Androgen Deficiency Contents At A Glance 04 Male Hormones 06 Androgen Deficiency 10 Symptoms 11 Causes 14 - DATE REVIEWED: JANUARY 2019 (6TH EDITION) © Healthy Male (Andrology Australia) 2003 Staying Healthy 20 Diagnosis 22 Health information in this booklet describes ANDROGEN DEFICIENCY. Diagnosis and treatment options are described to help men and their families understand the health problem, Treatment 29 make men aware of the available treatment options, and to help make talking with their doctor easier. Support 45 The information contained in this booklet is based on up-to- date medical evidence. It has been provided for educational purposes only. It is not intended to take the place of a clinical Glossary 48 diagnosis or medical advice from a fully qualified health professional. Healthy Male urges readers to seek the services of a qualified health professional for any personal health Expert Reviewers 51 concerns. Although the information in this booklet has been carefully reviewed, Healthy Male does not take any responsibility for any person using the information or advice available in this booklet. Information is given on the understanding that users take responsibility for checking the relevance and accuracy of the information. Healthy Male is supported by funding from the Australian Government Department of Health and is administered by Monash University. At A Glance What causes androgen problems in the testes or the deficiency? pituitary gland. Androgen deficiency happens when there are problems within the testes How is androgen deficiency or with hormone production in the treated? brain. This may be due to genetic What is testosterone? conditions or may occur as a result Androgen deficiency is treated of other medical problems affecting with testosterone therapy; this Testosterone is the major androgen (male sex hormone) the testes (e.g. infection, surgery) means giving testosterone in doses or pituitary (benign tumours and/ that return the testosterone levels in men and is needed for normal reproductive and or their treatment). A common in the blood to a normal range. sexual function. Testosterone is required for the physical chromosomal disorder that causes Testosterone is prescribed for men androgen deficiency is Klinefelter with androgen deficiency confirmed changes that happen during male puberty, such as syndrome. by blood tests. Once started, development of the penis and testes, and for the features testosterone therapy is usually continued for life and the man typical of adult men such as facial and body hair and a How is androgen deficiency needs to be monitored regularly by masculine physique. Testosterone also acts on cells in the diagnosed? a doctor. testes to make sperm. A diagnosis of androgen deficiency involves having a thorough medical Can I do anything to prevent evaluation and at least two blood androgen deficiency? Testosterone is also important for overall good health. samples (taken in the morning on There are no known ways to It helps the growth and maintenance of bones and different days) to measure hormone levels. Diagnosis should not be simply prevent androgen deficiency muscles, and affects mood and libido (sex drive). Some based on symptoms as these could caused by damage to the testes or pituitary gland. However, if your testosterone is changed into oestrogen, the female sex be caused by other health problems that need different treatment. low testosterone levels are caused hormone, as this is needed for bone health in men. by other illness, living a healthier In a man with clinical features of lifestyle and managing other androgen deficiency, the diagnosis health problems, may improve your What is androgen deficiency? What are the symptoms of is only confirmed when blood testosterone levels. Not all men have a drop in testosterone levels androgen deficiency? tests show a lower than normal Androgen, or testosterone, testosterone level and other blood with age. Those who maintain good deficiency occurs when the Symptoms of androgen deficiency tests show whether it is due to health as they age are more likely body is not able to make enough include low energy levels, to have normal testosterone levels. testosterone for the body to mood swings, irritability, poor function normally. Although not a concentration, reduced muscle life-threatening problem, androgen strength and low libido (sex drive). deficiency can affect your quality Symptoms often overlap with of life. those of other illnesses. Androgen deficiency has different symptoms depending on the age of the man. 04 05 Male Hormones Lumen Androgens are male What are hormones? Seminiferous tubule sex hormones that Developing sperm Hormones are chemical messengers made by increase at puberty glands in the body that are carried in the blood Supporting or and are needed for a to act on other organs in the body. Hormones are boy to develop into nurse cell (Sertoli cell) needed for growth, reproduction and well-being. a sexually mature Leydig cells adult who can reproduce What are androgens? Cross-sectionLumen of a