Doc Talk: Men don’t have to resign themselves to low testosterone

10/15/2013 12:00 AM

08/08/2014 10:19 AM

In the early 1900s, Kansas was home to one of the most financially successful doctors in American history – John Brinkley who practiced in Milford. He became famous – or infamous to some – for procedures which involved the transfer of tissue from one species to another; specifically, transplanting goat testicles into humans as a treatment of sexual dysfunction. Brinkley was scrutinized and eventually exposed as a charlatan and stripped of his license to practice medicine; however, his work was partially responsible for inspiring serious investigators to discover testosterone.

In the mid-1930s, researchers Adolf Butenandt and Leopold Ruzicka were awarded the Nobel Prize for successfully isolating the primary testicular hormone, testosterone. Today medical professionals can effectively help men maintain their testosterone level and enjoy a better quality of life.

Low testosterone

Hypogonadism is the medical term for low testosterone. Late-onset hypogonadism (LOH) typically affects men of middle age or the elderly, however much younger men can also experience low testosterone. A whole spectrum of health-related issues can occur with low testosterone depending on what age of male it effects.

Symptoms of LOH

Low testosterone levels can affect a number of organ systems, so symptoms can vary greatly. Sexual health is the most noticeable. Decreased sexual libido and problems with erectile dysfunction are the hallmark symptoms of LOH. But what many men may not know is that LOH can present itself with mood changes, lack of motivation or being easily fatigued, sleep disturbances, and loss of muscle or bone mass. Treatment of LOH can help restore some or all of these problems.

Diagnosing LOH

Some have tried to strictly use blood test values, but that is not consistent. A low blood level of testosterone for one man may be more than adequate for another. Strictly following medical questionnaires to define LOH is also unreliable. Currently, we use a combination of lab values, questionnaires, and a physical exam to establish a diagnosis of LOH.


Treatment options include:

• Behavioral changes. Testosterone is converted to Estrogen (predominate female hormone) in the outer fat cells. So in obese men, the foundation of successful treatment of LOH is weight loss. Heavy alcohol abusers often suffer from LOH. Their first step in treatment is getting help decreasing alcohol consumption.
• Intramuscular injections. Replacing testosterone through intramuscular injections is safe and generally well tolerated. The downside is a less consistent level of testosterone with symptoms often recurring prior to the next scheduled injection.
• Topical replacement. This option is very popular. Transdermal patches and gels can produce safe blood levels of testosterone with the main side effect being skin irritation.

Oral forms of testosterone replacement have led to very erratic blood levels and significant risks of liver damage. Although drug companies continue to work on safer oral therapies, currently they are not part of our regular practice.

In addition to treating the symptoms discussed above, increasing testosterone levels also helps improve bone density, reduce fat mass, improve cholesterol levels and, according to some studies, may decrease cardiovascular risk.

On the downside, there is a risk of polycythemia (too many red blood cells) and a potential for increased prostate problems. Physicians recommend routine monitoring of liver function, blood counts and PSA (prostate blood test) while on testosterone therapy.

As you begin to seek treatment for sexual difficulties, be skeptical of anything that sounds too good to be true. People may not be trying to fool you with goat testicle transplantation, but that doesn’t mean that medical quackery isn’t alive and well. Television and radio are constantly airing new ads for the latest gizmo that promises weight loss or the latest blend of vitamins and supplements to cure all your ailments. Be wary of any new treatments that do not come with the approval of the Food and Drug Administration.

Low testosterone is a medical condition that can negatively affect multiple organ systems. If you think you may be experiencing any of the symptoms of hypogonadism mentioned above, see your doctor to discuss whether or not you may benefit from any of these safe, effective treatments.

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