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Paging Dr. Frischer - Low Testosterone
WRITTEN BY :   Dr. Alan Frischer

The condition that we will explore today often remains undiagnosed. The Food and Drug Administration estimates that up to five million American men have it, and only five percent of them receive treatment. The symptoms are subtle and may be mistaken for other conditions. If you are guessing low testosterone, then you are correct.
Symptoms of low testosterone include fatigue, depression, weakness, loss of sexual desire (libido), difficulty with erections, loss of endurance, loss of muscle mass, increased body fat, and slowed growth of facial and body hair. This condition is worse when it affects young boys or teenagers. For them, lack of testosterone may also result in a failure to go through normal puberty, infertility, and osteoporosis.
Testosterone is made in the testes, which produce sperm as well. The process is controlled by the pituitary gland. The cause of low testosterone levels lies either with the testes or the pituitary gland. When the problem is with the testes, it can be the result of damage from injury, undescended testes from birth, mumps, infection, medications (including chemotherapy), or an inherited genetic abnormality (Klinefelter’s syndrome).
The other source of this condition lies within the brain’s pituitary gland. The cause is often unknown, but possibilities include a tumor, high iron levels, inflammatory diseases such as sarcoidosis, infections such as tuberculosis and HIV/AIDS, and medications like opioids and hormones. Finally, obesity and simply getting older can lower testosterone levels.
Fortunately, a simple lab test can detect low testosterone levels. However, the test needs to be specifically ordered, and due to the vagueness of the symptoms, it’s not always among the first things that your doctor will think of. Also, testosterone levels change from day to day, and throughout the day, especially in younger men. They are highest in the morning, and are ideally measured between 8 and 10am. Low blood protein levels also can cause low testosterone levels.
Once the diagnosis is made, the next step is to understand why. Further lab tests can help narrow the cause to either the testes or the pituitary gland. A brain MRI may be required to examine the pituitary gland.
Treatment for low testosterone has expanded greatly in recent years. Assuming that the underlying problem cannot be fixed, which is usually the case, replacement therapy is started. Testosterone replacement therapy includes injections, patches, gel, or a tablet that sticks to the inside of the mouth. The oldest and cheapest treatment is the injection, but it has largely been replaced by a variety of gels that rub onto various parts of the body, including the arms, chest, and armpits.
Diagnosing and treating low testosterone levels may have even greater significance. One 18-year study funded by the National Institute on Aging and the American Heart Association showed that men, aged 50 to 91, with low testosterone levels, had a 33% greater risk of death.
Treatment is generally safe and well tolerated. However, prostate cancer is common among men as they age, and it is felt that although testosterone treatment does not cause the cancer, it can stimulate its growth. Therefore, proper screening for prostate cancer is a must before starting treatment. Treatment can also cause elevations in the red blood cell count, breast tenderness, worsening of sleep apnea, and possibly more problems with urinary flow due to prostate growth.
If you are a man in your 40′s or older, and start to notice some of these symptoms of low testosterone, you will want to see your doctor and request a testosterone blood test. At the very least, correcting low testosterone levels will increase the quality of your life!
Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

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Published: November 22, 2012 – Volume 11 – Issue 32



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