednisone and anti-androgens may cause a drop in testosterone levels.
    How is a testosterone deficiency diagnosed?

    Questionnaires: the patient will complete various questionnaires, including the Q-ADAM.

    Physical Examination: Dr. Marois will examine physical characteristics such as hair growth, muscle mass and testicle size.

    Blood analysis: total and bio-available testosterone should be taken in the morning, which is the time of day when testosterone levels are highest.

    Total testosterone is the most common measure of androgenic activity, but it is a poor indicator of tissue activity. Free testosterone for its part, is an inaccurate measure in the treatment of symptoms. The reference values are unfortunately very variable from one laboratory to another.

    Treatment is thus focused on improving symptoms, and not the absolute value of testosterone.
    What are the consequences of having low testosterone?

    Effects on sex life: this is manifested by the decrease in sexual activity, ranging from low sexual desire to erectile dysfunction...

    Effects on the cardiovascular system: a drop in testosterone is associated with an increase in mortality in older men, especially of a cardiovascular nature.

    Effects on bone health: the lack of this hormone slowly weakens the bones and can even lead to osteoporosis (loss of bone resistance).

    Effects on quality of sleep: testosterone is known as a soothing and revitalizing hormone, which plays a role in regulating sleep. The person with low testosterone always feels the need to take naps. The deficiency of this hormone leads to a very shallow and uneven sleep.

    Effects on the mood: a testosterone deficiency causes a dysfunction in the regulation of mood by the brain. Thus, signs of depression, nervousness, anxiety and moodiness appear in the person. Men might also exhibit a lack of motivation in their activities.

    Muscular effects: testosterone is essential for muscle growth and tone. A deficiency in testosterone is thus mainly reflected by a decrease in overall muscle force and mass.

    Metabolic effects: a decrease in testosterone can cause an excessively high increase in cholesterol which in turn, leads to cardiovascular problems, such as high blood pressure and arteriosclerosis. It can also cause the degradation of the heart muscle, and consequently a reduction of its capacity and function.

    Effects on the brain: testosterone deficiency can also lead to problems with concentration and memory. Indeed, testosterone plays an important role in neurological synapses and contributes to good memory.
    What are the long-term consequences of low testosterone levels in humans?
    An increased risk of Alzheimer's disease, cardiovascular disease, osteoporosis-related fractures, diabetes, sarcopenia and the possibility of more prostate cancer.
    What are the benefits of testosterone replacement therapy?
    The main goal of treating testosterone deficiency is to improve male vitality and health. It includes an improvement in sexuality (especially libido), daily energy, bone density, muscle mass, sleep, mood, and cognitive functions such as concentration and memory. These improvements may vary from man to man, depending on the risk factors.
    References ?

    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, cardiovasculars disease and cancer in men: European prospective Investigation into cancer in Norfolk

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    Dr. Marois is a urologist who is not a member of the Régie d’Assurance Maladie du Québec (RAMQ). As such, the clinic can not claim the RAMQ for the payment of his services. If you consult Dr Marois, you must pay for the services rendered.

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    Thank you for your understanding.

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