Testosterone Deficiency (TD) is the second most common endocrine presentation affecting men after diabetes mellitus type 2. Despite this, screening for TD is regularly overlooked. As a result, men with TD and its associated symptoms are very often not being treated which has a direct impact on their quality of life and its unnecessary burden of symptoms.
Symptoms usually present under three broad headings, physical, sexual and psychological.
Physical symptoms – loss of strength, central weight gain, loss of muscle mass and fatigue
Sexual – Erectile dysfunction and loss of libido
Psychological – Fluctuations in mood, increased anxiety and loss of confidence
Causes for TD can be :
- Classical - This can be for various reasons an issue with brain signalling to stimulate the testi to produce testosterone or it can be that there is a problem with production of testosterone from the Leydig cells in the testicle itself .
- There can be resistance at the androgen receptor level meaning that the testosterone is not having an effect at the cellular level
- Age can impact testosterone production
- Environmental factors such as lifestyle can affect testosterone levels and people with a history of poor lifestyle habits are more likely to have lower testosterone levels. People with diagnosed metabolic disease such as diabetes, cardiovascular disease or obesity are also at a higher risk of low testosterone
- Certain medications can also affect production
A comprehensive history, examination and laboratory work (fasting is essential) are carried out in order to establish causative factors of symptoms, this usually takes an hour, follow up appointments are then made as required. If treatment is appropriate there will be regular screening of symptoms and relevant blood tests.