Barry Shepard, M.D.

Low testosterone level, or hypogonadism as it is referred to in medical books, is a common condition in men. Testosterone is produced mainly in the testicles with a small amount being made in the adrenal glands (a gland which sits above the kidneys.) It is estimated that in men between 40 and 70 years of age, the incidence of low testosterone ranges between 12 and 45%.  This means that approximately 500,000 new cases are diagnosed each year in the United States.  As men age, they are more likely to experience the symptoms of low testosterone levels.

In the past the symptoms of having inadequate testosterone levels were thought to be mainly sexual in nature including loss of sexual desire and erectile dysfunction (impotence.)   However, more recently, it has been recognized that the effects of low testosterone are much more far reaching. 

Similar to women who have gone through menopause with reduced estrogen levels, men with low levels of testosterone may experience:

 – Muscle weakness.

 – Decreased bone density. 

 – Fatigue.

 – Loss of energy.

 – Changes in mood.

The diagnosis of low testosterone is made by measuring total testosterone and free testosterone (the active form of the hormone) blood levels early in the morning.  If the laboratory tests confirm low testosterone and there are symptoms of testosterone deficiency, a diagnosis of hypogonadism can be made and treated appropriately.

Treatment of testosterone deficiency is accomplished by replacing testosterone with one of various synthetic preparations:

 – Testosterone injections – may be given every 2 to 4 weeks depending on the preparation.

 – Testosterone gels – Testosterone patches were originally used, which had to be placed on the scrotum on a daily basis. Recently these have given way to testosterone gels that can be rubbed into the skin every morning.

 – Testosterone pills are available but are poorly absorbed and are rarely prescribed.  

The patient should decide on either testosterone injections or testosterone gels in conjunction with their Urologist or Primary Care Physician.  Although the benefit of a once monthly injection is convenient, the gel can be applied at home on a daily basis.

Side effects of receiving testosterone replacement are generally minor and infrequent.  Blood testing to measure liver function, cholesterol, triglyceride levels and blood counts, should be done on a routine basis.  Mood swings are sometimes seen, especially with the injectable form of testosterone, as the patient’s blood levels may swing from high to low during the month. 

Much has been written about the relationship between testosterone and prostate cancer.  It was previously believed that men with established prostate cancer should not receive testosterone replacement under any circumstances.  This concept is now being challenged and current urological literature supports the cautious use of testosterone replacement in men with prostate cancer if they have low testosterone levels and are symptomatic. This should be done in selected patients as long as they are carefully monitored.  Finally, the issue of whether testosterone replacement can actually cause prostate cancer is generally not accepted; however, some questions do remain.

In summary, testosterone deficiency is a common condition in men as they age and can lead to a variety of symptoms including both sexual and nonsexual complaints.  This condition is easily treated and may help restore vitality.