Testosterone — What It Does & Doesn’t Do

When you think of testosterone, what comes to mind? Macho men? Aggressive, impatient, type a behavior? Road rage? Violence?  There’s more to testosterone than guys behaving badly.

Testosterone’s Role

ed11Testosterone is the major sex hormone in males and plays a number of important roles, such as:

  • The development of the penis and testes
  • The deepening of the voice during puberty
  • The appearance of facial and pubic hair starting at puberty; later in life, it may play a role in balding
  • Muscle size and strength
  • Bone growth and strength
  • Sex drive (libido)
  • Sperm production

Too Little Testosterone

Despite the notion that too much testosterone is responsible for impulsiveness, violence, rage and stereotypical machismo, too little testosterone is probably a much bigger problem.

Recently, more attention has been paid to the effects of testosterone deficiency, especially among men. In fact, as men age, testosterone levels drop very gradually, about 1% to 2% each year — unlike the relatively rapid drop in estrogen that causes menopause. The testes produces less testosterone, there are fewer signals from the pituitary telling the testes to make testosterone, and a protein (called sex hormone binding globulin (SHBG) increases with age. All of this reduces the active (free) form of testosterone in the body. More than a third of men over age 45 may have “testosterone deficiency.” That’s about 13 million men in the U.S. alone. At some point, testosterone levels in the blood may become very low.

Symptoms of testosterone deficiency in adult men include:

  • unsatisfied-woman-erectile-dysfunctionReduced body and facial hair
  • Loss of muscle mass
  • Low libido, impotence, small testicles, reduced sperm count and infertility
  • Irritability, poor concentration and depression
  • Loss of body hair
  • Brittle bones and an increased risk of fracture

Some men who have a testosterone deficiency have symptoms or conditions related to their low testosterone that will improve when they take testosterone replacement. For example, a man with osteoporosis and low testosterone can increase bone strength and reduce his fracture risk with testosterone replacement.

Diseases and Conditions That Affect Testosterone

Men can experience a drop in testosterone due to conditions or diseases affecting the:

Testes – direct injury, castration, infection, radiation treatment, chemotherapy, tumors

Pituitary and hypothalamus glands – tumors, medications (especially steroids, morphine or related drugs and major tranquilizers, such as haloperidol), HIV/AIDS, certain infections and autoimmune conditions

Testosterone Therapy

Currently, testosterone therapy is approved primarily for the treatment of delayed male puberty, low production of testosterone (whether due to failure of the testes, pituitary or hypothalamus function) and certain inoperable female breast cancers.

However, it is quite possible that testosterone treatment can improve symptoms in men with low levels of active (free) testosterone, such as:

  • Generalized weakness
  • Low energy
  • Disabling frailty
  • Depression
  • Problems with sexual function
  • Problems with cognition

Few Treated for Low Male Hormones

Most men who have symptoms of low male hormone levels are not being treated, a study has found. The condition is called androgen deficiency. It is treated with testosterone. The study included 1,486 men. About 5.5% had untreated androgen deficiency. Another 0.8% were being treated. Only about 1 out of 8 men with low hormones was getting treatment. HealthDay News wrote about the study May 27. It was published in the journal Archives of Internal Medicine.

What Changes Can I Make Now?

Consider getting tested for testosterone deficiency. Factors that increase risk include:

  • Use of certain medicines (such as corticosteroids or drugs for diseases of the prostate gland)
  • Excessive alcohol intake
  • Testicle injury, infection or removal
  • Radiation therapy or chemotherapy
  • Diseases of the pituitary gland (a hormone-producing gland at the base of the brain)
  • Reduced facial and body hair
  • Loss of muscle mass
  • Infertility
  • Feeling irritable or depressed
  • Poor concentration
  • If you have low testosterone, talk to your doctor about your treatment options. These include:
  • Injections (usually every one to three weeks)
  • Topical Creams daily, Patches, or gel applied to the skin

Don’t take testosterone if you have prostate cancer. It’s important before starting treatment to be screened for prostate disease. You will need a rectal examination and a prostate-specific antigen (PSA) blood test.

The Bottom Line

Testosterone is so much more than its reputation would suggest. Men and women need the proper amount of testosterone to develop and function normally. And most badly behaved men have normal levels of testosterone. Too little, rather than too much, testosterone is probably a much bigger problem.

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