Low libido is one of many symptoms of male hypogonadism (HG), a condition in which the body doesn’t produce enough of the sex hormone testosterone. As many as 5 million men in the United States may have such a problem. Testosterone works to stimulate the formation of male sex organs and continues to play an important role through puberty and adulthood by triggering male characteristics and maintaining sex drive. As men age, the development of HG or decreased testosterone is more likely to cause temporary problems that may improve with treatment such as testosterone replacement therapy.
In adult males, HG may alter certain masculine physical characteristics and impair normal reproductive function. Signs and symptoms may include:
• Erectile dysfunction
• Infertility
• Increase in body fat
• Decrease in beard/body hair growth
• Decrease in size/firmness of testicles
• Decrease in muscle mass
• Development of breast tissue
• Loss of bone mass (osteoporosis)
HG can also cause mental and emotional changes. As testosterone decreases, some men may experience symptoms similar to those of menopause in women. These may include:
• Fatigue
• Decreased sex drive
• Difficulty concentrating
• Hot flashes
• Irritability
• Depression
In order to properly diagnose HG, your doctor will test your blood for its testosterone level. Early diagnosis and treatment offers better protection against osteoporosis and other related conditions. Because testosterone levels vary and are generally highest in the morning, blood testing is usually done early in the day. If tests confirm low testosterone, further testing may be needed to determine if a testicular disorder or a pituitary abnormality is the cause.
Testosterone testing also plays an important role in managing HG. For HG caused by testicular failure, doctors use testosterone replacement therapy (TRT). TRT can restore sexual function and muscle strength and prevent bone loss. In addition, men receiving TRT often experience an increase in energy, sex drive and sense of well-being. Several delivery methods exist for TRT. Choosing a specific therapy will depend on personal preference, side effects and cost. TRT can be taken by injection, gel, gum and cheek insert, and orally.
Lifestyle choices are important when managing HG. Prevent osteoporosis by exercising regularly and getting adequate amounts of calcium and vitamin D to maintain bone strength. The Recommended Dietary Allowance (RDA) for calcium is 1,000 milligrams (mg) for men younger than 65 and 1,500 mg a day for men older than 65.
Learn about erectile dysfunction as this can cause psychological and relationship problems. Talk with your doctor about how you can reduce the anxiety and stress that often accompany these conditions. Many men benefit from psychological or family counseling. Support groups can help people with HG and related conditions cope with similar situations and challenges. Most men feel invigorated and full of life effectively treated for HG. TRT reduces fatigue and increases sexual interest.
Special conditions exist for men who have HG and prostate cancer. TRT in men who have undergone treatment for prostate cancer is a hotly debated topic and deeply contentious issue among experts. Patients should seek counsel from their urologist for the latest guidelines and recommendations for their individual situation.
Article contributed by Nikhil L. Shah, DO, MPH, urologist at Saint Joseph’s and President of the Men’s Health and Wellness Center at Saint Joseph’s.
