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From the Winter 2019 Quest
Dr. Joshua Halpern

Who is at risk for low testosterone, and why is it important for men to be aware of testosterone deficiency?

Testosterone deficiency, or hypogonadism, is an important condition for men to be aware of, because it can impair men's health and cause a variety of bothersome symptoms. Men with low testosterone may have decreased bone health, decreased muscle mass, low sex drive, erectile dysfunction, or a number of other symptoms.

There are many risk factors for testosterone deficiency - congenital diseases (ex: undescended testicle, Klinefelter's syndrome), diabetes, obesity, HIV infection, sleep apnea, opioid use, and many other conditions have been associated with low testosterone. There is also evidence that testosterone levels tend to decrease as men age.

What causes low testosterone? Can men take any steps to avoid developing the condition?

Low testosterone is usually caused by one of two mechanisms - either the testicles are unable to produce enough testosterone (primary hypogonadism) or the brain (pituitary gland) does not produce enough of the hormones that signal the testicles to make testosterone (secondary hypogonadism).

There is good evidence that maintaining a healthy lifestyle with a sensible diet, regular exercise, and good sleep habits can improve a man's testosterone level. These habits are also good for preventing heart disease and other chron.2ic conditions, which are themselves risk factors for low testosterone.

What should a man do if he's experiencing symptoms of low testosterone?

Men experiencing symptoms of low testosterone such as low energy, decreased libido, or erectile dysfunction, should see their primary physician. The initial evaluation for this condition typically involves a good medical history and physical examination along with some blood tests. From there, the physician can help to determine whether a man might benefit from treatment for low testosterone.

Is there a standard treatment for men diagnosed with testosterone deficiency?

The standard treatment for men with testosterone deficiency is testosterone replacement therapy. This usually means taking testosterone in one of a few forms - topical (gels, patches), injectable, or pellets.

Dr. Robert Brannigan

Are there risks of testosterone treatment?

There are risks of treatment. In men with untreated prostate cancer, testosterone can promote cancer growth. However, there is increasing evidence that testosterone is safe in men who have cancer that has been completely treated. Men who use testosterone therapy are also at risk for infertility, so be sure to talk to your doctor about family planning before starting these medications.

Lastly, there is conflicting evidence about the relationship between testosterone and cardiovascular disease. Men who have low testosterone are at increased risk for having cardiovascular disease. There were some early studies showing that men who started testosterone therapy were also at increased risk of cardiovascular disease, but subsequent studies have found no link between testosterone therapy and cardiovascular disease. We are still awaiting additional research to help us understand the relationship between testosterone replacement and heart disease.


Learn More About Testosterone Deficiency

Dr. Joshua Halpern and Dr. Robert Brannigan, both urologists at Northwestern University, co-authored a JAMA Patient Page on testosterone deficiency in September.

The resource is free and available online at jamanetwork.com/journals/jama/fullarticle/2749876, or you can search the citation:

JAMA. 2019;322(11):1116. doi:10.1001/jama.2019.9290.




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