The level of testosterone in men peaks in the late teens and early twenties and then begins to gradually decline by about one percent per year. Some men (an estimated twenty to forty percent) suffer from greater declines due to a condition referred to as hypogonadism. The effects of declining testosterone levels, either simply due to aging or due to hypogonadism, lead to decreased muscle mass, increases in body fat, declines in endurance and strength, declines in libido and sexual performance, and feelings of depression. Hormone replacement therapy for men can treat these symptoms, and it may be just what you have been looking for to feel your best again.
What is Testosterone?
Testosterone is an androgenic hormone. Although it is commonly referred to as a “male” hormone, women produce testosterone as well, albeit at lower levels than in men. Testosterone is produced primarily by the testicles, although some is also produced by the adrenal glands. Once secreted into the bloodstream, this hormone has many different effects on different tissues. In some tissues such as hair follicles, testosterone is converted into DHT, an androgenic hormone that is far more potent than testosterone but only acts locally. Both DHT and testosterone mediate their functions by binding to androgen receptors; once bound to a hormone, these receptors move into the nucleus and alter the gene expression pattern of the cell. They can also interact with signalling pathways in the cytoplasm and directly alter them without affecting the expression levels of the proteins involved in these signalling pathways.
Alterations of gene expression patterns and signalling pathways in response to androgens act to create and maintain the obvious “masculine” features everyone is familiar with, such as:
- Increases in muscle mass and strength
- Changes in fat distribution
- Stimulation of facial and body hair growth
In addition to these visible changes, testosterone acts to increase bone density and is a necessary factor to stimulate the production of sperm and to maintain libido and sexual performance. Androgen receptors are also present in the brain, and their activation can alter emotions that can affect behavior, such as increasing aggression levels and inducing feelings of confidence and well-being.
What Causes Abnormally Low Testosterone Levels?
In addition to the natural decline of testosterone with age, many other conditions can cause testosterone levels to be lower than normal for a man’s age, all generally referred to as hypogonadism. In hypogonadism, the testicles don’t produce normal levels of testosterone. Some cases of hypogonadism are congenital and are usually diagnosed at birth when the infant shows signs of an intersex condition or has ambiguous genitalia, or are diagnosed later when a boy does not progress through puberty normally. However, the majority of cases of hypogonadism develop later in life in adult men, and this condition is thought to affect up to forty percent of adult men at some point during their lifetime.
Adult men who develop hypogonadism may experience the following symptoms:
- Hot flashes
- Difficulty concentrating
- Reduced libido
- Erectile dysfunction
- Reductions in facial and body hair growth
- Decreases in muscle mass
- Development of breasts (gynecomastia)
Causes of hypogonadism in adult men include trauma to the scrotum, mumps, pituitary tumors, hemochromatosis (an inherited condition where the body retains too much iron, causing damage to multiple organs including the testicles), and chemotherapy or radiation treatment. Sarcoidosis, HIV infection, and obesity can all lead to lower levels of testosterone, as can a number of different medications used to treat a wide variety of conditions. In addition, substance abuse, such as excessive alcohol consumption or abusing amphetamines, opioids, and other drugs can lead to lower levels of testosterone. Malnutrition and prolonged fasting can have the same effect.
Diagnosis of hypogonadism is usually straightforward and is based on taking a medical history, performing a physical exam, and measuring the blood testosterone level and comparing it to the normal age-adjusted level. However, identifying the cause of the condition may require a lot of additional tests to be performed, such as blood tests for HIV infection, genetic tests for hemochromatosis, careful scrutiny of all prescribed medications, and imaging evaluations to look for testicular damage and possible pituitary tumors.
If the cause of the hypogonadism can be identified, in some cases, the condition can be reversed by simply treating the primary cause. However, sometimes no cause can be found, and in other cases, the cause cannot readily be treated. For example, if the testicles have been damaged by mumps or hemochromatosis, there is not much that can be done other than hormone replacement therapy for men to treat the symptoms.
What if I Don’t Have Hypogonadism But Still Don’t Feel Right?
