Saturday, June 25, 2011

Hypogonadism or Low testosterone


Hypogonadism or  Low testosterone
Hypogonadism is a medical term for decreased functional activity of the gonads. Low testosterone is caused by a decline or deficiency in gonadal production of testosterone in males. The gonads, typically called testicles in males, produce hormones (testosterone, estradiol, antimullerian hormone, progesterone, inhibin B, activin) and gametes or sperm.
Symptoms
In men
Effects of low testosterone in men may include: (not all are present in any single individual)
    Poor libido (Low sexual desire)
    Fatigue (medical) always tired
    Muscle loss/atrophy
    Erectile Dysfunction
    Increasing abdominal fat
    Glucose intolerance (early diabetes)
    High Cholesterol/Lipid
    Poor sleep
    Difficulty concentrating
    Memory Loss-difficulty in choosing words in language
    Shyness
    Depression
    Anxiety
    Psychological and relationship problems
    Gynecomastia
    Hot flashes
    Decrease in growth of, or loss of, beard and body hair
    Loss of bone mass (osteoporosis)
    Irritability
    Infertility
    Shrinking of the testicles
    Decrease in firmness of testicles
    Frequent urination (polyuria) without infection/waking at night to urinate
    Achy muscles
    Liquid stools
    Night sweats
    Dry skin and/or cracking nails

In women
    Effects of low estrogen levels in women may include: (not all are present in any individual)
        Hot flushes
        Irritability/Aggressiveness
        Poor libido/Anger
        Infertility
        Loss of, or failure to develop, menstruation
        Loss of body hair
        Loss of bone mass (osteoporosis)
        Heart disease
        Sleep disturbances
        Symptoms of urinary bladder discomfort like frequency, urgency, frequent infections, lack of lubrication, discharge
        Shrinking of breasts
        Loss of or nonexistent sense of smell

Diagnosis
In men

Low Testosterone can be identified through a simple blood test performed by a laboratory, ordered by a physician. This test is typically ordered in the morning hours, when levels are highest, as levels can drop by as much as 13% during the day.
Normal total testosterone levels range from 300 - 1000 ng/dl
Treatment is often prescribed for total testosterone levels below 350 ng/dl. If the serum total testosterone level is between 230 and 350 ng/dl, repeating the measurement of total testosterone with sex hormone-binding globulin (SHBG) to calculate free testosterone or free testosterone by equilibrium dialysis may be helpful.
Blood testing
A position statement by The Endocrine Society has expressed dissatisfaction with the manner in which most assays for TT (Total Testosterone) and FT (Free Testosterone) are currently performed. In particular, research has questioned the validity of commonly administered assays of FT by RIA. The FAI (Free Androgen Index) has been found to be the worst predictor of Free Testosterone.
Hypogonadism can have many psychological effects, due to low libido, erectile dysfunction, depressed mood, lethargy, diminished physical performance, infertility and/or appearance. Possible treatments include the use of regular injections or the application of gels, patches, or ointments.
In women
Similar to men, the LH and FSH will be used, particularly in women who believe they are in menopause. These levels change during a woman's normal menstrual cycle, so the history of having ceased menstruation coupled with high levels aids the diagnosis of being menopausal. Commonly, the post-menopausal woman is not called hypogonadal if she is of typical menopausal age. Contrast with a young woman or teen, who would have hypogonadism rather than menopause. This is because hypogonadism is an abnormality, whereas menopause is a normal change in hormone levels.
Hypogonadism is often discovered during evaluation of delayed puberty, but ordinary delay, which eventually results in normal pubertal development, wherein reproductive function is termed constitutional delay. It may be discovered during an infertility evaluation in either men or women.
Treatment
Male hypogonadism is most often treated with testosterone replacement therapy (TRT). Commonly-used testosterone replacement therapies include transdermal (through the skin) using a patch or gel, injections, or pellets. Oral testosterone is no longer used in the U.S. because it is broken down in the liver and rendered inactive; it also can cause severe liver damage. Like many hormonal therapies, changes take place over time. It may take as long as 2–3 months at optimum level to reduce the symptoms, particularly the wordfinding and cognitive dysfunction. Testosterone levels in the blood should be evaluated to ensure the increase is adequate. Levels between 500-700 ng/dl are considered adequate for young, healthy men from 20 to 40 years of age, but the lower edge of the normal range is poorly defined and single testosterone levels alone cannot be used to make the diagnosis. Modern treatment may start with 200 mg intramuscular testosterone, repeated every 10–14 days. Getting a blood level of testosterone on the 13th day will give a "trough" level, assisting the physician in deciding whether the correct dose is being given.
Recently some have reported using anastrozole (Arimidex), an aromatase inhibitor used in women for breast cancer, to decrease conversion of testosterone to estrogen in men, and increase serum testosterone levels.
While historically men with prostate cancer risk were warned against testosterone therapy, that has
Other side effects can include an elevation of the hematocrit to levels that require blood to be withdrawn (phlebotomy) to prevent complications from it being "too thick". Another is that a man may have some growth in the size of the breasts (gynecomastia), though this is relatively rare. Finally, some physicians worry that Obstructive Sleep Apnea may worsen with testosterone therapy, and should be monitored.
Another feasible treatment alternative is human chorionic gonadotropin (hCG).
For both men and women, an alternative to testosterone replacement is Clomifene treatment which can stimulate the body to naturally increase hormone levels while avoiding infertility and other side effects as a consequence of direct hormone replacement therapy.
For women, estradiol and progesterone are replaced. Some types of fertility defects can be treated, others cannot. Some physicians will also give testosterone to women, mainly to increase libido.

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