Testosterone deficiency has been called the male menopause, which is not hugely helpful. On one hand, like the menopause, it happens because of declining levels of the primary sex hormone with age. On the other hand, every woman experiences menopause, but only a minority of men experience testosterone deficiency. Many of the symptoms also mirror what you might expect from getting older – lethargy, loss of strength – making it all the more likely that men put up with it, keep their mouths shut and resign themselves to seemingly irreversible decline.
It doesn’t have to be that way, though. If a GP makes a diagnosis, testosterone replacement can mean a return to a better quality of life and the motivation to make the lifestyle changes that can ward off testosterone deficiency from returning.
That’s the message from Tackle TD, an awareness campaign launched by pharma giant Bayer. To discover more about the issue, how to spot it and how to tackle it, we spoke to Dr Jonny Coxon, a GP and president-elect of the British Society for Sexual Medicine.
How common is testosterone deficiency?
Testosterone deficiency becomes more common with age, but it does become more common with some other factors as well. When you try to get absolute figures it depends on how it’s been studied, and what age cut-offs and definitions are used, but a rough guide is a big European study that said about 2% of men over 40 reached the diagnostic criteria. If you look at men over 50, a big American study said it was about 12%.
How is it diagnosed?
To formally define the diagnosis, it has to be a collection of symptoms that are related to having low testosterone, and in addition, confirming low testosterone with at least two blood tests.
What are the common symptoms?
Things like erectile dysfunction and problems with the libido – the desire for sex – but while they are important, I’m keen to get across the other symptoms that may less readily come to mind but are very real for the men affected. It can affect things like mood and energy levels, so a general fatigue or less zest for life – there are definitely higher rates of depression. It can affect the ability to concentrate, and it can definitely affect muscle mass and therefore strength gradually declines over time. As with the menopause there can be hot flushes. There can be reduced body hair and it can even cause some loss of height if someone’s having osteoporosis – thinning of the bones including in the spine. It’s one of the commonest causes of osteoporosis in men, actually.
I would stress that these are non-specific symptoms and there’ll be plenty of men with symptoms like that who don’t have low testosterone levels. We have to accept some decline with age, but it could be low testosterone contributing to those symptoms and it’s usually worth investigating. I would have been guilty of [not investigating] a few years ago as a GP. You see a guy coming in feeling down with less energy, and we think about things – understandably – like depression and thyroid levels, and we get diverted down a different route. It’s just about thinking about testosterone deficiency and undoubtedly finding it in some men.
Is there value in a patient bringing up the possibility of testosterone deficiency with a GP?
Yes, and it can be good to come armed with a little material. You’ll get different views from GPs about patients coming with material, but honestly, I think it depends on what people come along with. This Tackle TD campaign has a symptom checker on the website and there’s a prompt to print the results out. Use that as a starting point to build a conversation on and say, “These are the symptoms, I read it could be testosterone deficiency, here’s where I read it.” And actually, in terms of saving time for the GP, that can be a good prompt.
Is testosterone deficiency associated with lifestyle factors? And are there steps younger men can take to ward off the possibility of developing it later in life?
It probably won't come as a big surprise: it’s the usual mantra about healthy living. Testosterone deficiency is strongly linked to obesity and diabetes, or what’s commonly called pre-diabetes. Those are the big factors, along with age, but there are a number of other risk factors – some medications are worth thinking about, certainly opiate medications. Codeine, co-codamol and dihydrocodeine are innocent-looking but all these opiates have been linked to reducing testosterone levels.
See related
- How To Increase Your Testosterone Levels
- Erectile Dysfunction: What Every Man Should Know About This Common Condition
- 13 Expert Weight-Loss Tips
What are the risks of not doing anything about testosterone deficiency? Is it just the continuation of the symptoms or can there be more catastrophic consequences?
Both, but I wouldn’t belittle the impact of those symptoms. With the list I’ve given you can see the sort of impact that's going to have on an individual, but it goes beyond that – affecting relationships with their partners, relationships within families. Work performance is often affected, as is an individual’s self-esteem in and out of work, and the ability to do hobbies, sports or things that interest them. It can have a huge impact. But beyond that, there are strong, well-established links for things like cardiovascular heart disease and now there are some ongoing trials on whether improving the testosterone can reduce heart disease risk.
How is testosterone deficiency treated? And how effective can you expect treatment to be?
We’ve already touched on the lifestyle factors that can cause it and of course working on them – trying to lose weight and improve diabetes control – can make a big difference. It’s quite hard to start the snowball going down the hill to gather momentum for losing weight. When you’ve got reduced motivation because of testosterone deficiency, it can be even harder, but it has been done by really determined people.
Equally, a lot of people have found lifestyle changes easier to do by taking testosterone replacement. We’re familiar with hormone replacement therapy (HRT) for female menopause, and that’s all we’re looking to do in this situation – replace the hormone up to a normal, healthy young man’s levels.
We would almost always offer either a gel, which has to be applied every day to the skin, or one of two types of injection: a short-acting one every three or four weeks or a longer-acting one, roughly every three months. I never tell an individual which type to have. I go through the advantages and disadvantages of both, and it comes down to preference – what suits an individual’s lifestyle better.
Once those treatments are done, I see guys who are hugely grateful for the benefits they feel. That’s anecdotal, but it’s absolutely backed up with good randomised controlled studies. All the symptoms I talked about improve.
