Testosterone deficiency (hypogonadism) in aging men

What is it about ?

Hypogonadism is a condition in which the testes produce too little male sex hormone (testosterone). As they age, men produce less testosterone. This phenomenon can be considered as male menopause and is also known as andropause or late hypogonadism.

In some cases, this andropause is accompanied by such symptoms that treatment should be considered. It is not always clear what the symptoms are due to.

Possible causes of symptoms

• a lack of testosterone, the male hormone;
• a decrease in the amount of growth hormone and a relative preponderance of estrogen, the female hormone;
• poor function of the pituitary gland (epiphysis) in the brain so that the testes do not receive the signal to produce testosterone (in rare cases);
• obesity;
• the use of muscle building hormones (anabolic steroids).

What is its frequency?

The production of testosterone decreases in all older men. In some, this decrease is rather slow and proceeds without symptoms; in others, it is rapid and is accompanied by troublesome symptoms.

How to recognize it?

The main symptoms are:

• decreased sexual desire (libido);
• erection problems;
• decreased muscle strength.

Some men have symptoms that resemble menopause in women:

• hot flashes;
• sweats;
• mood swings ;
• irritability;
• tired ;
• depressive feelings;
• sleeping troubles ;
• bone decalcification (osteoporosis).

Sometimes memory problems are also present. Some typically masculine characteristics may also be less marked:

• decrease or disappearance of hair on the body;
• loss of muscle mass;
• decrease in the size of the testicles.

How is the diagnosis made?

• The doctor usually recognizes the condition on the basis of the symptoms.
• To confirm the diagnosis and rule out other causes, hormones (for example, testosterone and luteinizing hormone (LH)) are measured in the blood.
• If the doctor wants to start treatment, he will also do a blood test and a digital rectal examination to feel the prostate.

What can you do ?

Contact the doctor if you have any symptoms that could suggest hypogonadism.

What can your doctor do?

Testosterone treatment

Treatment consists of testosterone in the form of gel, tablets or injections. The gel is the preferred form because it is the easiest to apply and does not cause long-term effects after stopping treatment.

Side effects

Treatment with testosterone can have serious side effects. It can cause liver function problems and thicken the blood.

There is some evidence that testosterone can trigger prostate cancer and make (rare) breast tumors worse. Therefore, the doctor may be reluctant to administer the hormone. You cannot be given testosterone in the following cases:

• benign hyperplasia (swelling) of the prostate with significant symptoms;
• high fat content in the blood;
• suspected breast or prostate tumor;
• cardiovascular illnesses ;
• thicker blood;
• liver function disturbances.

If the doctor decides to start treatment with testosterone, he will clearly define with you a schedule of regular check-ups.

Sources

Foreign clinical practice guide ‘Male hypogonadism and hormonal substitution’ (2000), updated on 08/09/2019 and adapted to the Belgian context on 06/24/2019 – ebpnet