It is not a substitute for medical advice, diagnosis or treatment. Testosterone is a hormone produced by the testicles and is responsible for the proper development of male sexual characteristics. Transdermal patches are more expensive than injections, but the convenience of use and maintenance of normal diurnal testosterone levels are advantageous.
Symptoms of testosterone deficiency syndrome in men and women include:
Clinical features and diagnosis of male hypogonadism. However, testosterone is only one of many factors that aid in adequate erections. A number of conditions can cause secondary hypogonadism, including: Inflammatory disease Certain inflammatory diseases such as sarcoidosis, Histiocytosis, and tuberculosis involve the hypothalmus and pituitary gland and can affect testosterone production, causing hypogonadism. These rumors have nothing to do with the truth, and originate in old wives tales and assumptions made by people who are very sure of what they say, but have no research to back them up.
Nitric oxide is a molecule that helps trigger a series of chemical reactions necessary for an erection to occur. When testosterone levels are too low, a man may have difficulty achieving an erection prior to sex or having spontaneous erections for example, during sleep. However, testosterone is only one of many factors that aid in adequate erections. Research is inconclusive regarding the role of testosterone replacement in the treatment of erectile dysfunction.
In a review of studies that looked at the benefit of testosterone in men with erection difficulties, nearly half showed no improvement with testosterone treatment. Many times, other health problems play a role in erectile difficulties. Testosterone plays a role in the production of semen, which is the milky fluid that aids in the motility of sperm. Men with low T will often notice a decrease in the volume of their semen during ejaculation.
Testosterone plays a role in several body functions, including hair production. Balding is a natural part of aging for many men. While there is an inherited component to balding , men with low T may experience a loss of body and facial hair, as well. Men with low T have reported extreme fatigue and decrease in energy levels. Because testosterone plays a role in building muscle, men with low T might notice a decrease in muscle mass.
Studies have shown testosterone affects muscle mass, but not necessarily strength or function. Men with low T may also experience increases in body fat. In particular, they sometimes develop gynecomastia , or enlarged breast tissue. This effect is believed to occur due to an imbalance between testosterone and estrogen within men.
Osteoporosis , or the thinning of bone mass, is a condition often associated with women. However, men with low T can also experience bone loss. Testosterone helps produce and strengthen bone. So men with low T, especially older men, have lower bone volume and are more susceptible to bone fractures. Men with low T can experience changes in mood. Because testosterone influences many physical processes in the body, it can also influence mood and mental capacity.
Research suggests that men with low T are more likely to face depression, irritability, or a lack of focus. Unlike women, who experience a rapid drop in hormone levels at menopause, men experience a more gradual decrease of testosterone levels over time. The older the man, the more likely he is to experience below-normal testosterone levels. Your doctor can conduct a blood test and recommend treatment if needed.
They can discuss the potential benefits and risks of testosterone medication, as well. A decrease in men's testosterone level is a natural function of aging.
For each year over age 30, the level of testosterone in men starts to slowly…. A testosterone test may be performed if a person has symptoms of a low or high amount of the hormone. Find out what the blood test means and who it's…. A testosterone level test measures the amount of testosterone in the blood. There is an important research being published to demonstrate that testosterone may have key actions on metabolism, on the vasculature, and on brain function, in addition to its well-known effects on bone and body composition.
This article has been used as an introduction for the need to develop sensitive and reliable assays for sex hormones and for symptoms and treatment of hypogonadism. Hypogonadism is a medical term for decreased functional activity of the gonads. The gonads ovaries or testes produce hormones testosterone, estradiol, antimullerian hormone, progesterone, inhibin B, activin and gametes eggs or sperm. Clinically low testosterone levels can lead to the absence of secondary sex characteristics, infertility, muscle wasting, and other abnormalities.
Low testosterone levels may be due to testicular, hypothalamic, or pituitary abnormalities. In individuals who also present with clinical signs and symptoms, clinical guidelines recommend treatment with testosterone replacement therapy. This type of hypogonadism — also known as primary testicular failure — originates from a problem in the testicles. This type of hypogonadism indicates a problem in the hypothalamus or the pituitary gland — parts of the brain that signal the testicles to produce testosterone.
The hypothalamus produces the gonadotropin releasing hormone, which signals the pituitary gland to make the follicle-stimulating hormone FSH and luteinizing hormone. The luteinizing hormone then signals the testes to produce testosterone. Either type of hypogonadism may be caused by an inherited congenital trait or something that happens later in life acquired , such as an injury or an infection.
This condition results from a congenital abnormality of the sex chromosomes, X and Y. A male normally has one X and one Y chromosome. In Klinefelter's syndrome, two or more X chromosomes are present in addition to one Y chromosome.
