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Low Testosterone Explained

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Low Testosterone Explained

Testosterone, the man's hormone right, we all know that. Well yours may be low and you don't even know it, and your doctor may not even know it, and it could be affecting your quality of life.

 

So what is Low Testosterone and how do you know?

There are many possible causes of testosterone deficiency, including disease and illnesses, testicular damage, congenital and genetic disorders.  However aging is also a cause as testosterone levels decrease about 1% per year after the age of 40.

 

Symptoms on Low Testosterone

Symptoms may include:

Specific Symptoms

  • Decreased spontaneous erections
  • Hot flushes
  • Low sperm count
  • Reduced libido

Less specific Symptoms

  • Decreased energy/motivation
  • Depression
  • Increased BMI and body fat
  • Poor concentration
  • Reduced muscle bulk and strength
  • Sleep disturbance

In my case decreased energy and motivation was noticeable, as was slower recovery after exercise, poor concentration and increased Body Mass Index (BMI), all of this gradually worsening in my early 50s.    It was really starting to affect my performance at work.

 

Medical Diagnosis

Testosterone levels are normally measured by blood test and can be arranged through your General Practitioner.  Measured results are compared against a reference range which is considered “Normal” in a healthy male population (see Table 1 below).

This “Normal” reference range was developed by measurement of hormone levels from a population sample, across the full age spectrum.  In other words a patients hormone levels will be assessed against adult males ranging from an age of 25 to over 80.  This may sound inherently wrong, but it is the criteria currently adopted for assessment of low testosterone (hypogonadism) in men.  In fact, unless the patients measured T levels are less than the low extreme of this range, i.e. 8.0 Nmol/L, hormone replacement therapy will not be included on the public benefits system, and some hormone treatments can be a little pricey. 

Unless a patient has a serious medical issue, I expect most General Practitioners would conclude the average man would fall into the “normal” range therefore does not need hormone replacement treatment.  This was the case for me, my measured testosterone levels were:

 

Testosterone

Nmol/L

SHBG

Nmol/L

calculated free testosterone

Nmol/L

Pauls Results

age 53 years

14

32

0.3

In comparison to the reference range in Table 1 above, my General Practitioner concluded I was in the normal range, and therefore did not need hormone treatment. 

However, I was not satisfied with this diagnosis, and it certainly did not address the physical decline I was experiencing.  Eventually I found the information in Table 2 below with normal testosterone levels broken down by age, which provided another view on the issue.  My Testosterone levels were similar to that of an 80 year old!!!! 

It took two more visits to my General Practitioner to convince him to put me on Testosterone treatment.

 

Risks with Testosterone Treatment

As with any medication there are some risks associated with testosterone therapy:

Testosterone should not be given to men with:

  • Uncontrolled or poorly controlled heart failure
  • Prostate or breast cancer
  • Severe untreated obstructive sleep apnoea

as these conditions may be exacerbated by testosterone,

For older men, a digital rectal examination should be performed and PSA measured prior to commencing treatment.

If fertility is desired testosterone treatment should not be given.

 

Dealing with Your General Practitioner

Be persistent with your General Practitioner, and point out the following in your discussion with him/her:

  • GP to not only consider the blood test results but also the reported symptoms reported, even if they are non-specific in in nature
  • Limitations of the reference levels considered in the medical practitioners assessment , by virtue of their generality
  • Increased hormone level will benefit your health in other ways, more active, likely to lose weight
  •  Low testosterone levels are associated with other diseases such as type 2 diabetes.  Check out the Midlife Man article ”Testosterone and Diabetes Link-The T4DM Study
  • So long as you have no conditions that may place you at a higher risk with testosterone therapy (see above) there is no downside to hormone replacement therapy
  •  If after 2 or 3 consults, and the answer is still no, then go to another doctor

 

Conclusion

  • Testosterone deficiency in men is a real medical issue, and not just for men “trying to hang on to their youth”. Effective treatments exist but the general medical community is reluctant to prescribe to patients in all but the most serious cases
  • Reference data for “Normal” testosterone levels currently used for assessment of testosterone deficiency in males is broad as it covers all ages.  These reference levels will identify those men with hormone deficiencies caused by major medical issues, but they may be too onerous for most cases with age related declining testosterone levels. 
  • A concerned patient may need additional discussions on their  condition to convince the medical practitioner to prescribe hormone replacement for you

 

 

Table 1: Testosterone Reference Range “Normal”

 

Testosterone

Nmol/L

SHBG

Nmol/L

Calculated Free testosterone

Nmol/L

adult male

8.0 - 30.0

10 - 45

0.20 - 0.60

Note: Testosterone is present as:

·         Tightly bound to SHBG(approx. 60%)

·         Loosely bound to albumin (approx. 38% )

·         Free (approx.  2% )

Bioavailable testosterone refers to albumin-bound and free testosterone.  However, total testosterone is normal measure for diagnosis of androgen deficiency.
 

Table 2: Mean Testosterone Levels in Healthy Men, by Age(1)

Age

Sample Size 

Testosterone

Nmol/L

Free Testosterone

Nmol/L

SHBG

Nmol/L

25-34

45

21.38 (5.90)

0.428 (0.098)

35.5 (8.8)

35-44

22

23.14 (7.36)

0.356 (0.043)

40.1 (7.9)

45-54

23

21.02 (7.37)

0.314 (0.075)

44.6 (8.2)

55-64

43

19.49 (6.75)

0.288 (0.073)

45.5 (8.8)

65-74

47

18.15  (6.83)

0.239 (0.078)

48.7 (14.2)

75-84

48

16.32 (5.85)

0.207 (0.081)

51.0 (22.7)

85-100

21

13.05 (4.63)

0.186 (0.080)

65.9 (22.8)

 

 

References

1.       Androgens and the Aging Male.   A. Vermulen & B. J. Oddens 

 

 

Disclaimer: The content of this article and other articles on this website are for informational purposes only and do not constitute professional advice. Please seek advice from a professional in the relevant field, in relation to any specific matter. Refer to the website Terms and Conditions.

 

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