There has been an explosion of information regarding Low Testosterone levels in the past several years. It is important to realize that not every man, even with what is considered Low Testosterone, needs to replace the hormone. The issue is whether or not a man is symptomatic.
It is not enough to tell your doctor that you are more tired than you used to be. There is a questionnaire with the acronym ADAM that is an indicator of symptomatic testosterone deficiency. ADAM stands for Androgen Deficiency in the Aging Male.
Most think of Erectile Dysfunction as a symptom of low testosterone and that may or not be true. The development of ED is actually somewhat predictive as the first symptom of future cardiovascular disease, the number one cause of death in the United States. Erectile dysfunction usually is caused from inadequate blood flow to the penis to achieve or maintain an erection. Atherosclerosis, high blood pressure and insulin resistance play an important role in addition to testosterone.
Some of the more common symptoms of low testosterone include loss of muscle mass, midsection weight gain, loss of sex drive and not being able to think as clearly or as organized as in the past.
Most men are screened for total testosterone levels and if they are in the “normal” range, even symptomatic men may be dismissed as not needing testosterone replacement. However, the total testosterone for that particular man, if symptomatic, may be less than optimal for him.
More important than total testosterone is the free testosterone level which is the amount of hormone available for binding with testosterone receptors. Bound testosterone to sex hormone binding globulin is not available for receptor interaction. Only free testosterone is available for use.
It is most important to monitor men who elect to undergo testosterone replacement. Lab tests should be done fairly frequently at the start and if stable may be done less often. This includes measuring blood counts to check for escalating hematocrit levels and Prostate Specific Antigen (PSA test) to screen for prostate cancer.
Evidence does not indicate that testosterone causes prostate cancer but is strong that it will grow a small prostate cancer that has already developed. Blood clotting and heart attack rates can increase in men on testosterone whose bone marrow produces a significant increase in red blood cells. This blood clotting risk can be reduced by donating blood every 2–3 months and keeping hematocrit levels below 52%.
The benefits of testosterone replacement include improved sex drive, firmer erections, increased muscle mass, less insulin resistance, weight loss, better mental clarity and better bone mass.
If a man has no symptoms, then testosterone replacement is really not indicated. The ADAM score questionnaire from St. Louis University is below. Men with symptomatic testosterone deficiency score 3 or higher on this screening test.