The Y chromosome contains the genetic material that determines the sex of a child and the related development. The extra X chromosome that occurs in Klinefelter's syndrome causes abnormal development of the testicles, which in turn results in the underproduction of testosterone. Before birth, the testicles develop inside the abdomen and normally move down into their permanent place in the scrotum. Sometimes, one or both of the testicles may not descend at birth. This condition often corrects itself within the first few years of life without treatment.
If not corrected in early childhood, it may lead to malfunction of the testicles and reduced production of testosterone. If a mumps infection involving the testicles in addition to the salivary glands mumps orchitis occurs during adolescence or adulthood, long-term testicular damage may occur.
This may affect normal testicular function and testosterone production. Too much iron in the blood can cause testicular failure or pituitary gland dysfunction, affecting testosterone production. Because of their location outside the abdomen, the testicles are prone to injury. Damage to normally developed testicles can cause hypogonadism. Damage to one testicle may not impair testosterone production. Chemotherapy or radiation therapy for the treatment of cancer can interfere with testosterone and sperm production.
The effects of both treatments are often temporary, but permanent infertility may occur. Although many men regain their fertility within a few months after the treatment ends, preserving sperm before starting cancer therapy is an option that many men consider.
Older men generally have lower testosterone levels than younger men do. As men age, there's a slow and continuous decrease in testosterone production. The rate that testosterone declines varies greatly among men. Whether or not treatment is necessary remains a matter of debate. In secondary hypogonadism, the testicles are normal, but function improperly due to a problem with the pituitary or hypothalamus. A number of conditions can cause secondary hypogonadism, including:.
Abnormal development of the hypothalamus — the area of the brain that controls the secretion of pituitary hormones — can cause hypogonadism. This abnormality is also associated with the impaired development of the ability to smell anosmia. An abnormality in the pituitary gland can impair the release of hormones from the pituitary gland to the testicles, affecting normal testosterone production. A pituitary tumor or other type of brain tumor located near the pituitary gland may cause testosterone or other hormone deficiencies.
Also, the treatment for a brain tumor such as surgery or radiation therapy may impair pituitary function and cause hypogonadism. Certain inflammatory diseases such as sarcoidosis, Histiocytosis, and tuberculosis involve the hypothalmus and pituitary gland and can affect testosterone production, causing hypogonadism.
This virus can cause low levels of testosterone by affecting the hypothalamus, the pituitary, and the testes. The use of certain drugs, such as, opiate pain medications and some hormones, can affect testosterone production. Being significantly overweight at any age may be linked to hypogonadism.
Stress, excessive physical activity, and weight loss have all been associated with hypogonadism. Some have attributed this to stress-induced hypercortisolism, which would suppress hypothalamic function. Throughout the male lifespan, testosterone plays a critical role in sexual, cognitive, and body development.
During fetal development, testosterone aids in the determination of sex. The most visible effects of rising testosterone levels begin in the prepubertal stage. During this time, body odor develops, oiliness of the skin and hair increase, acne develops, accelerated growth spurts occur, and pubic, early facial, and axillary hair grows. In men, the pubertal effects include enlargement of the sebaceous glands, penis enlargement, increased libido, increased frequency of erections, increased muscle mass, deepening of voice, increased height, bone maturations, loss of scalp hair, and growth of facial, chest, leg, and axillary hair.
Even as adults, the effects of testosterone are visible as libido, penile erections, aggression, and mental and physical energy. The cerebral cortex — the layer of the brain often referred to as the gray matter — is the most highly developed portion of the human brain. This portion of the brain, encompassing about two-thirds of the brain mass, is responsible for the information processing in the brain. It is within this portion of the brain that testosterone production begins.
The cerebral cortex signals the hypothalamus to stimulate production of testosterone. To do this, the hypothalamus releases the gonadotropin-releasing hormone in a pulsatile fashion, which stimulates the pituitary gland — the portion of the brain responsible for hormones involved in the regulation of growth, thyroid function, blood pressure, and other essential body functions. Once stimulated by the gonadotropin-releasing hormone, the pituitary gland produces the follicle-stimulating hormone and the luteinizing hormone.
Once released into the bloodstream, the luteinizing hormone triggers activity in the Leydig cells in the testes. In the Leydig cells, cholesterol is converted to testosterone. When the testosterone levels are sufficient, the pituitary gland slows the release of the luteinizing hormone via a negative feedback mechanism, thereby, slowing testosterone production. With such a complex process, many potential problems can lead to low testosterone levels. Any changes in the testicles, hypothalamus or pituitary gland can result in hypogonadism.
Such changes can be congenital or acquired, temporary, or permanent. Recent studies have found that testosterone production slowly decreases as a result of aging, although the rate of decline varies. Unlike women who experience a rapid decline in hormone levels during menopause, men experience a slow, continuous decline over time. Regardless of the age or comorbid conditions, obesity is associated with hypogonadism.
