Testosterone Deficiency- Symptoms, Causes, Diagnosis, and Treatment

Introduction

Testosterone deficiency, also known as male hypogonadism, is a condition where the testicles produce reduced testosterone. This condition may be caused by injury to the testicles, pituitary gland, or hypothalamus. A major issue of this condition is erectile dysfunction in males. Low testosterone levels can be treated with testosterone replacement therapy.

What Is Known as Low Testosterone?

Male hypogonadism is a condition where the testicles do not produce enough of the male sex hormone called testosterone. Testicles are the male sex organs known as gonads, which contain Leydig cells responsible for testosterone production. Testosterone is a male hormone that females also produce in small amounts. Low levels of testosterone result in different symptoms at different ages.

What Is the Function of Testosterone?

Testosterone is an important androgen, which triggers the development of male sex characteristics and is important for spermatogenesis (sperm production). Testosterone plays an important role in males and also helps in the development of:

• Sex organs and genitalia.

• Muscle mass.

• An adequate level of red blood cells.

• Bone density.

• Sense of well-being.

• Sexual and reproductive functions.

The body regulates the level of testosterone in the blood. The testosterone level is high in the morning and declines through the day. The hypothalamus and the pituitary gland usually regulate the release of testosterone by the testicles. The hypothalamus produces gonadotropin-releasing hormone (GnRH), which stimulates the pituitary gland to release luteinizing hormone (LH), which moves to the gonads and stimulates the production of testosterone. The pituitary gland also releases follicle-stimulating hormone (FSH), which triggers sperm production.

Who Are More Affected by Testosterone Deficiency?

Testosterone deficiency is a medical condition that may affect people from birth through adulthood. It usually affects people who:

1. Elderly people.

2. Have obesity.

3. Poorly managed type 2 diabetes.

4. Show obstructive sleep apnea.

5. With chronic conditions like kidney dysfunction and liver cirrhosis.

6. Have HIV/AIDs.

What Are the Signs and Symptoms of Male Gonadotropins?

The symptoms of low testosterone can differ, particularly by age. Some common symptoms are:

1. Decreased sex drive.

2. Erectile dysfunction.

3. Reduced armpit and pubic hair.

4. Shrinking testicles.

5. Hot flashes.

6. Low or nil sperm count causes male infertility.

Other Symptoms Are:

1. Depressed mood.

2. Difficulty in concentration and memory.

3. High body fat.

4. Gynecomastia (enlarged male breast).

5. Reduced muscle strength and mass.

6. Reduced endurance.

What Are the Symptoms of Low Testosterone in Children?

1. Slow growth in height, whereas the arms and legs grow out of proportion with the body.

2. Reduced pubic hair.

3. Decreased development of penis and testicles.

4. Reduced voice deepening.

5. Lower strength and endurance.

What Are the Types of Male Hypogonadism?

• Primary hypogonadism.

• Secondary hypogonadism

What Are the Causes of Primary Hypogonadism?

Primary hypogonadism is caused when there is some defect in the testicles which do not allow them to produce the required amount of testosterone. Primary hypogonadism is also called hypogonadotropic hypogonadism. In this type of hypogonadism, the pituitary gland synthesis increased LH and FSH in response to reduced testosterone levels. The high levels of these hormones usually trigger increased testosterone and sperm production. However, when a person has defective or no testicles, they can not respond to the increased level of these hormones. This results in reduced or no testosterone production.

What Are the Causes of Secondary Hypogonadism?

Secondary hypogonadism is known as hypogonadotropic hypogonadism. This condition results in lower production of LH and FSH hormones. These may reduce testosterone and sperm production.

Late-onset hypogonadism (LOH) is a form of male hypogonadism which is caused due to aging. As age increases in males, the functioning of the hypothalamus and the pituitary glands reduces, whereas the Leyding cell reduces testosterone and sperm production. It is common in people with type 2 diabetes, overweight or obese.

How Is This Condition Diagnosed?

If a person experiences any signs and symptoms of the condition, the doctor may perform a physical examination. Medical history, intake of any medications, and smoking habits are considered. In addition, a blood test may be recommended.

How Is Low Testosterone Level Treated?

An important method to treat testosterone deficiency is testosterone replacement therapy, which has many forms, such as:

1. Testosterone Skin Gel:

There are many forms of gel and solutions with different application methods. Depending on the brand, the testosterone is applied to the skin in the upper arm, shoulder, front, and inner thigh.

Testosterone will be absorbed through the skin. Some side effects include skin irritation, and there are chances of transferring the gel to another person through skin-to-skin contact.

2. Intramuscular Testosterone Injection:

The doctor administers the injection into the muscle every one to two weeks. Long-lasting testosterone injections can be administered every ten weeks.

3. Testosterone Patches:

These patches can be applied on the skin as directed. However, it should be applied in different regions to avoid a skin reaction.

4. Testosterone Pellets:

Doctors implanted these pellets into the skin every three to six months. These provide long-term doses of testosterone.

5. Buccal Testosterone Tablets:

These sticky pills are placed in the buccal region twice a day, where testosterone is absorbed fast into the blood through the gums.

6. Testosterone Nasal Gel:

This testosterone gel is applied in the nostrils three times daily.

7. Oral Testosterone:

A pill form of testosterone is available for people with reduced testosterone levels caused due to specific medical conditions.

A person with a certain condition can not undergo testosterone replacement therapy. Some conditions are:

1. Prostate cancer.

2. An unknown lump on the prostate.

3. Breast cancer.

4. Heart failure.

5. Untreated obstructive sleep apnea.

What Are the Risk Factors of Testosterone Replacement Therapy?

1. Acne.

2. Enhanced production of red blood cells.

3. Enlarged breast.

4. Sleep disturbance.

5. Prostate enlargement.

6. Reduced sperm production.

What Is the Management of Infertility Due to Hypogonadism?

If infertility is caused due to pituitary gland, then pituitary hormones are provided to trigger sperm production and restore fertility. Any pituitary tumor requires surgical removal, medication, radiation, or replacement of another hormone.

How Can Low Testosterone Be Prevented?

Some lifestyle habits help to maintain normal levels of testosterone, such as:

• Eating a healthy diet.

• Regular exercise.

• Weight management.

• Avoiding excess alcohol and drugs.

When to See a Doctor?

Regular appointments with the doctor are recommended if a person is under hormone replacement therapy. In addition, if a person experiences any symptoms related to low testosterone levels, like reduced sex drive or hot flashes, a consultation with the doctor is advisable.

Conclusion

Low testosterone levels greatly impact a person's life as they result in delayed puberty, reduced sex drive, hot flashes, and stress. This condition may be caused due to injuries or no testicles, where the testosterones are produced. A low level of testosterone is a natural process in older people. This condition is usually treated by testosterone replacement therapy, where testosterone supplements are provided. Low testosterone is treatable when identified at the initial stages.