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Home , Androgen, Androgen deficiency

FFactact Sheet () Deficiency

What are ?

Hormones are chemical messengers made by glands in the body that are carried in the blood to act on other organs in the body. are needed for growth, reproduction and well-being.

2 hormones from the pituitary - e n

Luteinising (LH) and Follicle o Stimulating (FSH) - act on the r Androgens are male sex hormones that increase at e t testis to stimulate production s o and are needed for a boy to develop into of testosterone and sperm. t s e a sexually mature adult who can reproduce. The T

most important androgen is testosterone. 2 hormones from the pituitary - e n

Luteinising (LH) and Follicle o Stimulating (FSH) - act on the r What is testosterone? e t testis to stimulate production s o Testosterone is the most important androgen of testosterone and sperm. t s e (male sex ) in men and it is needed T for normal reproductive and sexual function. Testosterone is important for the physical changes that happen during male puberty, such as development of the penis and testes, and for the features typical of adult men such as facial and Pituitary and a masculine physique. Testosterone also acts on cells in the testes to make sperm. Testis

Testosterone is also important for overall good health. It helps the growth of and muscles, and affects mood and (sex drive). Some testosterone is changed into oestrogen, the female How do hormones control the testes? , and this is important for health in men. The and the hypothalamus, located at the base of the , control the production of Testosterone is mainly made in the testes. A male hormones and sperm. small amount of testosterone is also made by the Hypothalamus(LH) and follicle stimulating hormone (FSH) are the adrenal glands, which are walnut-sized glands that two important messenger hormones made by the sit on top of the kidneys. Pituitarypituitary gland that act on the testes. LH is needed for the Leydig cells in the testes Testisto make testosterone, the male sex hormone. Testosterone and FSH from the pituitary gland then act together on the seminiferous tubules (sperm-producing tubes) in the testes to make sperm.

1 / 4 What is androgen (or testosterone) deficiency? Symptoms of androgen Androgen, or testosterone, deficiency is when the body is not able to make enough testosterone deficiency at different for the body to function normally. Although not a stages of life life-threatening problem, can affect your quality of life. How common is androgen deficiency? Early childhood • (penis does not grow to Androgen deficiency due to of the testes expected size) or hypothalamus-pituitary affects about one in 200 men under 60 years of age. It is likely that • Small testes androgen deficiency is under-diagnosed and that many men are missing out on the benefits of Early teenage years (puberty) treatment. About one in 10 older men may have • Late puberty or failure to go through full testosterone levels lower than those in young men, normal puberty but this is usually linked with chronic illness and obesity. The benefits and risks of testosterone • Small testes and penis treatment for such men are not yet known. • Poor development of facial, body or • Poor muscle development How does ageing affect testosterone • Voice does not deepen (larynx levels? underdeveloped) Testosterone levels in men are highest between • ( development) the ages of 20 and 30 years. As men age there is • Poor growth (height) surge a small, gradual drop in testosterone levels; they may drop by up to one third between 30 and 80 years of age. Adulthood • Mood changes (low mood and irritability) Some men will have a greater drop in testosterone levels as they age, especially when they are • Poor concentration obese or have other chronic (long-term) medical • Low energy (lethargy, low stamina) problems. On the other hand, healthy older men • Reduced muscle strength with normal body weight may not experience any • Increased body fat drop in serum testosterone levels. • Decreased libido (low interest in sex) There is no such thing as ‘male ’ or • Difficulty getting and keeping erections ‘andropause’ that can be compared to menopause (uncommon) in women. • Low semen volume What are the symptoms of androgen • Reduced beard or body hair growth deficiency? • Gynecomastia () • Hot flushes, sweats Low energy levels, mood swings, irritability, poor concentration, reduced muscle strength and low • (thinning of bones) sex drive can be symptoms of androgen deficiency (low testosterone). Symptoms often overlap Later life (after 60 years) with those of other illnesses. The symptoms of androgen deficiency are different for men of • Mood changes (low mood and irritability) different ages. • Poor concentration What causes androgen deficiency? • Easily fatigued • Poor muscle strength Androgen deficiency can be caused by genetic • Increased body fat disorders, medical problems, or damage to the • Decreased libido (low interest in sex) testes or pituitary gland. Androgen deficiency happens when there are problems within the testes • Difficulty getting and keeping erections or with hormone production in the brain. A common • Gynecomastia (breast development) chromosomal disorder that causes androgen • Osteoporosis (thinning of bones) deficiency is Klinefelter syndrome.

