Summary
Androgens (including testosterone) are the hormones that give men their ‘male’
characteristics.
Androgen deficiency means the body has lower levels of male sex hormones,
particularly testosterone, than is needed for good health.
Causes of androgen deficiency include problems of the testes, pituitary gland
and hypothalamus.
Androgen deficiency is treated with testosterone replacement therapy.
On this page:
Androgens are sex hormones
On this page:
Androgens are sex hormones
Symptoms of androgen deficiency
Androgen deficiency in older men
Androgen deficiency in boys
Causes of androgen deficiency
Diagnosis of androgen deficiency
Treatment of androgen deficiency
Side effects of treatment of androgen deficiency
Self-prescription may not be safe
Where to get help
Androgen deficiency is when the body has lower levels of male sex hormones,
particularly testosterone, than is needed for good health. This deficiency may
be caused by problems in the areas of the brain that control the function of
the testes (the pituitary gland and the hypothalamus), or by problems in the
testes themselves. Treatment involves testosterone replacement therapy.
The term ‘male menopause’ is meaningless as it doesn’t exist: there is no
sudden, severe or inevitable drop in sex hormone production in men as
experienced by women.
A modest and gradual drop in sex hormone levels is seen across male populations
from the age of about 30 but this fall is not seen in all men. In most cases
the drop in testosterone appears to be caused by them developing other
illnesses along the way.
Androgens are sex hormones
Hormones can be thought of as chemical messengers. They communicate with
tissues in the body to bring about many different changes. Hormones are needed
for different processes like growth, reproduction and well-being.
Androgens are the group of sex hormones that give men their ‘male’
characteristics (collectively called virilisation). The major sex hormone in
men is testosterone, which is produced mainly in the testes. The testes are
controlled by a small gland in the brain called the pituitary gland, which in
turn is controlled by an area of the brain called the hypothalamus.
Androgens are crucial for male sexual and reproductive function. They are also
responsible for the development of secondary sexual characteristics in men,
including facial and body hair growth and voice change. Androgens also affect
bone and muscle development and metabolism.
The term androgen deficiency means your body is not making enough androgens,
particularly testosterone, for full health. The effects of this depend on how
severe the deficiency is, its cause and the age at which the deficiency begins.
Testosterone
The major sex hormone in men is testosterone. Some of the functions of
testosterone in the male body include:
starting and completing the process of puberty
bone and muscle development
growth of body hair, including facial hair
change of vocal cords to produce the adult male voice
sex drive (libido) and sexual function
prostate gland growth and function
sperm production.
Symptoms of androgen deficiency
When there is not enough testosterone circulating in the body, it can cause a
wide range of symptoms. However, a number of these symptoms may be non-specific
and can mimic the symptoms of other diseases and conditions.
Some of the symptoms of androgen deficiency include:
reduced sexual desire
hot flushes and sweating
breast development (gynaecomastia)
lethargy and fatigue
depression
reduced muscle mass and strength
increased body fat, particularly around the abdomen
weaker erections and orgasms
reduced amount of ejaculate
loss of body hair
reduced bone mass, therefore increased risk of osteoporosis.
Androgen deficiency in older men
If testosterone levels decline with age, a number of factors may be causing it.
In particular, any cause of poor general health, including obesity, will lower
testosterone. Recent research shows that testosterone levels do not drop significantly
in healthy older men.
The impact of the fall in testosterone levels in older men is still not
completely understood. There has been much media coverage of ‘andropause’ or
‘male menopause’, suggesting that many older men would benefit from testosterone
treatment (testosterone replacement therapy). However, there is limited
evidence to suggest benefit, and the risks are not clear.
A recent study on the effects of testosterone treatment in older men showed a
small increase in sexual function with testosterone treatment (in some cases
for less than 12 months), but no significant improvement in mood, vitality or
physical function.
Do not start any testosterone treatment without careful diagnosis of androgen
deficiency. Make sure you have a full health assessment, and that your
testosterone levels have clearly been shown to be consistently low. Often,
there are other health problems at play (such as obesity and diabetes) that
should be treated first, which may make testosterone replacement therapy unnecessary.
The effect of lower testosterone levels with increasing age and the effects of
testosterone replacement therapy in men are currently being studied. Of concern
are some studies suggesting a rise in cardiovascular disease after starting
testosterone therapy in older men, but this remains controversial.
Androgen deficiency in boys
Boys who have not completed puberty should only be treated by paediatric
hormone specialists (paediatric endocrinologists).
Causes of androgen deficiency
Some of the causes of androgen deficiency include conditions affecting the:
testes