Tired? Are your endurance and strength declining? Have you noticed a decline in your sexual function and lost interest in your sex life?
Every man could answer “yes” to at least one of these questions after age 40. Common symptoms of low testosterone, they can also result from a myriad of lifestyle, social, emotional and behavioral issues.
It is a physician’s goal to “treat the whole patient,” so we try to identify those issues that are most relevant to the symptoms. For decades, it was believed low testosterone was responsible for the above … but not much else. Physicians were taught a decline testosterone was “normal” as men aged.
These beliefs have substantially changed in the last five years.
We now know a condition known as “metabolic syndrome” is intimately linked to low testosterone. Metabolic syndrome is a constellation of diabetes (or insulin resistance), hypertension, elevated triglycerides (fat levels in the blood), abdominal obesity and low testosterone. It’s estimated as many as 25 percent to 45 percent of American men over 40 may have metabolic syndrome and therefore a significantly elevated risk of stroke and heart attack.
How testosterone interacts with obesity, diabetes and cholesterol is not fully understood. It is also unclear whether low testosterone is the cause of the increased risk or it is involved in some other way. Clearly, low testosterone is more than simply a factor in declining strength and sexual performance.
Testosterone is essential for male development, libido and erectile function. Because of the success of medications such as Viagra in treating erectile dysfunction, low testosterone is often overlooked. However, low testosterone is a common cause of poor or declining response from ED medications and should always be considered when evaluating ED. Testosterone replacement may be all that’s required to restore sexual function.
The good news is managing low testosterone is easier and simpler than ever before. Just a decade ago, almost all testosterone replacement was by a painful, deep-muscle injection with oil-based testosterone administered ever two weeks. Levels were difficult to manage and had dramatic swings with levels too high for the week immediately following the injection and too low for the week prior to the injection.
Today, testosterone is applied via a cream or gel that is applied to the skin daily. These preparations provide even absorption and steady testosterone levels. Small implants that release a steady, consistent level of testosterone in the bloodstream for eight to 10 months are also available.
Managing testosterone levels requires a thorough knowledge of treatment risks and benefits. Men with an enlarged prostate may be at greater risk for obstruction of the urine flow. Additionally, testosterone treatment should be considered only if prostate cancer is not present, or has been successfully treated. Baseline levels should be checked in the early morning as levels normally decline in late afternoon or evening.
A thorough physical examination and additional blood tests are also important to evaluate low testosterone levels. Urologists specialize in evaluating and treating low testosterone, prostate disease, voiding, erection and testicular health, all of which can be influenced by testosterone levels.
Identifying low testosterone is as simple as a blood test, and modern management is as simple as a daily application of a skin cream. Every man should know his testosterone level. Normal testosterone levels can be an important aspect of maximizing longevity and maintaining quality of life.
Advanced Urology Center