Testosterone Deficiency Syndrome

Testosterone Deficiency Syndrome (TDS), also known as hypogonadism, is a condition in which a man’s body does not produce sufficient testosterone. Testosterone is the primary male hormone and is produced in the testicles. It is important in sexual development during puberty, helping boys develop male features like body and facial hair, deeper voice and muscle strength. In the adult male, testosterone plays a key role in maintaining one’s sex drive (libido), sperm production, muscle mass as well as mental and physical energy.

Overall, data suggests that TDS occurs in approximately 2 out of every 100 men. TDS generally occurs in older men, but younger patients can also be affected for a variety of reasons. TDS is often commonly referred to also as “andropause”, but strictly speaking this is an inaccurate term because unlike menopause in women, TDS is not an inevitable result of ageing.

What are the causes of TDS?

In most men, the exact cause of TDS cannot be identified. In some cases, however, a specific cause may be discovered. Some examples include:

  • Ageing

  • Obesity

  • Genetic conditions eg. Klinefelter syndrome, Kallmann’s syndrome

  • Injury to one or both testicles

  • Undescended testicles

  • Removal of testicles due to cancer

  • Chemotherapy or radiotherapy

  • Pituitary disorders leading to hormone deficiency

  • Mumps orchitis (a viral infection involving the testicles)

  • Autoimmune conditions (when the body makes antibodies that attack its own cells)

  • Use of certain medications eg. antidepressants and opiate painkillers

  • HIV/AIDS

What are the symptoms of TDS?

There are a range of symptoms associated with TDS in men, including:

  • Reduction or complete loss of libido

  • Erectile Dysfunction

  • Increase in body fat

  • Reduction in lean muscle mass

  • Frequent lethargy or fatigue

  • Lower energy level, endurance and physical strength

  • Mood changes eg. irritability

  • Depression

  • Difficulty concentrating or making decisions

  • Poor memory and focus

  • Poor work performance

  • Poor results from exercise programs

  • Loss of bone density

The link between TDS and other chronic health conditions

Beyond the symptoms that many men experience, TDS can also contribute to the onset or worsening of various diseases, such as:

  • Cardiovascular disease

  • Increased risk of death from a cardiovascular event

  • Metabolic syndrome: hypertension, elevated insulin and cholesterol levels, and excess belly fat

  • Diabetes

  • Higher incidence of prostate cancer

What can I expect at my visit?

In order to diagnose TDS, your doctor will take a detailed medical history and ask about your symptoms, then perform a physical examination. A blood test is then performed to assess your testosterone level along with other related hormones. As testosterone levels fluctuate and are generally highest in the morning, this is usually done early in the day, ideally before noon. If tests confirm that you have low testosterone, further investigations may be warranted, such as imaging scans of the testes or pituitary, or a testicular biopsy.

How is TDS treated?

When a specific cause for TDS can be identified, treatment can be focused on that cause. In cases where no specific cause can be identified, Testosterone Replacement Therapy (TRT) is the most common treatment option. TRT raises the body’s testosterone levels through regular administration of testosterone. This therapy can take several forms. At RMDY clinic, we offer the following options:

    • This is applied daily on upper arms and shoulders, and absorbed through the skin. Done consistently, this method can achieve stable testosterone levels.

    • Possible side effects include skin irritation and the possibility of transferring the medication to others, including children and women.

    • This is taken once daily after a meal. It is a good option for men who are not keen on receiving injections.

    • Possible side effects include oily bowel motions, abdominal discomfort, nausea, vomiting, diarrhoea and acne.

    • There are short-acting and long-acting forms of testosterone injection. These are injected into muscle. The short-acting form is self-injected once weekly whereas the long-acting injection is given at the clinic by your doctor every 8 to 14 weeks.

    • Your testosterone levels might fluctuate depending on the frequency of your injections, causing your symptoms to waver between doses.

Each treatment option has its pros and cons, and you may wish to consider which option is best or most useful for you. Talk about the choices with your doctor. Whilst on TRT, it is recommended to follow up with your doctor for regular blood tests in order to monitor for treatment effectiveness and side effects. Once an effective treatment regime has been established and testosterone levels are normalized, follow up reviews can be spread out farther apart.

TRT carries various risks, including limited sperm production, increased production of red blood cells, prostate enlargement, testicular atrophy, gynaecomastia (man boobs) and sleep disturbances.

Before starting TRT, patients should recognize that it is a life-long commitment as the treatment results in a reduction in the amount of testosterone that is naturally produced by the body, therefore the body will then depend on the external form of testosterone supplementation.

Need help?

If you are concerned that you might have low testosterone, please visit our doctor today for a detailed consultation.