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Testosterone Replacement


What is Andropause or Low Testosterone?

Testosterone is the hormone responsible for muscle mass, facial and body hair patterns and the deep voice found in males. As men age, the level of testosterone in the body and production of sperm gradually lowers and they experience physical and psychological changes as a result. This is part of the natural aging process and it is estimated that testosterone decreases about 10% every decade after men reach the age of 30.

Andropause is a condition that is associated with the decrease in the male hormone testosterone. It is unlike menopause in that the decrease in testosterone and the development of symptoms is more gradual than what occurs in women. Approximately 30% of men in their 50’s will experience symptoms caused by low testosterone levels. A person experiencing low testosterone may have a number of symptoms related to the condition and could be at risk of other serious health conditions such as osteoporosis without proper treatment.


What are the causes?

The decrease in testosterone is an important factor in men suspected of having andropause. However, as men age, not only does the body start making less testosterone, but also the levels of another hormone called sex hormone binding globulin (SHBG), which pulls usable testosterone from the blood, begins to increase. SHBG binds some of the available testosterone circulating in the blood. The testosterone that is not bound to the SHBG hormone is called bioavailable testosterone, meaning it is available for use by the body.

Men who experience symptoms associated with andropause have lowered amounts of bioavailable testosterone in their blood. Therefore, tissues in the body that are stimulated by testosterone receive a lower amount of it, which may cause various physical and possibly mental changes in a person such as mood swings or fatigue.


What are the symptoms?

Although symptoms may vary from person to person, common symptoms of men going through andropause include:

  • Low sex drive
  • Difficulties getting erections or erections that are not as strong as usual
  • Lack of energy
  • Depression
  • Irritability and mood swings
  • Loss of strength or muscle mass
  • Increased body fat
  • Hot flashes

Complications associated with andropause include an increased risk of cardiovascular problems and osteoporosis (brittle bones).


How can andropause be diagnosed?

Dr. Schmidt will ask a series of questions about your health and history to see if your symptoms match those of people with low testosterone. Because there are other conditions that are associated with low testosterone levels (diabetes, high blood pressure, etc.), Dr. Schmidt will order lab work to exclude these possibilities before making a diagnosis of andropause. He will also check a PSA (a screening test for prostate cancer) and a hematocrit (a measurement of red blood cells in your body). A PSA is checked to make sure that the patient does not have prostate cancer and a hematocrit is tested because men receiving testosterone may experience an increase in their red blood cell count.

It is important to note that many of the symptoms associated with andropause are also a normal part of aging, and they may not be reversible with treatment.


Treating and Preventing Andropause

Replacing testosterone in the blood is the most common treatment for men going through andropause. This treatment may provide relief from the symptoms and help improve the quality of life in many cases. Lifestyle changes such as increased exercise, stress reduction, and good nutrition also help. Your doctor will help you decide if testosterone treatment is right for you, as treatment does have risks.

Testosterone is available in a variety of different forms. Core Medical Group finds the gel and injections the most effective options. Follow-up visits with your doctor will be important after the initial treatment begins. At follow-up visits, Dr. Schmidt will check your response to the treatment and make adjustments if necessary.

Testosterone gel: This treatment is applied directly to the skin, usually on the arms. Because the gel may transfer to other individuals through skin contact, a person must take care to wash the gel from the hands after each application.

Testosterone injections: This treatment involves injections of testosterone (testosterone cypionate* and testosterone enanthate) in the muscle every 2 to 4 weeks. They may cause mood swings due to changes in testosterone levels. Men with severe heart disease, severe kidney disease, or too much calcium in their blood should avoid testosterone cypionate. Men with severe kidney disease should not take testosterone enanthate.

Testosterone should not be taken by any man with prostate or breast cancer. If you have heart disease, are taking some medications such as blood thinners, have an enlarged prostate, or have kidney or liver disease, you will need to discuss with your doctor whether or not testosterone therapy is right for you.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.


Read studies on Low Testosterone and Therapy:

Testosterone Replacement in Men with Andropause: An Overview.

Testosterone replacement therapy patterns for aging males in a managed care setting – Abstract.


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