Low testosterone levels pose certain disease risks, but thankfully, the diagnosis of testosterone deficiency is not limited to laboratory test values. This article will discuss the criteria for the diagnosis and the various contraindications.
The health risks of testosterone deficiency are numerous, including an abundance of studies and meta-analyses that show a clear association between low testosterone levels in men and cardiovascular disease. There is also a strong association between low testosterone levels and all-cause mortality. In fact, researchers conclude that a decrease of 2.1 standard deviations from normal levels of total serum testosterone is associated with a 25% increase in mortality.
Furthermore, low testosterone is found in up to 40% of patients with type 2 diabetes. The Endocrine Society recommends routinely screening for low testosterone in men with metabolic syndrome (now almost one in three American adults have this) and type 2 diabetes. They also recommend screening for low testosterone in men with chronic lung disease, osteoporosis, HIV infection, infertility, alcohol abuse, and prolonged treatment with steroids, opiate pain relievers, or anticonvulsants.
Low Testosterone Correlates with Other Illnesses
Many conditions are associated with low testosterone, indicated by the fact that testosterone replacement therapy improves all of these conditions:
- Improves skeletal muscle mass and strength, and builds bones
- Decreases pain and death resulting from sarcopenia (degenerative loss of skeletal muscle mass) and osteoporosis (loss of bone density)
- Improves cognitive function
- Reduces Alzheimer’s disease and increases cerebral blood flow
- Lowers inflammation and inflammatory cytokines TNF and IL-1 beta
- Lowers total cholesterol
- Improves prostate health (if non-cancerous)
- Increases libido, sexual appetite, frequency, and firmness of erections
- Increases energy and feeling of well-being
- Treats anemia
- Strengthens the heart, blood vessels, and lowers blood pressure
- Reduces blood clots and improves tissue oxygenation
Who Gets to Have Testosterone Replacement Therapy?
Clinical practice guidelines state: “We recommend making a diagnosis of androgen deficiency only in men with consistent symptoms and signs and unequivocally low serum testosterone levels.” However, the definition of “androgen deficiency” varies, as does the cut-off level of “low” serum testosterone.
International experts define androgen deficiency by not only a low level but also clinical symptoms. They will give a six months trial of therapy if it is a borderline low testosterone level and a man has any symptoms of low testosterone.
In the U.S., the normal total testosterone range is reported to be from 250 to 350 up to 1,200 nanograms per deciliter (ng/dl). However, for optimal levels, many experts argue for treatment at a much higher threshold level.
U.S. experts agree that fatigue, loss of libido, and erectile dysfunction are commonly reported. They emphasize that laboratory results must be interpreted in the appropriate clinical setting and that clinical evaluation is crucial alongside laboratory measurements.
Conclusion
The health risks of testosterone deficiencies are numerous, and it is crucial to evaluate patients based on both laboratory measurements and clinical symptoms. If you suspect you have low testosterone, seek medical advice to determine whether testosterone replacement therapy is right for you.
