Testosterone plays a crucial role in men's health, influencing everything from muscle mass to mood. Find out what happens when the levels of this hormone drop, causing a deficiency and how this is managed.

“Men generally begin to experience a gradual decline in testosterone levels around the age of 40,” says Dr Chris Greyling, an endocrinologist at Mediclinic Durbanville. This decline, averaging 1-2% per year, is a natural phenomenon, he adds. However, factors such as obesity and type 2 diabetes mellitus can speed up this process, so men are more susceptible to testosterone deficiency as they age. By age 70, almost one third of men may experience significant hypogonadism – in other words, their body doesn't produce enough testosterone or sperm, or both.

There are three main categories of testosterone deficiency causes, Dr Greyling explains:

  1. Primary hypogonadism, which stems from testicular issues like trauma or infections.
  2. Secondary hypogonadism, resulting from pituitary dysfunction often associated with obesity or chronic diseases.
  3. Tertiary hypogonadism, originating from hypothalamic abnormalities such as tumours, or genetic conditions like Kallmann syndrome – a condition that causes diminished libido, erectile dysfunction, and decreased muscle strength.

How does testosterone deficiency affect a man’s health?

Testosterone deficiency, clinically known as hypogonadism, displays multiple symptoms. Dr Greyling says common signs include fatigue, mood disturbances such as depression and anxiety, diminished sexual desire, erectile dysfunction, infertility, weight gain, loss of muscle mass, and even reduced facial and body hair growth.

Most alarmingly, decreased bone density poses a serious risk of osteoporotic fractures. Weakening bones can lead to debilitating injuries and addressing testosterone deficiency is an important part of maintaining skeletal health, he cautions.

What are the risks and benefits of hormone therapy for men?

Various treatments are effective in treating testosterone deficiency, says Dr Greyling – each with its own set of risks and benefits. AndroGel, a topical testosterone formulation, is effective, but absorption is unpredictable, and it may inadvertently be transferred to others if they come into contact with the area on which you applied it. In contrast, Depo-Testosterone, administered as intramuscular injections every three weeks, offers a more stable approach with well-tolerated outcomes. Another option, Nebido, has the advantage of predictable absorption when administered every three months.

"However, as with any medical intervention, doctors carefully consider individual needs and potential risks," he emphasises. A tailored approach, guided by comprehensive expert evaluation and ongoing monitoring, is crucial to optimise the benefits of hormone therapy and minimise risks.

Can hormone therapy restore sexual function?

The restoration of sexual function is a common concern for men grappling with testosterone deficiency. Fortunately, says Dr Greyling, hormone therapy can rejuvenate libido and improve erectile function in many cases. By replenishing testosterone levels to within the physiological range, it’s common for patients to regain their sexual vitality, enhancing both intimacy and quality of life.

But it’s also important to have realistic expectations when you begin a course of holistic treatment and management, he advises. “Hormone therapy can yield significant improvements in sexual function, but it’s crucial to address underlying factors and adopt a multifaceted approach that includes lifestyle modifications and psychological support.”

What kind of specialist do I consult?

While testosterone deficiency can play havoc in many areas of a man’s life, help is at hand. Seeing an endocrinologist is your first step towards receiving the help and relief you need. This specialty focuses on conditions that affect the body’s hormonal systems, which is why endocrinologists are best placed to diagnose and treat testosterone deficiency. They will perform a comprehensive evaluation, formulate a precise treatment plan, and provide ongoing management tailored to individual needs. This optimises outcomes for patients struggling with hormonal imbalances.

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