Many men who do not technically have abnormally low testosterone because their testosterone levels are within the normal range for their age still don’t feel that they are feeling “normal”. The reduced level of testosterone due to aging is causing troublesome symptoms for these men, such as fatigue, depression, difficulty concentrating, and loss of muscle mass. Men who technically do not have hypogonadism report that after they start taking hormone replacement therapy for men, their symptoms go away, their energy comes back, they experience an improved sense of well-being, and in addition, most experience a loss of body fat and increases in muscle mass, especially if they combine hormone replacement therapy for men with an exercise regimen.
A Note About Osteoporosis
Although often thought of as a “woman’s disease”, a lot of men develop osteoporosis as they age. During puberty, the bones grow rapidly, and they continue to gain in density throughout the 20s before finally reaching their peak density in the early 30s. In order to maximize bone density during this time period, adequate exercise that puts minor stresses on the bones, such as running and weight lifting, and adequate calcium and vitamin D intake are necessary. In addition, sex hormones play important roles in stimulating the bones to build a good, strong, dense network. Testosterone plays a key role in inducing the formation of dense bones and in maintaining it over time.
After the mid-thirties, bone density tends to gradually decrease over time. In women, this decline accelerates after menopause when sex hormones suddenly decline to very low levels. In men, there is no sudden defining point at which bone density declines start to accelerate because of the gradual natural decline in testosterone levels, but both men with hypogonadism and those with just a natural decline in testosterone can be at high risk of developing osteoporosis.
Osteoporosis is defined as a chronic condition of excessive loss of bone density, which eventually leads to extremely brittle bones that can fracture in response to even minor trauma or sometimes just fracture spontaneously. Men who have hypogonadism, a slight stature, and a family history of bone fractures in elderly relatives are thought to be at higher risk for developing osteoporosis and may want to consider getting bone density tests. Ensuring that sufficient calcium and vitamin D are consumed and regularly engaging in exercises like weight lifting, walking, biking, or running can help maintain bone density, especially in conjunction with hormone replacement therapy for men.
Getting Started with Hormone Replacement Therapy
Before starting on hormone replacement therapy for men, these males should get a complete workup to determine if they have hypogonadism and if so, what might be causing it; and if not, to determine if there is some other health issue causing the troubling symptoms, like sleep apnea or a thyroid problem. It is vitally important to obtain an accurate measurement of the current blood testosterone level so the doctor can select the correct dose of hormone replacement therapy. It is also important to be regularly tested for testosterone levels throughout the therapy in order to ensure the correct dose is being delivered.
Testosterone can be delivered by injections given as needed, but in addition to being inconvenient, this approach causes peaks and declines of testosterone levels that can worsen symptoms or even induce new ones to appear. Methods that deliver a constant, steady dose of the hormone are far preferable. The two most common methods of delivery are patches and pellets, but other methods are available such as creams that are applied daily.
The patch is a small, sticky square that is stuck to the skin. Most need to be applied once a day and then replaced as needed. After placement of the patch, it is important to avoid getting it wet for a set amount of time, after which it is ok to shower, swim, or exercise heavily; however, if it gets very wet, it may fall off. Patches can also cause skin irritation. Thus, this method is not terribly convenient.
Pellets are tiny grains of pure testosterone. After determining the correct dose, they are skillfully inserted under the skin. They can be placed in a number of different areas. They are so small they cannot be felt once placed. After placement, they just gradually dissolve and release a constant, steady dose of testosterone into the body. Since they are composed of pure hormone, there is no residue that remains or needs to be removed later.
If you are suffering from symptoms like fatigue, depression, loss of muscle mass, loss of libido, and/or erectile dysfunction, consider making an appointment with us at World Wellness Health Institute for an evaluation to determine if hormone replacement therapy for men may be right for you. We offer expert hormone health services for both men and women. Why not have your case evaluated and learn about your treatment options? Contact us today to book an appointment at our office in Bala Cynwyd. We look forward to speaking with you!