Men with symptomatic hypogonadism can have a low quality of life and are at increased risk for cardiovascular disease (CVD) mortality compared to eugonadal men. They may have a low libido and/or ED.
Male hypogonadism can be congenital or acquired during adulthood. Symptoms of hypogonadism can be mild and easily confused with the normal aging process or other conditions such as Klinefelter syndrome or diabetes.
Testosterone Replacement Therapy
Testosterone levels decrease with age, and low T is seen in 4 out of 10 men over the age of 45. It’s also more common among men with certain health problems, including diabetes and obesity. A specific class of injectable testosterone treatment goes under the brand name Sustanon 250 injection. For males with hypogonadism, a disorder marked by low testosterone levels, it is frequently used in hormone replacement therapy.
Testosterone is important for sexual function, bone mass, red blood cell production, and muscle strength. It’s also a key hormone that helps prevent cardiovascular disease.
Men with low testosterone can experience symptoms such as libido loss, erectile dysfunction, and swollen or tender breasts (gynecomastia). They may have less energy and more body fat. Other signs and symptoms can include depression and an inability to concentrate.
The sex hormone testosterone is available as a prescription medicine in the form of a gel, lotion, or tablet. Testosterone replacement therapy is used to treat male hypogonadism and can be effective. But studies on its long-term safety have yielded conflicting results. Some researchers have found that testosterone therapy can help with sexual function and improve libido, while others have reported an increased risk of heart problems and prostate cancer.
Gonadotropin Replacement Therapy
Testosterone replacement therapy (TRT) increases serum testosterone to normal levels. It is available in the form of oral tablets, transdermal patches or gels, and intramuscular injections. Symptoms associate with low testosterone are improved by TRT, although long-term use may cause gynecomastia, acne, testicular atrophy, and erythrocytosis. Testosterone replacement also suppresses spermatogenesis, and it should not be use in patients who want to become fertile in the future.
Symptomatic men with late-onset hypogonadism who do not have classical clinical syndromes benefit from androgen replacement, especially when symptoms are accompanied by decreased energy, concentration, and sleep disturbance. Men who are taking anti-rejection medications for cancer treatment should discuss with their physicians the possibility of discontinuing therapy during and after treatment to prevent long-term suppression of spermatogenesis.
Men with hypogonadism should be considere for cardiovascular risk reduction, including smoking cessation, weight loss, and lowering cholesterol, blood pressure, and triglyceride levels. Longitudinal population studies have linked hypogonadism to increased CV morbidity and mortality.
Selective Androgen Receptor Modulators (SARMs)
SARMs are structurally modified anabolic steroids that bind to androgen receptors with less affinity than testosterone but exhibit tissue-selective activation of androgenic signaling. They have been show to increase serum testosterone levels, improve hypogonadal symptoms, and enhance bone mineral density without increasing PSA or hematocrit. They also reduce the risk of gynecomastia in women and do not increase BPH growth.
Although not FDA-approved, online vendors and social media influencers promote SARMs as an effective and safe treatment for low testosterone. Men are urge to talk with their doctor before considering these unproven treatments for themselves.
A physical examination and a brief screening questionnaire can identify hypogonadism. Testosterone testing is recommend to confirm the diagnosis and determine the appropriate dose of replacement therapy. The ADAM questionnaire has been validate as a tool to help clinicians diagnose and treat hypogonadism. This patient-centered approach has the potential to lead to earlier detection of hypogonadism and improved outcomes.
Other Therapies
Men with a low level of testosterone can develop a variety of symptoms, most commonly loss of libido and erectile dysfunction. Low testosterone also negatively affects muscle mass, increases the risk of osteoporosis, and can lead to depression. Low testosterone can also cause a delay in puberty or an overall eunuchoid phenotype with scant body hair and small testes, penis, and prostate. Hypogonadism can be cause by primary or secondary causes, including central or pituitary problems. Hypogonadotropic hypogonadism is due to a defect in the development of nerve cells within the hypothalamus that produce gonadotropin-releasing hormone and can be cause by diseases such as Prader-Willi syndrome, Kallmann syndrome, and pituitary tumors or by medications such as corticosteroids, alcohol, and certain medicine.
A diagnosis is typically make with laboratory tests and a thorough physical examination. A simple questionnaire know as the ADAM (Androgen Deficiency in Aging Male) has been develop to screen for androgen deficiency. Men with late-onset hypogonadism are at increase risk for cardiovascular disease. And should be referre to a cardiologist for evaluation of their cardiovascular risk.
