Testosterone Deficiency
The Disease

        Most people have heard of testosterone, but very few are aware of the disease(s) resulting from the hormone’s deficiency. This situation is not surprising. Testosterone is frequently in the news media either because of its energizing effect on our sexuality or, more commonly, because of its illegal overuse to enhance athletic performance. Because of this the hormone has taken on something of a sordid, sleazy, even illegal, aura.
        The reason very few people are aware of the disease of testosterone deficiency is that no one talks about it. It’s been swept under the medical rug and kept there. Even most of the medical community know very little, if anything, about the scope and severity of this disease. Many don’t want to know about it. They are frightened by the myths and don’t want to be associated with the popular perceptions.

        The reality is that testosterone deficiency is an extremely common condition affecting men and women of all adult age groups. It robs us of our strength, energy, and sexuality. It damages our psyche and affects our personal relationships. It is a cause of, or a great contributor to, a wide range of diseases that result in illness, debility, and, ultimately, death. It is the medical tragedy of our time that the medical establishment chooses to ignore and neglect this disease. The costs in human suffering, infirmity, and death, and the costs to society in dollars, are immense.

What is testosterone?

        Testosterone is one of the steroid family of hormones. “Steroid” has become a well known term during recent decades, but few people know what the word actually means. Steroid is a descriptive chemical term defining a class of hormones that are derived from the parent compound cholesterol. There are many different steroid hormones, and different steroid hormones have markedly different, often even opposite effects. When you encounter someone expressing an opinion about "steroids" as if they were a single entity, you'll know that they have absolutely no idea of what they're talking about.

        The steroid hormones are made in the ovaries, the testes, and the adrenal glands on top of the kidneys. The main steroid hormones made by the adrenal glands are necessary for life and are secreted during our entire lifespan.

        The steroid hormone, cortisol (a form of cortisone), for example, is vital. It has major effects on our metabolism, regulating sodium and potassium concentrations and maintaining adequate blood sugar levels. It sustains blood pressure and stabilizes the cardiovascular system. It inhibits and regulates the immune system and inflammatory processes, affects our mental functioning, and inhibits new bone formation (counterbalanced by testosterone). If our adrenal glands stopped secreting cortisol, an uncommon condition, we would get progessively ill and die. This condition, an Addisonian crisis, is characterized by severe body pain, vomiting and diarrhea, and falling blood pressure and sugar levels which, if untreated, leads to seizures, coma, and death.

       The nature of cortisone is such that when large doses are used to treat a disease the hormone is catabolic (biologically destructive). It can cause or worsen diabetes, severely depress the immune system, thin bones (osteoporosis), and markedly weaken muscles.

        The main steroid hormones made by the ovaries and testes are estrogen, progesterone, and testosterone, the reproductive hormones.

        Quite the opposite of cortisone, testosterone is anabolic (biologically constructive). It is recognized as the male steroid hormone, although in both sexes it stimulates body growth, muscle and bone strength, and sexual desire. The testes make much more testosterone than the ovaries, and these larger quantities are responsible for masculine sex organs, facial hair, and body size, etc.

        In a similar way the steroid hormones estrogen and progesterone are known as female hormones because of their role in the menstrual cycle and pregnancy.

        Unlike the adrenal glands, the ovaries and testes do not secrete their hormones in adequate quantities during our entire lifespan. While these hormones are fundamental for sex and reproduction, they are not necessary for life in the manner of cortisone. The loss of testosterone does kill us, but very, very, slowly, so slowly in fact, that this fundamental reality, the devastation caused by testosterone deficiency, has yet to be fully recognized.


What are the effects of testosterone deficiency?

        As mentioned above, the disease of testosterone deficiency is insidious, coming on us so gradually that we don’t even notice it as a disease. I would divide the consequences to both sexes into five categories.

