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Low testosterone, or hypogonadism, is a collection of symptoms caused by low blood levels of testosterone. The prevalence of the condition is difficult to determine as studies have used variable methods and definitions of low testosterone, but estimates are as high as 40 percent of men > 45 years old with the likelihood increasing as men age.
Symptoms can include poor erectile function, decreased libido (sex drive), increased body fat, decreased muscle mass, decreased energy or exercise tolerance, impaired fertility, and depression. Low testosterone may be associated with other conditions that are increasing in prevalence in the United States, which may explain, in part, why low testosterone is also increasingly common.
Conditions associated with low testosterone
- Hypertension, up to 40%
- High blood cholesterol, up to 40%
- Diabetes, up to 50%
- Obesity, up to 50%
- Chronic opioid use, up to 75%
- HIV, up to 30%
- Endocrine disorders (pituitary tumors, primary testicular failure)
- Genetic conditions (Klinefelter syndrome, Kallman syndrome)
- Testicular disorders (trauma, inflammation, varicocele)
- Cancer treatments (chemotherapy, radiation)
- Chronic stress and sleep distrubance
Due to the fact that low testosterone symptoms are non-specific and may be related to associated conditions, it is important to accurately diagnosis low testosterone and treat related medical problems. Diagnosis involves a complete medical history, physical examination, and at least separate two blood tests for testosterone drawn in the early morning. Other tests may be performed to investigate for cardiovascular disease, diabetes, and endocrine hormone balance. A testosterone level of > 300 ng/dL is generally accepted by the American Urological Association to represent the normal threshold above which testosterone replacement therapy should not be prescribed.
Treatment options vary according to the cause of low testosterone and can include lifestyle changes (exercise, weight loss, improved nutrition and sleep), treatment of associated conditions, and also testosterone hormone replacement. Testosterone replacement is demonstrated to improve energy, libido, erections, muscle mass, and mood. Other benefits include increased bone mineral density and decreased risk of bone fracture. Options for testosterone replacement include topical gels and patches, nasal gels, injections, and long-acting pellets implanted by your physician.
It is important to recognize that testosterone replacement may cause unwanted effects and should be monitored closely to prevent negative consequences. Adverse effects include increasing estrogen level which may lead to breast swelling and tenderness, increased red blood cell count, acne, hair loss, decreased testicular size, infertility, and swelling of the hands and feet. Routine blood tests should be used during treatment for monitoring purposes including testosterone level, estrogen level, hematocrit (red blood cell count), and PSA. Dr. Carrasquillo may also closely monitor your blood cholesterol and liver function testing.
The association between testosterone therapy and increased risk of prostate cancer and cardiovascular disease remains controversial with the quality of evidence weak. Despite this, the FDA requires labeling to indicate the possible increased risk of heart attack and stroke. It is important to discuss the risk:benefit ratio whenever considering a new treatment and Dr. Carrasquillo can help you nagivate this.