When the risk factors of obesity and age are removed, diabetes mellitus still remains an independent risk factor for hypogonadism. Although diabetes mellitus—related hypogonadism was previously thought to be associated with testicular failure, study results show one-third of diabetic men had low testosterone levels, but also had low pituitary hormone levels. Certain medications are shown to reduce testosterone production. Among the medications known to alter the hypothalamic-pituitary-gonadal axis are spironolactone, corticosteroids, ketoconazole, ethanol, anticonvulsants, immunosuppressants, opiates, psychotropic medications, and hormones.
Signs of hypogonadism include absence or regression of secondary sex characteristics, anemia, muscle wasting, reduced bone mass or bone mineral density, oligospermia, and abdominal adiposity. Symptoms of post pubescent hypogonadism include sexual dysfunction erectile dysfunction, reduced libido, diminished penile sensation, difficulty attaining orgasm, and reduced ejaculate , reduced energy and stamina, depressed mood, increased irritability, difficulty concentrating, changes in cholesterol levels, anemia, osteoporosis, and hot flushes.
In the prepubertal male, if treatment is not initiated, signs and symptoms include sparse body hair and delayed epiphyseal closure. Early diagnosis and treatment can reduce risks associated with hypogonadism.
Early detection in young boys can help to prevent problems due to delayed puberty. Early diagnosis in men helps protect against the development of osteoporosis and other conditions.
The diagnosis of hypogonadism is based on symptoms and blood work, particularly on testosterone levels. Often the first step toward diagnosis is the Androgen Deficiency in Aging Male ADAM test — a 10 item questionnaire intended to identify men who exhibit signs of low testosterone. Testosterone levels vary throughout the day and are generally highest in the morning, so blood levels are typically drawn early in the morning.
If low testosterone levels are confirmed, further testing is done, to identify if the cause is testicular, hypothalamic, or pituitary. These tests may include hormone testing, semen analysis, pituitary imaging, testicular biopsy, and genetic studies.
Once the treatment starts, the patient may continue to have testosterone levels drawn to determine if the medication is helping to produce adequate testosterone levels. Testosterone replacement therapy is the primary treatment option for hypogonadism. According to the guidelines from the American Association of Clinical Endocrinologists,[ 12 ] updated in , the goals of therapy are to:.
To achieve these goals, several testosterone delivery systems are currently available in the market. Clinical guidelines published in , by the Endocrine Society, recommend reserving treatment for those patients with clinical symptoms, rather than for those with just low testosterone levels.
Transdermal testosterone patches are available in India under the brand name Androderm. Transdermal patches deliver continuous levels of testosterone over a hour period. Application site reactions account for the majority of adverse effects associated with transdermal patches, with elderly men proving particularly prone to skin irritation. Local reactions include pruritus, blistering under the patch, erythema, vesicle formation, indurations, and allergic contact dermatitis.
Some patients report that the patch easily falls off and is difficult to remove from the package without good dexterity. Transdermal patches are more expensive than injections, but the convenience of use and maintenance of normal diurnal testosterone levels are advantageous.
Some patients report that the patch is noisy and therefore they feel stigmatized by its presence. Currently, two topical testosterone gels — Androgel and Testim, are available in India.
Application in the morning allows for testosterone concentrations that follow the normal circadian pattern. Topical testosterone gels also provide longer-lasting elevations in serum testosterone, compared to transdermal patches. Adverse effects associated with therapy include headache, hot flushes, insomnia, increased blood pressure, acne, emotional labiality, and nervousness.
Iamges: testosterone deficiency symptoms
Too much iron in the blood can cause testicular failure or pituitary gland dysfunction, affecting testosterone production. Chemotherapy or radiation therapy for the treatment of cancer can interfere with testosterone and sperm production.
Therefore, there is a clear need to increase the awareness of hypogonadism throughout the medical profession, especially in primary care physicians who are usually the first port of call for the patient. Early diagnosis in men helps protect against the development of osteoporosis and other conditions.
Some men may experience testosterone deficiency symptoms decline in sex drive testosterone deficiency symptoms they age. He retrieved prostate tissue from young sustanon 250 cycle with winstrol and old men, and then placed both types of tissues in a low testosterone environment, and high testosterone environments. Blood tests as well as free PSA should always be done to monitor testosterone treatment especially in men. Regardless of the treatment option, patients should be aware of the risks associated with testosterone therapy, including: Key triggers for the physician to consider investigating for hypogonadism are reduced libido, fatigue, osteoporosis and fractures, and erectile dysfunction. Deficiecy secondary hypogonadism, the testicles are normal, but function improperly due to a problem with the pituitary or hypothalamus.
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