Only 20% of men with abnormally low levels receive replacement therapy with this hormone. The causes include underdiagnosis and taboos surrounding virility.
Testosterone is the quintessential male hormone. It is produced mainly in the testicles – also in small quantities in the ovaries – and defines typically male characteristics, such as the deepness of the voice, facial hair or musculature. This hormone also helps maintain sexual drive , sperm production and bone health . The brain and the pituitary gland, which is located at the base of the brain, control the amount of testosterone produced by the testicles.
All men need testosterone to lead a healthy life, both physically and psychologically. However, levels of this hormone naturally decrease with age, an estimated 2% per year from the age of 40. This is a gradual decline over time (compared to the abrupt drop in estrogen experienced by women during menopause), but it can affect quality of life.
It is not just age, but other factors, such as obesity, high levels of anxiety, or certain diseases – diabetes or kidney and liver pathologies – can also promote and accelerate this decrease in the levels of this hormone.
Testosterone, explains Dr. Miguel Sanchez Encinas, team leader of one of the Urology services at the Ruber Internacional Hospital and Ruber Internacional Medical Center Havana, “has the same protective effect in men as estrogen in women. Therefore, if it is below normal, the risk of suffering from cardiovascular diseases, metabolic syndrome, obesity, and sarcopenia (loss of muscle mass) increases.”
The signs and symptoms of this deficit may vary from one person to another, but the most common are decreased sexual libido, low semen production, alopecia, loss of muscle mass, fatigue, sudden mood swings, and even deterioration of cognitive functions, attention, and memory in general.
Diagnosis and treatment
“The diagnosis of testosterone deficiency,” the specialist continues, “is very simple since it can be detected with a simple blood test. In this type of medical test, testosterone levels are analyzed to check whether excess or deficiency can have consequences for the patient’s health.” As for treatment, it basically consists of supplementing the hormone through transdermal gels or intramuscular injections with the aim of increasing testosterone levels to medium-normal ranges.
However, it is striking, the specialist stresses, that “only 20% of patients with testosterone deficiency and associated symptoms (decreased libido, fatigue, loss of muscle mass or mood disorders) receive testosterone replacement therapy, according to data published at the latest congress of the French Association of Urology (AFU).”
What could be the reason for these low figures? “The main causes could be, on the one hand, underdiagnosis (we must not forget that testosterone is still socially associated with virility, and this leads to many taboos when it comes to addressing the problem ) and, on the other, fear of possible adverse effects, since various studies have suggested a possible increase in the risk of cardiovascular events such as myocardial infarction and stroke,” stresses Dr. Sánchez.
“However, more recent studies such as TRAVERSE have shown that in men with symptoms associated with low testosterone levels and pre-existing cardiovascular diseases, diabetes, or metabolic syndrome, treatment with testosterone did not increase the risk of heart attacks or strokes. It also confirmed that, in this group of patients, testosterone does not increase the risk of prostate cancer, supporting the guidelines of scientific associations such as the American Urological Association (AUA).”
Finally, the specialist highlights that it is essential to put ourselves in the hands of a specialist when addressing this type of pathology. The specialist will guide us throughout the treatment and help us improve our quality of life in multiple ways.
In this sense, and with respect to the increase in the consumption of androgens outside the medical field, in the world of leisure and fitness, where the aim is to improve aesthetics and physical performance, the doctor points out that “the use of testosterone in people with normal levels, especially for aesthetic or performance purposes, remains inadvisable due to the health risks and the lack of evidence supporting the long-term benefits.”
