The Role of Testosterone in Men’s Health
In 2021, MORPh were honoured to be joined by guest speaker Mike Kirby FRCP to deliver a webinar on men’s health. Mike is an editor for PCCJ and Trends in Urology. He is on several NHS advisory boards including the Prostrate Cancer Risk Management Programme, Prostrate Cancer Advisory Group and National Prostrate Cancer Audit. This blog post is taken from his webinar and is packed full of advice about the impact of testosterone on men’s health.
Testosterone deficiency
Deficiency of testosterone is a significant medical condition characterised by serum androgen level deficiency as well as the relevant signs and symptoms. It can have an adverse effect on multiple organ systems, therefore resulting in a significant decrease in quality of life including changes in sexual function.
Testosterone levels influence:
- Mood
- Cognitive ability
- Muscle mass
- Strength
- Bone mass
- Red blood cell production
- Fat distribution
- Sexual function, sexual desire and sperm production
Symptoms of testosterone deficiency
The symptoms of testosterone deficiency can manifest as psychological, cardiometabolic, physical and sexual.
Psychological symptoms:
- Mood changes such as depression, anger, irritability and sadness
- Poor self-rated health and decreased wellbeing
- Reduced cognitive function including impairments of spatial performance, verbal memory and concentration
Cardiometabolic symptoms:
- Increased BMI or obesity
- Visceral obesity
- Metabolic syndrome
- Insulin resistance and type 2 diabetes
Physical symptoms:
- Decreased body hair
- Gynaecomastia
- Decreased muscle mass and strength
- Hot flushes and sweats
- Sleep disturbance
- Fatigue
- Osteoporosis, height loss and low trauma fractures
Sexual symptoms:
- Delayed puberty
- Small testes
- Infertility
- Decreased sexual desire and activity
- Decreased frequency of sexual thoughts
- Erectile dysfunction
- Delayed ejaculation
- Decreased volume of ejaculate
- Decreased or absent morning or night time erections
Classification of testosterone deficiency
Estimates of the number of people affected by testosterone deficiency are varied because different experts will use different criteria to define it. Prevalence of testosterone deficiency increases with age but can occur in men of all ages. Classification is as follows:
- Primary: testicular damage
- Functional: Caused by morbidities influencing leydig cell functioning and hypothalmamic/pituitary response
- Secondary: Hypothalamic/pituitary damage
Causes of testosterone deficiency
The causes of testosterone deficiency can be divided into primary and secondary and organic and functional.
Primary organic:
- Klinefelter syndrome
- Cryptocidism, anorchia
- Myotonic dystrophy
- Irradiation, chemotherapy
- Castration, trauma
- Orchitis
- Older age
Primary functional:
- Chronic illness
- Ketoconazole
Secondary Organic:
- Pituitary/hypothalamic tumour, surgery, trauma or disease
- Stalk section or disease
- Hypopituitarism
- Haemochromatosis
- Kallman syndrome, idiopathic hypogonadotropic hypogonadism
Secondary functional:
- Opioids
- Glucocorticoid excess
- Hyperprolactinaemia
- Organ failure
- Chronic illness, malnutrition, wasting
- Malnutrition
- Obesity/type 2 diabetes
- Excessive exercise
- Androgens, progestins, oestrogen, GnRH agonists
- Older age (with comorbidities)
Diagnosis
There are various challenges associated with diagnosing testosterone deficiency, including:
- Delay in seeking treatment
- Non-specific and variable signs and symptoms
- Lack of definitive cut-off point for serum levels
- Variation in reference ranges for total testosterone
- Inadequate attention to sexual health by both men and physicians
- Undefined age range for investigating testosterone levels
- Lack of NICE guidelines on the topic
Further information
Testosterone deficiency is not just a lifestyle condition. There is an abundance of patient types that should be screened for the condition. We need to adhere to evidence-based action limits rather than local laboratory reference ranges when diagnosing patients and longevity of treatment matters.
To find out more about diagnosis and treatment of testosterone deficiency, including the benefits and potential adverse effects of Testosterone Therapy, sign up for our FREE webinar on men’s health. The webinar also covers other aspects of men’s health including:
- The diabetes crisis in men
- Obesity
- The effect of opioids
- Anaemia
- Case studies to reinforce learning
We look forward to welcoming you to one of our webinars soon. Have a look at the list of free online pharmacist training coming up to see if we can help you to keep your CPD up to date.
