Hypogonadism (Low Testosterone)
Hypogonadism is defined as low testosterone. Over the past 10 years we have been seeing more and more men with hypogonadism. Low testosterone is not dangerous to your body in terms of causing issues with heart or lungs, but it can cause many symptoms that are disruptive to daily life. The most common symptoms are fatigue, sleeping too much, weight gain, low libido (low interest in sex), and can impact quality of erections.
Testosterone is a hormone found at high levels in men and at much lower levels in women. It is produced mostly in the testicles and production is stimulated by signals from the brain. Most men with low testosterone have issues with testicular production. Rarely it can be a sign of pituitary dysfunction in the brain. At normal levels it gives men energy, the ability to lose weight and build muscle, have interest in sex and can positively impact erections.
Causes:
- Previous use of testosterone
- Pituitary adenoma (growth in the pituitary gland in the brain)
- Major stressors in life- trauma, major surgery, severe illness,
- Poor sleep habits
- Stress
- Sleep apnea
- Testicular trauma, radiation or chemotherapy
- Heavy alcohol or drug use
Symptoms:
- Fatigue
- Sleeping too much and taking naps regularly- and still not feeling rested
- Low interest in sex
- Poor erections
- Weight gain (especially around the belly)
Evaluation and Treatment:
Dr. Shaba will perform a history and physical and order some blood tests to confirm and diagnose. Sometimes imaging is required.
Standard blood tests include:
- CBC
- CMP
- PSA
- Free and total testosterone
- Estradiol
- Prolactin
- FSH
- LH
If prolactin is elevated this may indicate an issue with the pituitary gland and an MRI may be ordered to evaluate. If there is a pituitary abnormality this can generally be permanently fixed with medication or surgery
As long as the prolactin level is normal, treatment can be started. Treatments include:
- Testosterone injections
- Testosterone creams or gels
- Testosterone pellets
- Clomiphene pills
The side effects of treatment can include:
- Elevated hematocrit- thickening of the blood which could predispose to heart attack or stroke
- Liver abnormalities
- Cholesterol elevation
- Prostate growth and prostate cancer growth- does not cause prostate cancer but can make it grow faster
- Lower sperm counts
Dr. Shaba will guide you to choose the option that works best for you.
For more information please visit: https://www.urologyhealth.org/urology-a-z/l/low-testosterone
