Men's Health Services

Testosterone deficiency occurs in approximately 5% to 8% of men. It is characterized by the presence of low T and clinical symptoms of testosterone deficiency. Up to 12% to 30% of men may have low levels without any signs or symptoms. The most sensitive signs of I deficiency are the sexual signs and symptoms: loss of sexual desire, loss of morning and other spontaneous erections, and erectile dysfunction (ED). Less specific signs include obesity, profound fatigue, loss of concentration, sadness or irritability, loss of exercise endurance, and loss of motivation.  Although most guidelines do not advocate for generalized screening as men age, if a man has a common medical problem associated with T deficiency -- such as type 2 diabetes, high blood pressure or elevated blood lipids, any chronic inflammatory disease -- that man should have a baseline testosterone test and further tests if clinical symptoms persist. In the above case, if that man had no other explanation for his fatigue or if he has a medical problem associated with T deficiency, then he should have a screening total testosterone level done and repeated if low. 

Erectile dysfunction shares common risk factors with cardiovascular disease and may be an early sign of changes in the function of blood vessels. The presence of erectile dysfunction may trigger an evaluation of cardiovascular risk which is known as a cardiometabolic workup. 

Erectile dysfunction can occur in sexually active males of any age. Studies have shown that up to 8 percent of men between 20 and 30 years old report problems with erections. For men under age 40, psychological factors more commonly contribute to the problem. 

Sexual activity can be as strenuous as walking quickly up two flights of stairs or walking one mile on a flat surface at a brisk pace. Patients who cannot do these activities may need further blood tests or tests on their heart to be sure that treatment for sexual dysfunction is safe. 

Testosterone therapy has not been shown to have any significant effects on the incidence of prostate cancer. While on testosterone therapy, your physician will check a blood test (PSA) and perform a digital rectal exam at regular intervals to follow prostate health closely. 

A study of T therapy is presently underway. This is the first such study with excellent methods and should be highly educational, though the results will not be available for 4 to 6 years. Testosterone has been used to treat medical conditions since the 1930s. Men who have low levels of T are thought to be at higher risk for heart attacks and strokes, but men who are treated with testosterone therapy appear to have the same risk as men who have normal levels of T. These relationships are known as associations, and at this time we cannot say that low I causes an increased risk of heart attack and stroke. 

Currently, most forms of testosterone therapy (with the possible exception of nasal testosterone gel) do suppress testosterone production beginning at the level of the pituitary gland and ending with cessation of testosterone production in the testes. This does not tend to bother older men as most are done fathering children. Both testosterone and sperm (semen) are produced by the testes. Thus, giving a man testosterone therapy is likely to make him infertile while he is using the therapy.