Testosterone Deficiency

TESTOSTERONE DEFICIENCY

Dr. Herman and Dr. Kester, top South Florida urologists, serving the Fort Lauderdale, Miami and Palm Beach areas, specialize in TESTOSTERONE DEFICIENCY. We now offer In-Office Testosterone Testing with Immediate Results.

Call us immediately to schedule an appointment for a thorough diagnosis and treatment plan.

Testosterone is the androgenic hormone primarily responsible for normal growth and development of male sex and reproductive organs, including the penis, testicles, scrotum, prostate, and seminal vesicles. Testosterone facilitates the development of secondary male sex characteristics such as musculature, bone mass, fat distribution, hair patterns, laryngeal enlargement, and vocal chord thickening. Additionally, normal testosterone levels maintain energy level, healthy mood, fertility, and sexual desire.

Testosterone production declines with age. Testosterone deficiency (TD) may result from disease or damage to the hypothalamus or pituitary gland, or from the testicles themselves. This condition is known as hypogonadism. Depending on age, insufficient testosterone production can lead to abnormalities in muscle and bone development, underdeveloped genitalia, and diminished virility.

The testes produce testosterone regulated by a complex chain of signals that begins in the brain. This chain is called the hypothalamic-pituitary-gonadal axis. The hypothalamus secretes gonadotropin-releasing hormone (GnRH) to the pituitary gland in carefully timed pulses (bursts), which triggers the secretion of leutenizing hormone (LH) from the pituitary gland. Leutenizing hormone stimulates the Leydig cells of the testes to produce testosterone. Normally, the testes produce 4–7 milligrams (mg) of testosterone daily.

TYPES of TESTOSTERONE DEFICIENCY

Hypogonadsim is classified by the location of its cause along the hypothalamic-pituitary-gonadal axis:

• Primary, disruption in the testicles
• Secondary, disruption in the pituitary
• Tertiary, disruption in the hypothalamus

Disease, injury, surgery, and drug side effects can cause hypogonadism and testosterone deficiency.

CAUSES of TESTOSTERONE DEFICIENCY

Hypogonadism may be congenital or acquired depending on the nature of the underlying condition.

Congenital causes include the following:

• Anorchia (vanishing testes syndrome; causing primary hypogonadism)
• Cryptorchidism (failure of testicles to descend into scrotum; causing primary hypogonadism)
• Hormonal deficiency (e.g., deficiency of leutenizing hormone releasing hormone; causing secondary or tertiary hypogonadism)
• Kallmann syndrome (insufficient hypothalamic GnRH production; causing tertiary hypogonadism)
• Klinefelter syndrome (underdeveloped testicles; causing primary hypogonadism

Acquired causes include the following:

• Chemotherapy
• Damage during surgery involving the pituitary gland, hypothalamus, or testes
• Glandular malformation
• Head trauma (affecting the hypothalamus)
• Infection (e.g., meningitis, syphilis, mumps)
• Isolated LH deficiency (e.g., fertile eunuch syndrome)
• Radiation
• Testicular trauma
• Tumors (of the pituitary gland, hypothalamus, or testicles)

SIGNS & SYMPTOMS of TESTOSTERONE DEFICIENCY

Congenital hypogonadism is generally characterized by underdeveloped genitalia (testes that do not descend into the scrotum) and, occasionally, undeterminable genitalia.

Hypogonadism developed near puberty can result in gynecomastia (enlargement of breast tissue), sparse or absent pubic and body hair, and underdeveloped penis, testes, and muscle.

Adult men may experience diminished libido, erectile dysfunction, muscle weakness, loss of body hair, depression, and other mood disorders.

TREATMENT of TESTOSTERONE DEFICIENCY

Treatment involves hormone replacement therapy.

The method of delivery is determined by age and duration of deficiency.

Treatment for adults is aimed at maintaining secondary sex characteristics, improving energy, strength, mood, and feelings of well-being, and preventing bone degeneration. Modes of delivery include transdermal, or intramuscular injection.

Transdermal delivery (through the skin) with a testosterone patch or gel is becoming the most common method of treatment for testosterone deficiency in adults. It establishes and maintains adequate serum levels in as many as 92% of men treated, without causing significant side effects.

Intramuscular injection (IM) is used less frequently because it is associated with erratic testosterone levels. The primary adverse effect associated with injected testosterone involves fluctuating mood, energy level, and libido caused by testosterone levels that rise rapidly upon injection and then fall too low before the next dose.

Call us immediately to schedule an appointment with Dr. Herman or Dr. Kester for the relief you deserve.