by John Bertini Jr., M.D., FACS
Testosterone deficiency syndrome (TDS), now commonly referred to as low testosterone or "low T," is a condition seen in aging men. Current estimates are that six to 12 percent of men 40 years and older experience adverse effects due to testosterone deficiency—and many of them go undiagnosed.
There are several symptoms characterized by low testosterone including fatigue, decreased libido and a depressed mood. An urologist can determine if these symptoms, among others, are caused by low T.
As background, while testosterone is a hormone that is present in both men and women, it is more abundant in men and plays a role in many bodily functions. It has an effect on metabolism, cardiovascular function, mood, sexual function, the prostate and other musculoskeletal development.
You need to know that screening for TDS is not part of a general physical examination. You must discuss the signs and symptoms of low testosterone with a physician who will then perform a blood test to check for levels of testosterone. Other screening tools, such as questionnaires, are available to help predict if you have low testosterone based on symptoms. One of them is called the ADAM (Androgen Deficiency in Aging Males) questionnaire, and while not 100 percent accurate, these tools do provide a starting point for evaluation.
A visit with your primary care doctor will include a discussion of your symptoms including their onset and severity. A physical examination will also provide information regarding any anatomical reasons for the hormone deficiency. These, in conjunction with a blood test, will give your doctor a baseline for potential treatment.
Treatment for TDS is typically testosterone replacement therapy (TRT) aimed at replacing the deficient hormone. Testosterone is available in many forms, but it is most commonly prescribed as a gel that is applied to the skin daily or as an injection that is performed every two to three weeks. Your physician will typically perform a trial of therapy to assess your response to treatment. If the trial is successful, then that treatment is continued. If unsuccessful, a higher dose of replacement may be used, or further evaluation may be needed to determine if the symptoms are attributable to another cause.
There are side effects of TRT that should be discussed with your physician. Also, there are men who are not candidates for TRT. These include men who are attempting to reproduce, men with certain heart conditions, men with untreated sleep apnea, as well as men with certain forms of prostate cancer.
If you experience these symptoms, discuss them with a primary care physician who may refer you to urologist for evaluation and treatment.
Dr. John Bertini is a board-certified urologist who practices at Gulf Coast Urology and is on the medical staff of St. Joseph’s Medical Center.