Maintaining testosterone levels may prevent obesity, loss of muscle mass, depression and lethargy. Photo: Filepic
Low testosterone levels have many consequences, including erectile dysfunction.
Testosterone is a hormone produced in the body. In men, it comes mainly from the testes, but small amounts are also produced by the adrenal glands located just above the kidneys. Levels in men peak during teen and early adult years, but start declining at the rate of about one per cent per year after the age of 30.
When testosterone levels in the body dip to a low level, the body experiences changes like obesity (increased waist circumference), muscle mass loss, lethargy, mood disturbance, irritability, depression, loss of concentration and what men fear most – erectile dysfunction. This is known as Testosterone Deficiency Syndrome or hypogonadism. There is no accurate cut-off point, but the consensus is that this usually occurs when testosterone levels in the body drops below 12 nmol/L.
When men experience these problems and there are documented low testosterone levels, the body would need replacement in the form of synthetic testosterone in the form of capsules taken orally, injections, gels applied to the body or a body spray. Studies show that in men who have low levels of testosterone, when a replacement is given, the quality of life and mood is improved.
There is increased muscle mass and alteration of fat distribution with testosterone therapy. Waist circumference is decreased and obesity reduced. The improvement in weight reduction and maintenance is better when testosterone is added compared to just lifestyle changes such as exercise and diet.
Those who experience erectile dysfunction and have low levels of testosterone normally would not respond optimally with medications such as tadalafil, vardenafil or sildenafil. They would need testosterone replacement to achieve normal levels before these medications can do their job. Studies show that testosterone supplementation can correct high cholesterol levels, obesity, high blood pressure and diabetes mellitus, and improve the overall well-being of men.
Other studies show the benefits of normalising testosterone levels on the heart. It improves myocardial ischaemia and stabilises the heart. It has been demonstrated that low testosterone levels in the body are predictors of increased mortality in men with heart failure. Testosterone replacement is also associated with decreased risk of death and has been shown to be able to reduce mortality by about 50% in men with low testosterone.
Known side effects of testosterone replacement include acne/oily skin, mild fluid retention, stimulation of prostate tissue, with perhaps some increased urination symptoms such as a decreased stream or frequency, breast enlargement, worsening of sleep apnoea (a sleep disorder that results in frequent night time awakenings and daytime sleepiness), decreased testicular size, increase in red blood count and decreased sperm count. It does not however cause prostate cancer.
Lately, the medical world was alarmed by two controversial studies stating that testosterone replacement therapy increases heart attack and stroke risks. Analysis showed they were fraught with discrepancies. The International Society of Sexual Medicine has issued a statement against these studies. Twenty-five medical societies have joined the Androgen Study Group to petition the journal to retract the misleading testosterone study.
Men diagnosed with testosterone deficiency should consider treatment with testosterone therapy after full discussion with their healthcare provider. This provides significant benefits for men with sexual symptoms, and also for a variety of non-sexual symptoms.
Like all medical treatments, testosterone therapy is associated with risks and should be discussed with one’s healthcare provider. Caution should exercised by those with sleep apnoea, congestive heart failure, symptoms consistent with lower urinary tract obstruction, and personal or family history of prostate or breast cancer.
This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mailstarhealth@thestar.com.my. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.
