Also referred to at "Low T" or "Male Hypogonadism", low testosterone has been demonstrated to affect 38% of males aged 45 and up with increased prevalence in men with high blood pressure, diabetes and obesity. Emerging research is suggesting that if left untreated men are at increased risk for several health issues including heart disease, metabolic syndrome, depression and dementia. Classic symptoms of Low T include fatigue, irritability, depression, anxiety, poor mental concentration, decreased work performance, decreased sex drive, erectile dysfunction, decreased muscle mass, decreased strength and weight gain. These symptoms are generally alleviated rather quickly within just 3-6 weeks of initiating Testosterone Replacement Therapy, with improved sleep and mental clarity usually being noticeable in 2-3 weeks time.
The exact incidence of true Adult Growth Hormone Deficiency (AGHD) is not known and thought to be relatively uncommon. That being said, Growth Hormone production is known to decline rather steadily every decade by about 14% starting in your early 30s (roughly 1-2% decline per year). By the age of 65 ,most males will produce about one-half of the amount they did earlier in life. Some men may suffer from an accelerated decline in GH production as a results of head (brain) injuries and disorders of the sleep-wake cycle. AGHD is associated with blood vessel wall thickening, heart failure and decreased life expectancy. Symptoms may include changes in memory, processing speed, attention, lack of well-being, depression, anxiety, fatigue, adiposity, decreased muscle mass, decreased bone density, and insensitivity to heat and cold.
As men age and/or become more obese, the activity of the enzyme Aromatase that convertalso increases leading to increased conversion of Testosterone to Estradiol. High Estrogen in men (in addition to low testosterone) can lead to enlarged and tender breast tissue, increased abdominal fat, weight gain, water retention, decreased morning erections, erectile dysfunction and infertility. Oral Aromatase Inhibitor medications such as Anastrazole are often prescribed to our TRT patients to control soaring Estrogen levels. That being said, excessively low Estrogen levels by over-treatment with these Aromatase Inhibitors can have equally detrimental side effects and care needs to be taken avoid inducing excessively low serum Estrogens. Estrogens play an important role in bone metabolism, hair and skin development and sexual function. Testosterone to Estrogen ratio is also important and plays an important role in TRT outcomes.
Although not thought about much in males, Progesterone deficiency can have a number of relatively subtle yet negative clinical effects that often go unrecognized because it is seldom tested in men. Sometimes referred to as the "Other male hormone" because of its role in sperm motility, Progesterone is important in keeping Estrogen activity controlled. It is also the precursor hormone to the adrenal steroids Cortisol and Aldosterone that regulate the immune system, blood pressure and mineral handling by the kidneys. Progesterone is also thought to be neuroprotective in times of trauma to the nervous system and some of its metabolites are also noted to be neuroactive with a general "calming " effect.
Commonly known as the "Master Gland" that controls our metabolism, the thyroid gland is susceptible to a number of disorders that can result in decreased thyroid hormone production with age. If left untreated, Hypothyrodism can result in heart disease (cardiomyopathy), weight gain, dyslipidemia, myxedema, dementia, depression, and a whole host of metabolic disorders. Often times, correction of thyroid deficiency alone can help normalize other hormonal deficiencies (including Testosterone deficiency). For that reason, it is important to screen patients with low T for hypothyroidism. When treating hypothyroid patients, it is important to recognize that some patients require dual supplementation with the more active T3 hormone in addition to T4.
The adrenal steroids Cortisol and Cortisone are extremely important in energy regulation, blood sugar metabolism, immune function and response to physiologic stress and injury. Although complete adrenal failure ("Addisonian crisis") is not compatible with life and requires emergency Cortisol replacement therapy, partial adrenal failure is becoming more and more recognized with improving methods of testing. Cortisol deficiency may result from the effects of chronic stress, illness, medication, poor sleep and nutrition. Symptoms usually involve severe fatigue, muscle weakness, loss of appetite, digestive problems, irritability and depression.