Talking about low testosterone

Low testosterone was once an embarrassing topic for men to discuss with their physicians. However, many men now seem to be more open about talking about their symptoms of low testosterone – including erectile dysfunction.

According to Nicole Ducharme, DO, Washington University specialist in endocrinology and internal medicine, “Erectile dysfunction (ED) is the predominant reason men consult their doctors. About 10 percent of ED is due to low testosterone, but ED itself has many causes. Other conditions such as vascular problems, hypertension, hyperlipidemia, diabetes, as well as depression and side-effects of medications can contribute. Adding testosterone may not correct the whole problem.”

Generally she says, low testosterone is not a problem for men under age 50. Screening below that age would be done for testosterone deficiency symptoms. To determine if low testosterone is a problem, doctors apply the Androgen Deficiency in Aging Males (ADAM) questionnaire. It has 10 areas that could indicate the need for testing.  If a patient answers yes to decreased libido or erectile dysfunction, or answers yes to three or more questions, then testing for low testosterone is indicated.

  1. Do you have a decrease in sex drive (libido)?
  2. Do you have a lack of energy?
  3. Do you have a decrease in strength and/or endurance?
  4. Have you lost height?
  5. Have you noticed a decrease in enjoyment of life?
  6. Do you have mood swings, sadness or irritability?
  7. Do you have weaker penile erections?
  8. Have you noticed a deterioration in your ability to play sports?
  9. Are you falling asleep in early evening?
  10. Has there been a deterioration in your work performance?

There are more serious problems that can develop with exceptionally low levels of the hormone, including osteoporosis, muscle wasting, and a decrease in cognitive abilities and memory.

Dr. Ducharme says it’s not simply a matter of testing and treating. “Testosterone levels are highest in the early morning and lower in the afternoon. The range of normal is 250 to 800 ng/dl. In order to get an accurate measurement, levels should be taken between 8 and 10 am.  If levels are less than 300, we would do another blood draw a week later.

 As men get older, those fluctuations appear to flatten out. Normal testosterone levels also vary with age.”

The risks of testosterone replacement therapy include increase in PSA (prostate-specific antigen) and/or prostate size, increased liver function and increase in red blood cell count.

Dr. Ducharme says “Patients should be screened for obstructive sleep apnea prior to starting testosterone replacement. Treating testosterone in untreated sleep apnea patients could potentially have the side effect of elevated red blood cell count.”

 You and your doctor should discuss which of the following therapies is right for you:

  • Gel (applied daily after showering)
  • Injection (every two to four weeks)
  • Testosterone patch (changed daily)
  • Intranasal spray
  • Oral medication

If you have concerns about your testosterone levels, and would like to make an appointment with Dr. Ducharme, please call 314-333-4100.

University Internal Medicine and Diabetes Associates
Center for Advanced Medicine
4921 Parkview Place, Suite 13A
St. Louis, MO 63110
(314) 333-4100