2023-12-20 17:15:00
Lack of testosterone, what are we talking about?
Lack of testosterone, also known ashypogonadisme or of testosterone deficiency (DF)refers to a condition in which the body does not produce enough male sex hormones (testosterone).
What is testosterone in men? What is his role ?
It is a hormone produced mainly by the testicles in men. It plays an important role in making new red blood cells, increasing muscle mass and strength, sexual health as well as maintaining sperm production and improving bone density.
Testosterone deficiency and andropause, what are the differences with menopause?
“The term “andropause” is used because of its resemblance to menopause but health professionals today agree to use the terminology of testosterone deficiency (DT)”, explains an article from the AFU (French Association urology) (source 1). In humans, the decrease in testosterone levels is gradual (1% per year from the age of 30) and varies depending on the person.
Also note: testosterone deficiency is often a partial phenomenon, while menopause represents the definitive cessation of the production of estrogens and progesterone.
“Why am I lacking testosterone?” Possible causes
Physiological causes
“As we age around 60/70 years, testosterone levels generally decrease. We will talk about hypogonadism,” explains Dr. Jean-Michel Lecerf.
Pathological causes
“Medical problems such as hormonal disorderstrauma to the testicles, chronic diseases (diabetes type), liver diseases, medical treatments such as chemotherapy or even genetic conditions such as Klinefelter syndrome (an anomaly due to the presence of an additional X chromosome),” illustrates the doctor, specialist in endocrinology.
Pituitary tumors (located near the pituitary gland in the brain, also known as the pituitary gland”), HIV/AIDS, but also an unfavorable lifestyle, characterized by excessive stress, lack of sleep, poor diet and a sedentary lifestyle can also contribute to a reduced level of testosterone. Not to mention, taking certain medications including anabolic steroids.
What are the symptoms of testosterone deficiency?
The symptoms of low testosterone (DT) are varied. They can be classified into two categories: sexual and non-sexual symptoms :
“Sexual symptoms: decreased libido, difficulty obtaining or maintaining an erection, loss of nocturnal erections…”, reports the French Association of Urology (source 1). Non-sexual symptoms: “the most common are fatigue , decrease in muscle mass, increase in adipose tissue, irritability, poor memory, hot flashes, decrease in body hair, drop in mood sometimes accompanied by a depressive state.
Testosterone: a clear link with bones
Just as estrogen is important for bone health in women, testosterone is important for bone strength in men, leading to an increased risk of osteoporosis and fractures.
If you have symptoms, who should you consult? What tests to do?
It is the general practitioner who will be the first healthcare professional to consult in the event of symptoms or simple suspicion of testosterone deficiency. “This will then redirect to one or more specialists (endocrinologist, sexologist or urologist) who will take care of this disorder and will be able to determine an appropriate treatment plan,” continues Dr. Lecerf.
How is the medical diagnosis carried out?
If testosterone deficiency is diagnosed or suspected, the healthcare professional will take an anamnesis (questions asked of the patient to understand their medical and family history), as well as a physical examination and laboratory tests.
Physical examination
The doctor examines different points of the patient:
Laboratory tests
Andblood test with total testosterone dosage can, if necessary, be carried out. “However, the results should be taken with caution,” warns urologist, Antoine Faix, in an article from the French Association of Urology (AFU) (source 1). “Laboratory standards are restrictive, and although we retain the threshold of 3.5 ng/ml, a level considered normal is not automatically so for all patients. You should therefore not hesitate to carry out a test treatment in the event of strong suspicion without biological evidence. »
He adds: “The total testosterone dosage does not appear to be the best reflection of testosterone for all patients. Indeed, with age, the globulin binding sex hormones, the Sex Hormone Binding Globulin (SHBG), increases. This glycoprotein binds to sex hormones, particularly testosterone. A larger portion of the testosterone will bind to this protein and therefore actually be inactivated.” Thus, a better hormonal reflection would be obtained by the dosage of bioavailable testosterone or better, free testosterone.
Rappel : before any treatment prescription, the doctor must “in all cases ensure the absence of prostate cancer, by rectal examination and by total PSA (prostate specific antigen) dosage”, insists Dr Lecerf, doctor nutritionist, specialist in endocrinology and metabolic diseases.
How to raise testosterone levels? Treatments available
Capsules to take orally during meals: they are reimbursed by Social Security. However, they do not provide stable concentrations of testosterone and their absorption fluctuates depending on the lipid content of meals.Transcutaneous gel : in daily application, it offers good stability of testosterone concentrations. However, it is not reimbursed by Social Security.”Intramuscular injection once or twice a month: “An injection every 2 to 4 weeks is reimbursed by Social Security,” specifies the AFU website (source 1).
The effectiveness and tolerance of the treatment will generally be assessed between 3 and 6 months after therapeutic initiation. And in addition to the biological dosage of testosterone, a complete clinical reassessment of the patient will be necessary, knowing that certain symptoms may take longer to improve.
What are the side effects of using testosterone?
Potential effects of testosterone therapy may include: skin irritation (acne, redness, etc.), breathing problems during sleep (sleep apnea), liver problems, gynecomastia (benign overgrowth of fat or mammary glands in men), polycythemia (abnormal increase in hemoglobin and the number of red blood cells in the blood), hypertension, worsening of prostate cancer (if present)…
Contraindications linked to replacement hormones?
“A testosterone supplement will essentially not be recommended in patients with prostate cancer,” warns Dr. Lecerf. But also, in cases of serious liver diseases.
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