Causes of Testosterone Deficiency
Male hypogonadism is the medical phrase used to describe men with severe testosterone deficiency. The degree of severity of the condition can vary from individual to individual, but there is universal similarity of symptoms in testosterone deficient males - these include fatigue, lethargy, mood changes, ill temper, sexual dysfunction, poor erectile function, loss of sexual interest, diminished muscle strength, osteoporosis and anemia.
Male hypogonadism is most frequently due to primary testicular disease e.g. Klinefelter's syndrome, but may result from malfunctioning of the pituitary gland or hypothalamus in the brain.
Male hypogonadism is estimated to have a prevalence of 5 per 1000 men making it one of the commonest forms of hormonal deficiencies in men.
Physiological androgen replacement aims to restore circulating testosterone concentration to normal in men with hypogonadism. The use of testosterone in the management in ageing men without specific causes of hypogonadism, commonly referred to as ADAM (the Androgen Deficient Aging Male), is one of the most rapidly expanding area of medical practice.
Common causes for reduced testosterone production that results in a deficiency state include:
Testicular Disorders
- Klinefelter's syndrome
- Cryptorchidism and defects of testis development (Twisted or strangulated testes)
- Orchitis (Inflammation of the testes resulting in permanent damage)
- Orchidectomy (surgical removal of the testes)
- Toxin exposure (radiation, chemotherapy or radiotherapy, domestic, industrial or environmental poisons)
Brain Disorders (Hypothalamic-Pituitary Dysregulation)
- Kallmann's syndrome (a genetic disorder)
- Other genetic causes
- Pituitary gland tumour and treatment (surgery and/or irradiation)
- Haemochromatosis (Blood iron disorder)
- Craniopharyngioma (benign tumour of the brain)
External Factors
- Acute critical illness, burns, major trauma or surgery
- Drug use (e.g., opiates, glucocorticoids, anabolic steroids)
- Chronic disease and its treatment
- Alcohol abuse
- Smoking
- Ageing
Regardless of the underlying cause of the testosterone deficiency the treatment is universally testosterone supplementation.
Testosterone replacement therapy (TRT) aims to restore circulating testosterone concentration to normal in men with all degrees of hypogonadism.
TRT is highly effective in restoration of blood testosterone levels to the normal ranges and safely and effectively resolves all symptoms associated with testosterone deficiency.
The use of testosterone in the management in ageing men who exhibit symptoms associated with lowered testosterone levels, commonly referred to as the ADAM (Androgen Deficient Ageing Male) or late-onset hypogonadal male, is one of the most rapidly expanding areas of medical practice.
It is the ADAM male that is the largest under diagnosed group of all testosterone deficient individuals. Symptoms are often non-specific, can be confounded by pre-existing medical conditions (obesity, chronic illness) and include lethargy, sleep disturbances, loss of libido, irritability, anxiety, reduced concentration and depressed mood.
