What is testosterone?
Testosterone is the most important male hormone and is produced mainly in the testicles in men. Its production in the testicles is controlled by the hypothalamus and pituitary gland in the brain, which release hormones that activate the testicles to produce testosterone.
Testosterone is carried in the blood bound to protein, and this bound protein cannot have any effect on the body. Only “unbound” or free testosterone can enter other cells of the body and have their effect. As a result, anything that affects the amount of testosterone that is bound can also influence the effect testosterone can have in the body.
Testosterone is responsible for helping the body create male characteristics during puberty, but it also has important roles to play in the adult male. It is important in maintaining healthy sexual function, energy levels, mood, strength and levels of muscle and fat in the body.
What are the symptoms of low testosterone?
In certain circumstances, the body is unable to produce and sustain sufficient levels of testosterone.
As a result, the man can experience unwanted effects, including a lack of sex drive and reduced sexual performance. Low testosterone is also associated with a feeling of irritability, depression, low motivation and energy levels. Men with this issue may also notice a loss of muscle mass and strength and an increase in fat levels, especially around the waist. Over a longer period of time, there can also be a reduction in bone density - increasing the risk of osteoporosis.
Typical examples of things that could be associated with low testosterone are regularly falling to sleep in the early evening when you should not be especially tired, poor performance at work due to constant tiredness, and feeling that you have lost your joy of living, so much so that things that you used to enjoy now feel like a nuisance or too much hassle. You may also notice fewer or no morning erections and less hard erections, reduced physical stamina or strength and weight gain.
It may be tempting to put these things down to the fact that you are getting older, and it’s true that we all slow down with age, but the real problem could be low testosterone and the good news is that if that is the case, effective and safe treatment is available.
What causes low testosterone levels?
It is true that testosterone levels fall as men age, and this decline is steady – about 1–2% a year from around the age of 40. This is normal but as the levels fall, it may not be desirable - especially if levels were not high in the first place.
Low testosterone can be caused by direct problems with the testicles that disrupt the production of testosterone. Such problems include physical damage to the testicles, the mumps virus and cancer therapy.
Testosterone levels can also be reduced as a result of changes in the parts of the brain that stimulate the production of testosterone in the testicles. Brain tumours can cause this. Certain infections such as tuberculosis and HIV can also affect the pituitary gland. Direct trauma can damage the brain and anabolic steroid abuse can temporarily reduce testosterone levels.
Obesity is also known to reduce testosterone levels as fat cells can convert testosterone to oestrogen. This is a normal bodily process, but excessive fat cells mean that it happens more than is normal.
How can low testosterone be treated?
It can be difficult to determine if you have clinical effects of low testosterone because a lot of the symptoms discussed above can result from other causes. It can also be difficult to determine as the normal level of testosterone varies according to the individual, as well as the time of day, age and which laboratory conducts the analysis to measure the levels. A fairly wide level of total testosterone in males is considered normal (9-32 mmol/l which is equivalent to about 270-1,000 ng/dl), but many men do complain of symptoms of low testosterone at the low end of this normal range. For example, a 45-year-old man with 10 mmol/l total testosterone may be unhappy at that level.
Despite these difficulties, if your overall experience of changes and problems matches the likely symptoms of low testosterone and you are concerned about how you are feeling then it’s worth exploring the matter further.
What are your options for treatment?
The treatments offered by the Pharmacy2U Online Doctor service are testosterone-containing gels that are applied to the skin. The testosterone is absorbed through the skin and builds up in the body over time to restore levels. The gels offer a safe way of administering without the need for injections, and the dose can be tailored easily. The treatments offered are Testim, Testogel and Tostran. Please click on each treatment name for further information.
Other treatments not available from the Pharmacy2U Online Doctor service include tablets that are taken every day, buccal patches that stick to the gum, intramuscular injections every few weeks and an implant that can last between four and five months.
When will you be required to take a blood test?
After review of your consultation to see if you are likely to benefit from testosterone replacement therapy, our UK-registered GP will require you to undergo some blood tests to determine if treatment is safe for you. These low testosterone blood tests and prostate tests can be conducted without any embarrassment, from the convenience of your own home, but they will be needed before treatment is initiated. Each blood test is provided at a cost of £25, but you will be able to decide whether or not to proceed at each step of the way.
After review of the results of the initial blood tests, if the doctor decides that it’s safe and appropriate to start testosterone replacement therapy, a prescription for one month’s testosterone replacement therapy will be authorised. A further blood test will be needed after three weeks to see how you are responding to treatment. All being well, a further five months of treatment will be authorised before another blood test is needed to check your testosterone levels again.Finally, a year after treatment is initiated, and each year after that, further blood tests will then be needed to ensure that the ideal level of testosterone in your body is maintained and that your continued use of testosterone replacement therapy remains safe. We will be checking for indications of prostate or blood problems that can occur.
If you’re concerned about your testosterone levels, we offer confidential consultations with UK registered GPs through our Online Doctor service.