Matthew Hoffman, MD
Brunilda Nazario, MD
Asking about symptoms of low testosterone might seem embarrassing. Just talking about it might make you feel like you’re light in the manhood department. But if you’re wondering about low testosterone, you’re far from alone.
Low testosterone becomes more common with age, affecting millions of men in the U.S. Although it may cause no symptoms, low testosterone can also result in poor libido, erectile dysfunction, depression, and loss of energy. These symptoms of low testosterone can masquerade as ordinary aging -- when, in fact, it’s a treatable condition.
“Most men don’t ask about it,” says Karen Herbst, MD, an endocrinologist with the University of California at San Diego. “It would be great if they would.” Talking with your doctor is the only way to find out if increasing testosterone levels would help reduce symptoms.
Testosterone levels naturally decline with age. Men lose about 1 percent per year of their testosterone levels after age 40. In middle age and later, levels can dip below the threshold of what’s considered normal.
Population studies suggest that 10% to 25% of men over 50 may have low testosterone. When asked about symptoms, though, only about one-half to two-thirds of these men report any symptoms of testosterone deficiency.
And the symptoms are what matters, Herbst tells WebMD. Unless a man has symptoms, Herbst believes that he should not have a testosterone test.
Low libido and erectile dysfunction are two common symptoms of low testosterone. But other symptoms are often vague and nonspecific. For example, fatigue, difficulty concentrating, depression, and irritability are common in men, and frequently occur with normal testosterone levels.
Low testosterone symptoms can also be insidious. Unlike menopause, when women’s estrogen levels abruptly fall to very low levels, “andropause” in men is a slow, steady decline in testosterone over decades. Changes in muscle mass, libido, and mood can be subtle, even unnoticed by a man himself.
Herbst thinks physicians could do more to ask about the symptoms of low testosterone. She adds, “Most of the time, it’s the last thing I ask about. ‘How’s your libido? Are you having any symptoms of ED?’” If a man over 50 mentions problems, a testosterone test is the appropriate next step, Herbst says.
Testosterone replacement therapy can help reduce symptoms. But talking with your doctor about any problems you have can be a tough conversation to start. In one study, 82 percent of men with erectile dysfunction wished their primary doctor had asked them about symptoms earlier. The vast majority of these men said they felt too embarrassed to initiate the discussion about ED themselves.
Andre Araujo, PhD, an epidemiologist focused on testosterone deficiency and treatment patterns, found treatment rates to be surprisingly low in a recent study in Boston. “Only about 12 percent of men with [symptoms of low blood testosterone levels] were receiving testosterone,” Araujo says. “We can’t say they should have been treated, but the low treatment rate didn’t seem due to poor access to care or unwillingness on their part.”
There’s no magic to asking your doctor about symptoms you’re having that might be related to low testosterone, Herbst says. “I think you just say what you feel, and start the conversation that way.”
Still, it’s not always easy to have a good discussion about sensitive issues in a few minutes of face time with the doctor. You can jump-start the conversation if you organize your thoughts before your visit. Here are a few possible ways WebMD suggests to talk to your doctor about possible symptoms of low testosterone.
For men with problems with energy, concentration, and well-being: “I’ve been feeling out of sorts -- just not myself. I’m tired and sleepy all the time, and I can’t seem to keep my mind on task. I get eight hours of sleep every night but I’m still tired. I’m wondering if something else going on. Do you think I need a testosterone test?”
For men with low libido or erectile dysfunction: “I know I’m not 18 anymore. But it seems like I should have more sex drive than I do. I don’t feel interested in sex, and I’ve had no sex drive for months. I know it bothers my wife, too. When it does happen, there are some problems with having a firm erection. It’s pretty embarrassing to talk about, but I want to make sure there’s nothing medical causing this.”
For men with symptoms of depression: “My family says I’m depressed. I admit that I’m irritable most of the time and can be hard to be around. I don’t like that. I’m not lying in bed all day, but my energy is down and I don’t feel interested in the things I used to. It’s hard to concentrate. All this makes me feel like a bad husband and dad. Can low testosterone cause these symptoms?”
Long-term studies on the risks and benefits of testosterone replacement are years away from providing meaningful answers, Araujo says. Until then, the best approach to possible symptoms of low testosterone is to bring them up with your doctor.
Keep this in mind, too: if you don’t have symptoms of low testosterone, it doesn’t make any sense to order a testosterone test. Because of potential testosterone side effects, testosterone replacement isn’t recommended just for a low level without symptoms since low levels may just be a normal part of aging.
SOURCES:http://www.nature.com/ijir/journal/v15/n2/full/3900948a.htmlBhasin S, Journal of Clinical Endocrinology and Metabolism, 2006; vol. 91: pp. 1995-2010.Karen Herbst, MD, PhD, assistant professor in medicine, University of California, San Diego.Araujo A, Journal of Clinical Endocrinology & Metabolism, 2007; vol. 92: pp. 4241-4247.Andre Araujo, PhD, New England Research Institutes, Inc.
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