Shalender Bhasin, MD, Brigham and Women’s Hospital
Alvin M. Matsumoto, MD, VA Puget Sound Health Care System
A clinical syndrome is a group of symptoms (health changes noted by the patient) and signs (abnormalities noticed by the physician). Androgen deficiency (AD) syndromes are due to a lack of the main male sex hormone, testosterone. This patient guide is based on clinical guidelines written by an expert group of doctors from The Endocrine Society to help physicians who are evaluating and treating men with AD syndromes. The guide summarizes information about the best way to diagnose AD, how physicians will care for patients who have AD, and the potential benefits and risks of testosterone therapy. It also provides information for patients with AD to help them improve results of their treatment.
These guidelines do not apply to people who want to take testosterone to improve their strength, athletic performance, or physical appearance, or to prevent aging. Using testosterone for these purposes is not approved by the U.S. Food and Drug Administration and may be harmful to your health.
AD syndromes caused by low testosterone levels in the bloodstream are common in adult men. Signs and symptoms of AD include:
When a decrease in testosterone is prolonged and severe, men may have loss of body hair, reduced muscle size and strength, brittle bones (osteoporosis), and smaller testicles.
The expert group recommended that a diagnosis of AD in adult men should be made only when there are (1) symptoms and signs that could be caused by low testosterone and (2) consistently low levels of testosterone in the blood (measured on more than one occasion). Diagnosis involves the following:
Measurement of testosterone levels
Note: Use of medications that cause very low testosterone levels has become an important way to treat some men with prostate cancer. These very low testosterone levels are linked to increased risk of sexual problems, fatigue, bone fractures, heart disease, and diabetes.
The expert group recommended that treatment be given to men with low testosterone levels and symptoms or signs of AD. Certain groups of men should not receive testosterone therapy, however.
The expert group would not recommend testosterone therapy for certain patients because of possible negative effects of exposure to testosterone:
The expert group suggested that the main goal of testosterone therapy is to increase testosterone levels from the low to the middle part of the normal range. Depending on the reason for treatment, the goals may be different from case to case but may include improving and/or maintaining the signs of masculinity (e.g., deep voice, growth of beard, pubic hair), sex drive (libido), erections, muscle strength, and the amount of bone.
Your doctor can prescribe testosterone in one of several forms: injections (usually every 2 weeks), patches (put on skin every day), gels (put on skin every day), buccal tablets (applied to the gums two times a day), and in some countries outside the U.S., pills or pellets implanted under the skin.
In addition to the rectal exam and PSA test, a blood test for a hematocrit (amount of red blood cells in your blood) should be done at the start of testosterone treatment to check for abnormalities. A blood test for testosterone levels at various times during treatment is also recommended to see if levels are in the normal range. During treatment, you should see your doctor about three to six months after you start treatment to evaluate whether you are improving and if you are having any problems or side effects. A rectal examination, PSA, and hematocrit blood tests help spot problems. After that, check-ups every year are recommended.
For men with osteoporosis or a past bone fracture with little or no stress on the bone, a bone mineral density test of the spine and hip area should be done after one to two years of testosterone treatment.
You and your doctor should be partners in your care. It is important that you provide a full description and history of your symptoms to your doctor. After a diagnosis has been made, it is important to use testosterone treatment as instructed. Keep regular appointments with your doctor and ask questions.
You should tell your doctor how well treatment is helping your symptoms and any side effects you are having. For example, testosterone injections into the muscle may be uncomfortable and may cause ups and downs in symptoms; patches may cause skin redness and rashes; gels may transfer testosterone to others if they contact skin where the gel has been applied; and buccal tablets may cause gum irritation.
You also will improve your health by following a healthy lifestyle that includes regular exercise, good nutrition, limited alcohol consumption, not smoking, and weight loss if you are overweight.