2 / 4 How is androgen deficiency What are the side-effects of diagnosed? testosterone therapy?

A diagnosis of androgen deficiency involves having Side-effects are not expected because a thorough medical evaluation and at least two testosterone therapy aims to bring a ’s blood samples (taken in the morning on different testosterone levels back to normal. However, days) to measure hormone levels. Diagnosis should testosterone therapy can increase the growth of not be simply based on symptoms as these could the gland which can make the symptoms be caused by other health problems that need of benign prostate enlargement (such as needing different treatment. A diagnosis of androgen to urinate more often) worse. In the case of deficiency is only confirmed when blood tests show , testosterone therapy is not a lower than normal testosterone level. used because of concerns that it can make the tumour grow. Too high a dose of testosterone can What is the ‘normal’ testosterone lead to , weight gain, gynecomastia (breast reference range? development), male-pattern and changes in mood. Any side-effects should be managed by a A reference range is used as a guide by testing doctor and the testosterone dose lowered. laboratories and doctors to decide whether a person’s hormone levels are normal or low, and Can herbal products help androgen whether treatment may be needed. Testosterone deficiency? is measured in units called nanomalor. The ‘normal’ testosterone reference range for healthy, young There are many herbal products marketed, adult men is about 8 to 27 nanomolar but these particularly on the Internet, as treatments that numbers vary between measurement systems. can act like testosterone and improve muscle strength and libido (sex drive). However, there How is androgen deficiency treated? are no known herbal products that can replace testosterone in the body and be used to treat Androgen deficiency is treated with testosterone androgen deficiency. therapy; this means giving testosterone in doses that return the testosterone levels in the blood to Will testosterone therapy affect my normal. Testosterone is prescribed for men with fertility? androgen deficiency confirmed by blood tests. Once started, testosterone therapy is usually Testosterone therapy generally stops the continued for life and the man needs to be checked production of the pituitary hormones FSH and regularly by a doctor. LH, which reduces the size of the testes and can lower or stop sperm being made. Testosterone What are the main forms of treatment should not be given to a man wanting testosterone therapy? to become a father in the foreseeable future. If sperm production was normal before testosterone In Australia testosterone therapy is available therapy, it usually recovers after treatment stops in the form of injections, gels, creams, patches but it can take many months to go back to normal. and tablets, and works very well for men with confirmed androgen (testosterone) deficiency. Will testosterone therapy affect The type of treatment prescribed can depend on sporting performance? patient convenience, familiarity and cost. Testosterone therapy in men with androgen Commercial testosterone products contain deficiency aims to bring testosterone levels back only the natural testosterone molecule that is to normal and to return muscle strength and chemically produced from plant materials. energy levels back to normal. However, the use of androgens (anabolic ) by normal men to improve athletic performance is illegal and has important short-term and long-term health risks.

Men who use anabolic steroids will lower or even turn off their own testosterone and sperm production. It may take many months for testosterone levels and sperm counts to return to normal after stopping anabolic steroids.

3 / 4 Can I do anything to prevent androgen deficiency?

There are no known ways to prevent androgen deficiency caused by damage to the testes or pituitary gland. However, if you live a healthier lifestyle and manage other health problems your testosterone levels may improve, if your low testosterone levels are caused by other illness. Not all men have a drop in testosterone levels with age. A healthy lifestyle may help you to keep testosterone levels normal.

Visit healthymale.org.au or speak to your doctor for more info.

EXPERT REVIEWER Prof Rob Mclachlan AM MBBS FRACP PHD Healthy Male (Medical Director)

DATE REVIEWED: MAY 2018

The information in this fact sheet has been provided for educational purposes only. It is not intended to take the place of a clinical diagnosis or proper medical advice from a fully qualified health professional. Healthy Male urges readers to seek the services of a qualified medical practitioner for any personal health concerns.

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© Healthy Male (Andrology Australia) 2018