Testosterone Deficiency Syndrome (TDS) and Low Testosterone

Which is the hormone that makes a man a man? Who needs testosterone replacement therapy?

It has to be testosterone.

Do you need testosterone replacement therapy? Testosterone is a hormone produced by the testis. It is the key hormone responsible for all of men’s physical characteristics, like:

• Facial hair
• Chest hair
• Muscle growth
• Deeper voice
• Sperm production
• Aggression
• Energy
• Stamina

So you can imagine what will happen when a man has low testosterone levels.

Why has my testosterone dropped?

Andropause, or testosterone deficiency syndrome (TDS), is the condition whereby a man faces lower testosterone levels than normal.
This is caused by the following:

1. Age
   In the vast majority of cases, low testosterone is just a consequence of aging. Similarly to how oestrogen production drops in women during menopause, men after the age of 40 will also have an equivalent decline in testosterone production.
2. Testes damage
   Damage to the testis will greatly impact testosterone production. This can be from infections, trauma, radiation, heat or surgery.Mumps is a common viral infection acquired during childhood. Aside from causing a swollen face, it can also infect the testis.
3. Hot environments
   Men who work in hot environments are also at risk. Particularly hawkers who work all day near an open stove positioned around the level of their testis.
4. Medical conditions
   Certain conditions promote faster decline in testosterone, such as:
   1. Obesity
   2. Diabetes
   3. High blood pressure
   4. High cholesterol

Some pre-existing medical conditions such as undescended testis or chromosomal abnormalities (e.g. Klinefelter’s syndrome) would already affect testosterone production from a very young age.

5. Steroids
   When anabolic steroids are used to boost testosterone for muscle growth, abuse over a long period of time, for sports or bodybuilding purposes, can eventually shrink the testis. This will then lead to testosterone deficiency syndrome.

How do I know when my testosterone has dropped?

Since testosterone affects so many characteristics, there will be an impact internally and externally. More visible signs include:

• Low energy
• Putting on weight around the stomach
• Loss of muscle mass
• Slow facial hair growth
• Erectile dysfunction
• Low amounts of semen
• Trouble with concentration
• Trouble sleeping well
• Temperamental

Low testosterone can also increase the risk of developing conditions within the body, this includes:

• Weaker bones (osteoporosis)
• High-grade prostate cancer
• Diabetes
• High blood pressure

A semi-quantitative way of knowing whether your testosterone is low or not is to take the Aging Male Symptoms (AMS) Questionnaire. The higher your total score, the lower your testosterone levels may be.

What tests can I do to check my testosterone?

A blood test is standardized to measure the total amount of testosterone in the body.

A second test is done if the blood test results are normal. This test will measure the protein levels of albumin and sex-hormone binding globulin (SHBG) in the body. Some testosterone molecules may bind with these proteins and hence render useless for the body. With the albumin and SHBG quantities, the amount of free testosterone actively available can be calculated.

A Full Blood Count (FBC) test and Prostate Specific Antigen (PSA) test might also be conducted to determine the number of red blood cells as well as the health of your prostate before receiving the Testosterone Replacement Treatment.

If your symptoms seem to suggest a different condition and not low testosterone, further tests will be conducted for them too.

What are my treatments options for low testosterone?

There are a number of methods that can help boost testosterone levels in the body.

1. Pills
   Testosterone pills are a simple enough treatment. They are both painless and super convenient. The only inconvenience is that they need to be taken on a regular basis. It should also be noted that testosterone is only soluble in oil, therefore the pills need to be taken along with a meal containing lots of oil in order for the testosterone to be well-absorbed into the system.
2. Gels
   Testosterone gels is another option. They are also painless and user-friendly. However, two things to remember. The first being that 4 hours after gel application, you should not swim, bathe, sweat excessively or do anything that might wash it off. Secondly, thoroughly washing your hands is required right after application to prevent accidentally transferring the gel onto someone else, like your wife.
3. Injections
   These testosterone injections are administered by a medical professional. Depending on the type of injection, some have to be given every three weeks, or some every three months. The pain level of these injections are equivalent to a standard injection. Unlike the previous two options, this one is the most convenient because there is nothing to worry about in between shots!

Does the Testosterone Replacement Treatment come with any side effects?

Testosterone replacement treatment is safe if consumed under the guidance of our doctors. Those horrible side effects in athletes and body-builders that you see in the news or online are due to over-dosing. Most people do not experience any side effects when administered under the guidance of a doctor. When they do, these are the more common side effects:

1. Acne Testosterone replacement is called an anti-aging treatment for a reason. When you were younger, do you remember those times where you used to get acne? Well, testosterone stimulates the oil glands in the body, which in turn leads to more oil production. If the bacteria that causes acne is present, it will lead to acne formation. This is not common and can be managed with creams.
2. Hair loss DHEA is formed from testosterone in the body. When the testosterone levels in the body the amount of DHEA that is converted from testosterone increase.. A rise in DHEA can lead to male pattern balding. Not to worry, there are medicines we can give to prevent this side effect should it occur.
3. Changes in PSA levels PSA is a protein that can be raised in the blood when there is inflammation in the prostate or prostate cancer. Testosterone replacement treatment may cause a rise in PSA initially before the levels start to drop down. This does not mean you have or will get prostate cancer. We further explain the relationship between testosterone and prostate cancer in a section below.
4. Increase in oestrogen levels
   Aromatase, which is found more in overweight people, converts testosterone in the body to estrogen.
   When patients go on testosterone replacement treatment, the body will convert it to estrogen. Estrogen is what makes a woman, therefore it can lead to the development of gynaecomastia (Male boobs). Moreover, high estrogen can cause all the symptoms of having low testosterone. Therefore this is usually the reason why some patients who start feeling great right after starting the testosterone replacement therapy, subsequently start having symptoms of low testosterone again.In this situation we usually ask the patients to lose weight, adjust the testosterone replacement dose or prescribed a drug that blocks the conversion of testosterone to estrogen.
5. Thickening of blood One of the reasons athletes use testosterone is because it cause the body to produce more red blood cells, which improves the delivery of oxygen in the blood and as a result increases the stamina. However, if the body produces too much red blood cells, the blood can thicken too much and cause problems. This is more commonly seen when a person over-doses on testosterone. To date we have not seen this in our patients, but to be on the safe side, we usually monitor the red blood cells concentration in the blood regularly.

What is the link between testosterone and prostate cancer?

There is still a widely held belief that testosterone leads to Prostate Cancer. This is not true.

Testosterone replacement therapy does not cause prostate cancer in patients who don’t have prostate cancer. In fact, studies have shown that low levels of testosterone increases a persons risk of developing high grade prostate cancer.