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The Emerging Role of Testosterone In Health and Diseases of Men
Low testosterone syndrome (low T) in middle-age men, often used synonymously with andro-pause, androgen deficiency or late onset hypogonadism (LOH), is defined as a condition associated with low serum testosterone and clinical signs and symptoms of diminished male hormone effect. Presently, most guidelines recommend testosterone replacement treatment (TRT) only if both criteria are met.
Population studies over time have indicated 20-30% of men between ages 45 and 50 have low serum testosterone. Also, epidemiological data in the expanding population of elderly men reveals a progressive age-related decline in testosterone. Therefore, low T is a common condition and it is estimated to affect between 2- 4 million men in the US.
Millions of men suffer needlessly from low sex drive, loss of vitality, mood disorders and various metabolic abnormalities as low T remains largely under diagnosed, misunderstood and undertreated. Serum testosterone is frequently not determined in men with symptoms consistent with low T and their complaints are often attributed to “normal aging.” Some men with low T have no symptoms and are overlooked since testosterone tests are not part of routine testing. These men can have unrecognized low T related weight gain, prediabetes, worsening high cholesterol, mild anemia and osteopenia (bone thinning).
The public, and many physicians, tend to associate the main clinical impact of low T with mainly sexual complaints in men such as diminished libido and erectile dysfunction. Many physicians are unaware of the numerous, recent reports that have implicated testosterone deficiency in the development of prediabetes, metabolic syndrome, diabetes, cardiovascular disease, angina, congestive heart failure, osteoporosis, the old-age frailty syndrome and premature death.
Moreover, important new studies document the benefits of using TRT for low T including improvements in mood, temperament, drive, focus, sleep, energy, exercise endurance, muscle strength and mass, bone density, heart function, angina frequency, blood sugar control, A1C, cholesterol, hemoglobin, irritability, anxiety, body fat. Testosterone is not just a “male sex hormone” but an important factor in normal functioning of multiple organ systems.
A persistent belief among providers which suppresses appropriate evaluation and treatment of men with low T is that TRT causes prostate enlargement and prostate cancer. Since 2004 there have been numerous, highly respected medical publications, which destroy what has become a myth that TRT causes prostate cancer. In fact, it has been suggested by recent reports that low testosterone is a greater risk factor for prostate cancer than more normal physiologic levels of testosterone associated with TRT. NIH is initiating a long-term prospective study of the safety and benefits of TRT to answer these lingering questions.
In summary, low T is common and it has health effects far beyond sexual function. Low testosterone is associated with chronic diseases such as atherosclerosis, diabetes and increased risk of sudden death. Men with low testosterone are numerous, they are unrecognized and often left unevaluated for low T by their providers. Many are symptomatic and their complaints are explained away as “aging symptoms.”
Men over 50 who have consistent symptoms with low T should find a doctor who understands how to evaluate a man for low T and to properly interpret results and begin TRT if indicated.
