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Is It My Imagination or Is My Manhood Fading: Low Testosterone!

Have you ever found yourself wishing for the good old days of your 20s? Those were the days of endless energy and perpetual horniness. Low testosterone is not necessarily a normal part of aging, and many older men maintain normal testosterone levels well into their 80s. However, with age and wisdom comes unwanted changes for many of us “old bulls.” Low testosterone (or hypogonadism) occurs when a man’s body does not produce normal testosterone levels. The normal range varies depending on the lab but typically ranges between 300-800 ng/dl (nanograms per deciliter). Testosterone is critical in the development that occurs in boys as they become men. Testosterone is required for normal development during puberty as males develop muscles and strength, body and facial hair, and a deeper voice. Testosterone is also necessary for the production of healthy sperm (or spermatogenesis).

Obesity and increased gut fat (“the belly”) are direct causes of low testosterone. The fat produces an enzyme called aromatase which will cause peripheral conversion of one’s testosterone into estradiol (female hormone). This will contribute to gynecomastia or the formation of “man boobs.”

Some of the symptoms of low testosterone include:
  • Decreased desire for sex

  • Lack of energy

  • Declining erections

  • Feeling depressed

  • Loss of muscle mass

  • Decreased strength

  • Loss of bone strength (decreased bone density)

  • Abnormal sperm production ( male infertility)

  • Mood swings

  • Anemia

If you suspect that you may have low testosterone, speak to your physician or a urologist and have your level checked. Depending on your age, I would check free testosterone, total testosterone, estradiol, and sex hormone-binding globulin. A PSA (prostate-specific antigen) or prostate cancer blood test should be included in men over 40. This is important in case you require testosterone replacement therapy which would be problematic if you have undiagnosed prostate cancer. This will be discussed in more detail in the prostate cancer section. The American Urological Association recommends checking the testosterone level on two different occasions, preferably in the early morning, to confirm that the level is indeed low.

If your level is low, very thoughtful consideration should be given to your treatment options which will vary based on one’s age, existing medical conditions, desire for fertility, and the presence of small children. The treatment options include topical gels, topical creams, topical patches, testosterone injections, testosterone pellets, HCG (human chorionic gonadotropin), and aromatase inhibitors. Testosterone replacement therapies are not without health risks. There is an inherent risk of stroke, heart attack, and clotting events. Testosterone therapy can overstimulate the production of red blood cells, increasing one’s hemoglobin and causing polycythemia (“thickening of the blood”). These risks are further increased in people with existing cardiovascular risks like high blood pressure, diabetes, and nicotine abuse. A prior history of deep vein thrombosis, heart attack, or stroke is also contributing factor. Buying testosterone off the street or using someone else’s medication is not a safe way to handle this problem. You might get more than you bargained for! Also, testosterone therapies will make you infertile if you are trying to have children. Seek the help of a specialist, a urologist like myself, to help you develop a treatment plan that suits your lifestyle. There is always a safe way to get your manhood back.

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