Testosterone Deficiency - Patient Challenges

Goals

To understand the problems and challenges men over the age of 30 with testosterone deficiency face and what specific steps or alternatives can be considered to improve their condition by identifying statistics and articles pertaining to the subject.

Early Findings

  • Testosterone in males is synthesized by the Leydig cells in the testicles under the influence of luteinizing hormone secreted from the pituitary gland.
  • The normal range for morning testosterone is between 300 and 1,000 ng/dl. Defects and abnormalities, whether acquired or congenital, that interfere with the testis production of testosterone or interactions with the hypothalamic-pituitary-gonadal axis can cause a decrease in testosterone levels. This clinical condition is called hypogonadism, which has been defined as total testosterone < 300 ng/dL by the Endocrine Society clinical practice guidelines.
  • Normally, testosterone levels in men decrease rapidly with age by 0.4–2% annually after the age of 30, with 35% of men in their seventh decade having lower testosterone levels than younger men and 13% of older age men meeting diagnostic levels for hypogonadism.
  • In addition, approximately 40% of men over the age of 45 and 50% of men in their 80s are hypogonadal.
  • Common causes of hypogonadism are multiple and they include radiation, prior treatment for testicular cancer, testicular infection, environmental toxins, medications with gonadotoxic effects such as chemotherapy, trauma, orchiectomy, idiopathic testicular atrophy, genetic conditions, or anatomic abnormalities such as varicoceles.
  • Other symptoms of testosterone deficiency are lack of motivation, changes in sleep patterns , difficulty concentrating , decreased bone density , reduced muscle mass and strength , large breasts in men , fatigue, and depression .

Challenges Commonly Faced in Hypoandrogenism

  • Not only the clinical signs and symptoms suggestive of androgen deficiency take time to clinically manifest, but they are also non-specific, which makes diagnosis difficult. Also, said diagnosis is made only after following specific procedures that are dictated in a diagnosis algorithm.
  • Another important challenge is the fact that most external testosterone therapy will suppress spermatogenesis thus decreasing fertility potential.
  • As an alternative, most non-exogenous testosterone replacement therapy aims to either increase the body's production of testosterone or decrease the conversion of this hormone to estrogen in adipose tissue. However, even if these medications (Anastrazole, Clomiphene citrate) have shown efficacy, their use as a treatment of testosterone deficency is considered off-label by the FDA. Moreover, they carry side effects such as decreased libido and bone mineral density.
  • Men with testosterone deficiency also deal with social and psychological issues due to their condition. A study made by the University of Sheffield determined that young male cancer survivors experienced a marked impairment in quality of life, as well as reduced energy levels and quality of sexual function and these experiences were exacerbated in survivors with a testosterone deficiency.
  • Furthermore, research found that hypogonadal men also have impaired emotional state, as well as a severe impairment in cognitive functioning and memory.

Summary of Findings

  • During our initial hour of research, we focused on assessing the availability of the information with a focus on the requested population. We have provided a brief overview of the disease as well as identified some of the main challenges faced by these patients, which are mainly social, health-related, and psychological. We can provide further information with continued research.
  • A global approach was chosen; however, if a regional approach is preferred (e.g. United States) this should be clearly stated in any response.

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