Late onset androgen deficiency

What is late-onset Androgen Deficiency?

Androgen deficiency, also known as late onset hypogonadism is sometimes defined as low testosterone, but it is actually a syndrome consisting of low testosterone and a combination of symptoms and lab findings.  There is no one specific test to diagnose this syndrome, and many of the symptoms are non-specific, which means they could be associated with other conditions.

How is it diagnosed?

  • Blood testosterone level.
  • Clinical assessment of some of the following symptoms:
    • Physical/metabolic symptoms like energy and strength, muscle mass or difficulty building muscle
    • Sexual symptoms like a decrease in erectile function, libido, or orgasm
    • Psychological symptoms like sleep disturbance, mental fogginess or low mood.

How is it treated?

Late onset Androgen Deficiency is treated with testosterone replacement or supplementation.  This can be very beneficial is select cases, but it is not the cure-all that some advertisers want you to believe.  For example, while increased testosterone can help increase energy and libido, it will not by itself help with the ability to have or maintain erections.  Testosterone is increased in two ways:

  • Make the body produce more testosterone
  • Give testosterone directly through pills, injections or skin gels

Medications that prompt the body to make more testosterone

  • Usually used for infertility, not hypogonadism
  • Hypogonadism use would be “off label” – expertise in prescribing and monitoring required
  • May indirectly increase testosterone

Testosterone replacement medications

  • Pills
    • 2 types available – Undeconoate, available in Canada and Europe and Methyltestosterone, available in the US only.
    • Injections
      • Delatestryl (Testosterone Enanthate) – taken every two weeks, may be better for older men.
      • Depo-testosterone (Testosterone Cypionate) – taken every two weeks, may be better for younger men.
      • Either may require more visits to your healthcare provider and cause serum testosterone levels to fluctuate more than either the pills or skin gels
      • Skin Gels
        • Dosage will vary
        • Different medications are applied to different areas – arms, upper arms, underarms, inner thighs and inside lip

Notes about skin gels

  • TRANSFERENCE is a concern.  Skin gels must be washed off with soap and water before you have skin to skin contact with another person.  They can be transferred to other people through skin-skin contact for up to 24 hours after application.
    • Be careful around women and children
    • Be extra careful around pregnant or breastfeeding women as the gel medications can harm a fetus or breastfeeding baby
    • MALE INFERTILITY can be caused by testosterone medications.  Tell your healthcare provider if you are planning to start a family.

How is testosterone replacement measured and monitored

  • Symptom improvement
  • Elevation of testosterone levels in the serum; target level will usually be between 15 and 25 nmol/liter
  • You will also be monitored for side effects by physical exam and lab tests.

Testosterone and Prostate cancer concerns

There are concerns that increasing testosterone in otherwise normal men either causes or promotes the progression of prostate cancer. It is believed that this is probably not true, but always checks with your healthcare provider for the latest evidence and recommendations.  Some guidelines from 2013 are as follows:

  • Men receiving supplemental testosterone, those with cancer or those with treated cancer should not be worried about testosterone causing cancer or making their cancer worse
  • Men with advanced cancer should not take supplemental testosterone

 

Michelle Strovski, Maple Ridge Urology, Serving Maple Ridge, Coquitlam, Mission, Abbotsford, Langley, and Vancouver.