Androgen deficiency in men

Androgen deficiency is a medical condition caused by problems with your body’s ability to make testosterone. Either the hormonal signal that tells your testis to make testosterone, or the ability of your testicles to make testosterone, is not working properly.

Androgens are necessary for normal development, health and wellbeing, so androgen deficiency can have wide-ranging effects.

Having a lower-than-normal testosterone level does not necessarily mean you have androgen deficiency. Low testosterone can be caused by short-term or long-term illnesses, such as an infection or diabetes.

Androgen deficiency affects between 1 in 20 and 1 in 200 men.

Androgens are sex hormones

Hormones can be thought of as chemical messengers. They communicate with tissues in the body to bring about many different changes. Hormones are needed for different processes like growth, reproduction and well-being.

Androgens are the group of sex hormones that give men their 'male' characteristics (collectively called virilisation). The major sex hormone in men is testosterone, which is produced mainly in the testes. The testes are controlled by a small gland in the brain called the pituitary gland, which in turn is controlled by an area of the brain called the hypothalamus.

Androgens are crucial for male sexual and reproductive function. They are also responsible for the development of secondary sexual characteristics in men, including facial and body hair growth and voice change. Androgens also affect bone and muscle development and metabolism.

The term androgen deficiency means your body is not making enough androgens, particularly testosterone, for full health. The effects of this depend on how severe the deficiency is, its cause and the age at which the deficiency begins.

Testosterone

The major sex hormone in men is testosterone. Some of the functions of testosterone in the male body include:

• starting and completing the process of puberty
• bone and muscle development
• growth of body hair, including facial hair
• change of vocal cords to produce the adult male voice
• sex drive (libido) and sexual function
• prostate gland growth and function
• sperm production.

Symptoms of androgen deficiency

When there is not enough testosterone circulating in the body, it can cause a wide range of symptoms. However, a number of these symptoms may be non-specific and can mimic the symptoms of other diseases and conditions.

Some of the symptoms of androgen deficiency include:

• reduced sexual desire
• hot flushes and sweating
• breast development (gynaecomastia)
• lethargy and fatigue
• depression
• reduced muscle mass and strength
• increased body fat, particularly around the abdomen
• weaker erections and orgasms
• lower sex drive
• reduced amount of ejaculate
• loss of body hair
• trouble sleeping
• reduced bone mass, therefore increased risk of osteoporosis.

Causes of androgen deficiency

The most common cause of androgen deficiency is a genetic condition called Klinefelter syndrome, which goes undiagnosed in up to 75% of men who have it.

Androgen deficiency is caused by problems with testosterone production by the testicles. This can be due to the testicles themselves not working properly (known as primary hypogonadism), or because there’s a problem with the production of the hormones that control the testicles’ function (secondary hypogonadism).

Primary hypogonadism can be caused by genetic abnormalities, undescended testes, testicular injury, some types of infections (e.g. mumps) or other diseases (e.g. haemochromatosis).

Secondary hypogonadism can be caused by some genetic syndromes (e.g. Kallmann’s syndrome), disease, or injury to the pituitary gland at the base of the brain.

Diagnosis of androgen deficiency

Androgen deficiency is diagnosed using a number of assessments, including:

• medical history – a full history is taken, including details about fertility, sexual function, symptoms of androgen deficiency, other medical problems, occupation, medication and drug use (prescribed and non-prescribed)
• physical examination – a thorough general examination is performed, including measuring the size of the testicles and checking for breast development
• blood tests – are taken to determine the level of testosterone in the blood. Ideally, a fasting blood test should be taken in the morning to detect the body's peak release of testosterone. Testosterone levels should be measured on two separate mornings. The pituitary hormone levels should also be measured
• other tests – may be required to determine if testosterone deficiency is due to another underlying medical condition. These may include blood tests to check for iron levels, genetic tests (to diagnose an underlying genetic condition, such as Klinefelter’s syndrome), or MRI scans of the brain (to examine the pituitary gland). Semen analysis will help to determine the potential fertility of men with androgen deficiency.

Treatment of androgen deficiency

How androgen deficiency is treated depends on whether it’s due to primary or secondary hypogonadism.

Management of primary hypogonadism involves testosterone replacement therapy using capsules, injections, skin patches, creams or gels, and is very effective at relieving symptoms of androgen deficiency.

Management of secondary hypogonadism involves medical care to deal with the underlying cause, often with testosterone replacement therapy.

Side effects of treatment of androgen deficiency

Once testosterone levels are restored to the normal range, side effects of testosterone replacement therapy are not common. Some of the possible side effects include:

• weight gain
• mild acne
• mood changes and increased aggression
• male pattern baldness
• breast development
• osteoporosis
• diabetes
• problems with urine flow (older men).

Self-prescription may not be safe

There is a large commercial market for testosterone products or herbal products to increase testosterone production. Do not start taking medications based on symptoms of low testosterone without consulting your doctor, who will assess your overall health and check for any serious conditions.

Using products that you buy online may:

• not help your symptoms
• mask other health disorders
• have unknown side-effects.

Where to get help

• Your GP (doctor)
• Healthymale