Testosterone and Hypogonadism
Testosterone is a male sex hormone, which is produced in the testicles (or testes). Testosterone is what helps develop a male’s features during puberty, such as body and facial hair, as well as body and muscle mass. Besides that, testosterone has an important role in both sperm production and sex drive or libido. While it is a crucial component for males, testosterone is also important for women, though in smaller amounts. In women, testosterone is produced in the ovaries and helps with maintaining ovarian functions and bone strength, among other things.
The hypothalamus and pituitary gland are responsible for regulating testosterone levels in the body. They are both located at the base of the brain. They send signals to the gonads (the testicles, or the ovaries in women) to produce testosterone, or to reduce production if testosterone levels are too high.
Testosterone levels naturally decrease as a person ages. Once they pass the age of 40, most men see an annual decline of 1.6 per cent in testosterone levels. However, there are cases where a young, healthy male might have a testosterone deficiency – some figures suggest that 2 men in every 100 might have a low testosterone count. Having low testosterone is known as hypogonadism. Hypogonadism occurs when the testicles do not produce enough testosterone needed by the body. Symptoms of hypogonadism may include low sex drive, erectile dysfunction, or abnormal developmental changes during puberty.
Types of Hypogonadism
There are two main types of hypogonadism, each of which is a dysfunction in how testosterone is produced.
The first type is primary hypogonadism. In this case, the testicles are not responding to hormone stimulation, which can either slow down or stop testosterone production entirely.
The second one is secondary, or central, hypogonadism. There is a dysfunction that affects either the hypothalamus or the pituitary gland, which causes difficulty in properly regulating hormone stimulation.
There is also andropause, although this decrease in testosterone happens as a person ages normally. Testosterone levels usually increase until a male reaches the age of 17, before it begins to decline after the age of 40.
Causes and Risk Factors of Hypogonadism
Generally, hypogonadism can be something inherited from family members or acquired at a later point in time due to injury or infection. The common causes of each type of hypogonadism may also differ. For instance, primary hypogonadism can occur in those who have had to receive radiotherapy treatments for cancer. Strong doses of radiation can interfere with bodily processes by killing off healthy cells, and that means testosterone (and sperm) production will be adversely affected over time.
For primary hypogonadism, some causes also include:
- Autoimmune disorders, such as Addison’s disease
- Congenital/genetic disorders, such as Klinefelter syndrome (abnormality of the sex chromosomes)
- Hemochromatosis (or iron overload, where there is too much iron in the bloodstream)
- Undescended testicles
- Infections or injuries that affect the testicles
- Surgery on the reproductive organs
For secondary hypogonadism, on the other hand, risk factors may include:
- Brain surgery
- Systemic illnesses (affecting the entire body)
- Severe inflammation
- Certain genetic disorders
- Heavy use of steroids or opioids
If you or your loved one has been diagnosed with hypogonadism, there are a few ways that hypogonadism can be treated. Some conditions that cause hypogonadism, such as obesity, require specific medical treatments that treat the root cause of hypogonadism. If testosterone levels are very low, or if there are symptoms detected which are associated with a testosterone deficiency, testosterone replacement therapy (or TRT) can be considered.
TRT is the recommended treatment method to address hypogonadism. The therapy will raise a person’s testosterone to normal levels. This will help reverse the effects of hypogonadism, such as decreased sexual desire, decreased energy, decreased facial and body hair, and loss of muscle mass and bone density. While you receive TRT, your doctor (or the monitoring medical team) will keep close track of the efficacy of the treatment, and whether there are any side effects caused by TRT.
TRT has a number of options to increase you or your loved one’s testosterone levels.
- Oral supplements: while there are oral supplements available, medical evidence has found that these are liable to cause significant harm to the liver. They are also unable to steadily maintain testosterone levels in a person. Always consult your doctor on the possible side effects that might come up if you or your loved one are prescribed an oral supplement.
- Topical gels/solutions: external use gels and solutions can be applied to the skin. Depending on the brand, it may need to be applied to specific parts of the body; the doctor will instruct you on this. The body then absorbs testosterone through the skin. Once applied, you or your loved one may be asked to not take a bath for some time to allow full absorption.
- Patches: a patch containing testosterone can be applied to a specific part of the body, which then slowly transfers the testosterone into the body. Side effects may include severe skin reactions.
- Injections: these are given in a muscle, under the skin, or as a deep intramuscular jab. The doctor or nurse will help inject these, or they can teach you or your loved one how to do it at home. For delayed puberty in boys, treatment may be given as part of a three to six-month period of testosterone supplementation injections.
Treatment of Secondary Hypogonadism
In cases where a pituitary gland dysfunction may be causing secondary hypogonadism, treatment methods include pituitary hormones that are given to stimulate sperm production and restore fertility; or surgery on the pituitary gland. Surgery is only done if there is a pituitary tumour found, but alternatives may include taking medications to shrink the size of the tumour, radiotherapy, or specific hormone replacement therapy.
Be sure to speak to the doctor at length about the options available, and their associated benefits and risks, before agreeing to any treatments.
Risks of TRT
While TRT has helped benefit many men in restoring their testosterone levels, there are a number of risks that are associated with TRT.
For one, the benefits of TRT for older men are rather suspect. Some studies indicate that older men receiving TRT are at a much higher risk of developing cardiovascular problems, such as heart attacks.
Other risks may also include:
- Worsening benign prostatic hypertrophy (BPH), or even prostate cancer
- Worsening sleep apnea
- Acne or other skin reactions
- Adversely affect sperm production
- Higher risk of developing a blood clot
- Increased risk of heart disease
In fact, the Endocrine Society cautions people from receiving TRT if they may have prostate or breast cancer; high red blood cell counts; have had a heart attack or stroke in the last 6 months, or are planning to have children. Note that this is not an exhaustive list.
The benefits of TRT are highly individualised and differ from person to person. You and your loved one may hear varying accounts of how TRT has helped others. There are also instances where people receive TRT even though they have normal testosterone levels. There is little evidence to support that TRT for those with normal testosterone levels helps to improve strength, athletic performance, physical appearance, or even treat or prevent problems associated with ageing. Take all this into consideration before agreeing to TRT.
Living with Hypogonadism
If you are worried that you or your loved one might have hypogonadism, be sure to get proper medical advice before purchasing any medications to treat it. The doctor will need to conduct two tests to accurately assess testosterone levels before making a diagnosis. If need be, seek out a second opinion.
The outlook of having hypogonadism is good if you or your loved one continue to receive treatment over time. The doctor(s) will constantly monitor your hormone levels and will provide advice on whether to continue treatment, change treatment methods, or address any concerns you or your loved one may have over time.
Medical practitioners also advocate the practice of a healthy and well-balanced lifestyle to help mitigate hypogonadism symptoms. Physical activity helps keep you or your loved one fit, while a healthy diet can meet nutritional requirements needed for the body and manage complications like obesity or diabetes. Losing weight can also help with keeping hormonal levels at optimal levels.
Other beneficial lifestyle changes include quitting smoking, stopping the use of opioids, and reducing (or stopping) alcohol consumption.
It is also important to prioritise your mental health during this time. Having hypogonadism can affect one’s mood, and can even make a person feel ashamed or isolated for having the condition. Having open communication channels with loved ones or trusted friends can allow you or your loved one to talk things through and share your frustrations. Joining a support group can also help by getting to know others who are going through the same thing and bonding with one another through shared experiences and new information on how to cope with hypogonadism.
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