How’s your testosterone?

You can blame the advertising campaigns that promise to restore youthful vigor, perhaps, but many men of a certain age start to worry if they are losing their manliness. They may be concerned that given the green light by their partner, they may not be able to get off the starting line.

Testosterone is the hormone that gives men their manliness. Produced by the testicles, it is responsible for male characteristics like a deep voice, muscular build, and facial hair. Testosterone also fosters the production of red blood cells, boosts mood, keeps bones strong, and aids thinking ability.

After age 30, most men begin to experience a gradual decline in testosterone — about one percent to two percent a year. A decrease in sex drive sometimes accompanies the drop in testosterone, leading many men to mistakenly believe that their loss of interest in sex is simply due to getting older.

Low testosterone levels can lead to sexual dysfunction and impotence. Erectile dysfunction can seriously hamper a man’s sexual relationship. Also, it can lead to a psychological dilemma such as low self-esteem, denial and depression.

OTHER REASONS FOR LOW LEVELS
“”Some say it’s just a part of aging, but that’s a misconception,” says a urologist at Oregon Health and Science University in Portland. A gradual decline in testosterone can’t explain a near-total lack of interest in sex, for example. And for men who are in their 20s, 30s, and early 40s and having erectile problems, other health problems may be a bigger issue than aging.

As men reach their 50s and beyond, this may lead to signs and symptoms, such as impotence or changes in sexual desire, depression or anxiety, reduced muscle mass, less energy, weight gain, anemia and hot flashes. While falling testosterone levels are a normal part of aging, certain conditions can hasten the decline.

These include: injury or infection, chemotherapy or radiation treatment for cancer medications, especially hormones used to treat prostate cancer and corticosteroid drugs. Also causing low testosterone levels are chronic illness, stress, alcoholism and obesity.

A man’s general health also affects his testosterone levels. For instance, being overweight, having diabetes or thyroid problems, and taking certain medications, such as glucocorticoids and other steroids, can affect levels. Therefore, simply having low levels does not always call for taking extra testosterone.

Hypogonadism is a disease in which the body is unable to produce normal amounts of testosterone due to a problem with the testicles or with the pituitary gland that controls the testicles. Testosterone replacement therapy can improve the signs and symptoms of low testosterone in these men. Doctors may prescribe testosterone as injections, pellets, patches or gels.

SYMPTOMS OF LOW TESTOSTERONE
Men can experience many signs and symptoms as they age, and some may occur as a result of lower testosterone levels. These can include:

• Changes in sexual function. This may include reduced sexual desire, fewer spontaneous erections — such as during sleep — and infertility.
• Changes in sleep patterns. Sometimes low testosterone causes insomnia or other sleep disturbances.
• Physical changes. Various physical changes are possible, including increased body fat, reduced muscle bulk and strength, and decreased bone density. Swollen or tender breasts (gynecomastia) and hair loss are possible. You may experience hot flashes and have less energy than you used to.
• Emotional changes. Low testosterone may contribute to a decrease in motivation or self-confidence. You may feel sad or depressed, or have trouble concentrating or remembering things.

DIAGNOSING LOW TESTOSTERONE
A blood test is the only way to diagnose a low testosterone level. Doctors diagnose low testosterone based on a physical exam, a review of symptoms, and the results of multiple blood tests since levels can fluctuate daily. If your doctor diagnoses low testosterone, other tests may be considered before therapy. For example, low testosterone can speed bone loss, so your doctor may recommend a bone density test to see whether you also need treatment for osteoporosis.

The possibilities of testosterone therapy are enticing — increase your muscle mass, sharpen your memory and concentration, boost your libido, and improve your energy level. As you get older, testosterone therapy may sound like the ultimate anti-aging formula. Yet the health benefits of testosterone therapy for age-related decline in testosterone aren’t as clear as they may seem.

Prostate cancer is a concern, as testosterone can fuel its growth. The Endocrine Society recommends against testosterone supplementation in men who have prostate cancer or have a prostate nodule that can be felt during a digital rectal exam.

TALK TO YOUR DOCTOR
It is possible to have low levels and not experience symptoms. If you wonder whether your testosterone level is low or if therapy might be right for you, talk with your doctor about the risks and benefits. If your doctor can identify the source for declining levels — for instance, weight gain or certain medication — he or she may first address that problem. A medical condition that leads to an unusual decline in testosterone may be a reason to take supplemental testosterone. But treating normal aging with testosterone therapy is not currently advisable.