Testosterone Deficiency

How do I know I have testosterone deficiency?

Testosterone deficiency can manifest in many ways.  These include low libido and erectile dysfunction but often it has psychological impacts like low mood, difficulty concentrating and fatigue.  Testosterone deficiency can also occur in women and is discussed later.

What causes testosterone deficiency?

The common causes of testosterone deficiency in men are divided into primary and secondary.  Primary means that the testes are not producing testosterone whereas secondary means the pituitary in the brain is not producing the hormone, LH or Leutinizing Hormone, which is needed to stimulate the testes to produce testosterone.   

There are many causes of primary testosterone deficiency.  These are divided into congenital or genetic causes like Klinefelter Syndrome or acquired causes like damage to the testis from infection like mumps, testicular torsion or trauma.  

Secondary causes can also be congenital or genetic like Kallman syndrome whilst acquired secondary causes of testosterone deficiency include damage to the pituitary.  This can be from infiltrative diseases like Sarcoidosis, immune reactions like Hypophysitis or medications used to treat other conditions like steroids, opioids and past steroid abuse.  

Not everyone falls neatly into categories outlined above and there can often be a mixed picture.  We will help you determine if this is the case and to see whether the cause is correctable and if not, discuss management options which include weighing the risks of testosterone replacement therapy versus the benefit.

What options for testosterone replacement are there for treating testosterone deficiency?

In terms of testosterone replacement therapy, there are several options available from topical to intramuscular injections.  Each option has its relative merits and tailoring the treatment that works best for you as well as monitoring for complications is vital as these complications can be severe like thromboembolic disease, dyslipidaemia, liver and renal dysfunction and prostate hypertrophy.

Women can also suffer from testosterone deficiency and this is present particularly after menopause when the ovaries no longer produce oestrogen.  The result is loss of libido and what is known medically as hypoactive Sexual Desire Disorder (HSDD) which can be an issue especially if it affects one’s self esteem or if there is a mismatch in libido with one’s partner affecting intimacy.  

After assessment to rule out secondary causes as well as an evaluation of risk versus benefit, topical androgens can be used in women to improve the symptoms but as with all hormone therapies, careful monitoring is needed to avoid side effects.