testis showing sperm-producing tubes Androgens are male sex hormones that increase (seminiferousSeminiferous tubules) tubule and Leydig cells at puberty and are needed for a boy to develop into a sexually mature adult who can reproduce. Developing sperm The most important androgen is testosterone. WhereSupporting is testosterone or made? nurse cell (Sertoli cell) Testosterone is mainly made in the testes by What is testosterone? cells (theLeydig Leydig cells cells) that lie between the Testosterone is the major androgen (male sex small tubes that make sperm (the seminiferous hormone) in men and is needed for normal tubules). Testosterone is carried in the blood to a reproductive and sexual function. Testosterone number of different organs in the body including is required for the physical changes that happen the skin, hair and muscle. A small amount of during male puberty, such as development of the testosterone is also made by the adrenal glands, penis and testes, and for the features typical which are walnut-sized glands that sit on top of of adult men such as facial and body hair. the kidneys. Testosterone also acts on cells in the testes to make sperm. How do hormones control the testes? Testosterone is also important for overall good The pituitary gland and the hypothalamus, health. It helps the growth and maintenance of located at the base of the brain, control the bones and muscles, and affects mood and libido production of male hormones and sperm. (sex drive). Some testosterone is changed into The hypothalamus makes gonadotropin-releasing oestradiol, the female sex hormone, and this is hormone (GnRH), which controls the release of important for metabolism (physical and chemical other (messenger) hormones from the pituitary processes in the body) and bone health in men. gland. Luteinising hormone (LH) and follicle stimulating hormone (FSH) are the two important 06 07 Male Hormones messenger hormones made by the pituitary gland that act on the testes to make testosterone and sperm. Hypothalamus Pituitary What happens to testosterone in the Testis blood? As testosterone moves through the body in the Hypothalamus blood, it is converted into other sex hormones, Hormone links between the brain and the testes Pituitary ‘oestradiol’ and ‘dihydrotestosterone’ (DHT). Oestradiol (a type of oestrogen) is needed for How doesTestis ageing affect testosterone male bone health and prevents osteoporosis (thinning of the bones). DHT is a powerful levels? androgen that is made from testosterone in Testosterone levels in men are highest between some parts of the body, such as the skin and the the ages of 20 and 30 years. As men age there prostate. may be a small, gradual drop in testosterone levels; this could be by up to one third between 30 and 80 years of age. How do testosterone levels change over the day? This fall in testosterone is largely due to the effects of other conditions that men may develop Blood levels of testosterone change across as they age, such as obesity, diabetes and other the day. Testosterone levels are highest early chronic health disorders. On the other hand, in the morning and lowest late in the evening. healthy older men with normal body weight Testosterone levels may also be up to 10% higher usually do not experience a significant drop in when men are fasting. This pattern across the serum testosterone levels. day is called a ‘circadian rhythm’ and happens normally in many of the body’s hormonal systems. There is no such thing as ‘male menopause’ or There is no longer term cycle for men like the ‘andropause’ that can be compared to menopause monthly menstrual cycle for women. in women. Such terms have no medical meaning and are frequently used by those wishing to promote the use of testosterone in settings where there is no real evidence that it will help and where the risks are unknown. 08 09 Androdgen deficiency Symptoms Testosterone is the What is androgen (or testosterone) What are the symptoms of androgen Symptoms of most important deficiency? deficiency? androgen deficiency androgen (male sex include low energy hormone) in men Androgen, or testosterone, deficiency is when the Symptoms of androgen deficiency include low levels, mood swings, body is not able to make enough testosterone energy levels, mood swings, irritability, poor irritability, poor for the body to function normally. Although not concentration, reduced muscle strength and concentration, a life-threatening problem, androgen deficiency low libido (sex drive). Androgen deficiency has reduced muscle can affect your quality of life. different symptoms depending on the age of the strength and low man (Table). libido (sex drive) How common is androgen deficiency? Any of these symptoms on their own may not mean you have androgen deficiency. Many Androgen deficiency caused by problems in the illnesses can cause a drop in testosterone levels testes or hypothalamus-pituitary (glands in the and some of the symptoms of these illnesses are brain) affects about one in 200 men under 60 like the symptoms of androgen deficiency.