It is rarely appreciated that Testosterone is required to maintain very diverse functions in many tissues of the body, in both males and females. Before birth and at puberty, testosterone determines normal genital development. In adulthood, the maintenance of sexual function is only one aspect of this hormone's function, both in both men and women. Testosterone has an important role in the function and physiology of brain, bone, muscle, cardiovascular system and metabolism. It is not surprising therefore that deficiency can produce a wide spectrum of symptoms, particularly in men, and these symptoms can be reversed by testosterone deficiency treatment.
The most immediate and obvious symptoms of testosterone deficiency include erectile dysfunction, loss of libido, loss of vigour, drive, and mood changes. These may affect work performance, quality of life and relationship difficulties. Other physical symptoms include sweating, aches and pains, dry skin and difficulty sleeping. Often such symptoms are attributed to work stress, relationship difficulties, travel and aging. These symptoms can be caused by declining testosterone levels, which occurs in all men as they age, and the symptoms can start to manifest in middle age. In the longer term, testosterone deficiency may contribute to other age-related conditions and diseases, characterized as Testosterone Deficiency Syndrome.
Symptoms acquired as a result of testosterone deficiency usually respond well to appropriate testosterone replacement treatment. The individual symptoms that an individual experiences tends to relate to the degree and duration of deficiency, with some symptoms being more troublesome than others. Some symptoms may be absent even in the presence of testosterone deficiency or they develop at a later stage if testosterone continues to decline. Untreated, longer term testosterone deficiency may adversely affect quality of life, and increase the risk of osteoporosis, metabolic disease, cardiovascular and neurological disease. However, before treatment can be recommended or begun, general medical and urological condition must be fully assessed, potential contraindications ruled out, and during treatment monitoring will be necessary.
Testosterone therapy may increase the growth of prostate cancer, but testosterone is not currently thought to cause of the cancer (nearly all men have testosterone, but only 3% will die from prostate cancer). Many but not all forms of testosterone deficiency treatment impair normal testicular function and fertility (and testosterone has been tested as a contraceptive). While testosterone treatment may be very effective for symptoms, occasionally side effects may develop. These include (but are not limited to) occasional breast swelling, an increase in balding (hair loss), slight testicular shrinkage, and an increase in blood count, though none of these are common with modern treatment monitoring. Since prostate cancer becomes more common with advancing age, careful monitoring is necessary to ensure it is detected and treated early. In men who have had prostate cancer, the effect of testosterone and consequences of deficiency require very careful consideration with a urological specialist.
Testosterone replacement therapy is usually carried out with skin gels, and a variety of gels are now available. These provide the most physiological levels of the hormone and are convenient and generally acceptable to most men. A minority of patients are better suited to an injectable form of testosterone. Hormone implants provide replacement for up to six months, but are least physiological and the symptomatic benefit may be somewhat unsatisfactory along with a greater tendency to side effects. Medications that improve erectile function can be used combination with testosterone supplementation depending on the underlying diagnosis.
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