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

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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.

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.

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.

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.