       Effects of testosterone deficiency known to, and accepted by, the medical community.
               Loss of sexual desire and responsiveness
               Chronic fatigue
               Muscle weakness
               Osteoporosis
               Anemia in older women
               Erectile dysfunction

        Effects of testosterone deficiency for which there is ample research evidence. (See “Medical Studies”)
              Type II diabetes
              Coronary artery disease
              Peripheral vascular disease
              Depression
              Senile dementia
              Prostate cancer
              Congestive heart failure
              Reduced life span

       Conditions I suspect may be caused or worsened by testosterone deficiency.
              Pneumonia in the elderly
              Symptoms of chronic lung disease
              Dependence on breathing machines
              Recurrent miscarriages
              Asthma

       Conditions I conjecture may be related to testosterone deficiency.
               Does low testosterone predispose to breast cancer?
                  (See "Medical Studies" / "Women - Testosterone and Breast cancer" / "Note from Dr. Gordon")
              Does low testosterone predispose to gynecological cancers?
              I wonder if testosterone strengthens the immune system.

                    Testosterone has so many opposite effects of cortisone, and cortisone certainly weakens the immune system.

              Would replacing testosterone preserve joint cartilage and delay the onset of osteoarthritis?
              Does low testosterone play a role in the constipation problems of the elderly?
              Would replacing testosterone preserve the strength of vertebral discs and inhibit herniation?
               I wonder if testosterone deficiency plays any role in promoting seizure activity.

                  I have a female patient in her late twenties who has had a poorly controllable seizure disorder since early adolescence. Because of her complaints of fatigue (and her testosterone deficient appearance) I checked her free testosterone level twice. The spring 2007 result was very low. Five months later her testosterone was bordering on being undetectable. (If she had 900% more testosterone in her blood she would not have too much.) I suggested a short trial of low dose testosterone replacement but, unfortunately, she declined.

        In addition to the above there are a number of effects of testosterone replacement that I have seen repeatedly in many patients:
              Anxiety and panic attacks often improve or disappear
              Many chronic and recurrent headaches lessen or disappear
              Fibroids shrink or disappear
              Menstrual cramps and excessive bleeding lessen or disappear
              Vaginitis and vaginal discomforts disappear
              Patients on replacement therapy begin to look younger


Who gets testosterone deficiency?

       There are large numbers of people of both sexes in their twenties and thirties who live with symptoms of testosterone deficiency negatively affecting their lives, and the numbers climb rapidly with each passing decade. Few people in their sixties or beyond are not testosterone deficient. As can be seen in “Medical Studies”, the U. of Florida found that about 40% of men over forty-five were deficient in testosterone.

       The young
              In my limited solo practice I have many women in their twenties, thirties and forties who exhibit what I now see as a classic triad of testosterone deficiency in young females: chronic fatigue, depression, and loss of sexuality. They live with chronic mental and physical lethargy and a complete, or near complete, disinterest in, and physical insensitivity to, sex. They even look like they’re testosterone deficient. If you take the time to notice, their mental and physical lassitude is readily apparent. They’re reluctant to move, to smile, to think. They just look blah.
        I think less men become symptomatic at this age because they start out with so much more testosterone.

       The middle aged and older
              The vast majority of men and women in the fifties, sixties, and older are deficient in testosterone. Aside from worsening fatigue, weakness, depression, and complete loss of sexual interest, the other diseases stimulated or worsened by the lack of testosterone gradually begin to become apparent: diabetes, vascular diseases, osteoporosis, prostate cancer, senility, congestive heart failure, and, I believe, recurrent pneumonia and worsening respiratory problems.


How can people find out if they are deficient in testosterone?

       It’s a simple blood test, but not so simple to get the right one done, nor to get reliable results. See “Medical Studies” / “Testosterone Blood Tests”.
        Some doctors actually refuse patients’ request to have this test done. They do this out of fear, because if it comes back abnormal they’re obliged to do something about it. If this happens to you become indignant (it's your health and life on the line), tell the doctor what you’ve learned about testosterone deficiency, suggest that he/she look at this website, demand to have the test done. If all that fails tell him/her that you’re going to go to another doctor - and do so.


What can be done about being deficient in testosterone?

       Testosterone replacement can be accomplished with pills, creams or patches, and injections. In my opinion, at the current level of knowledge and technology, the injections are, by far, the most effective therapy.


What are the undesirable side effects of testosterone?

        During the past ten years, at the proper dose, I have not seen, nor read about, any significant undesirable side effects of testosterone replacement. (See “Medical Studies” / “Prostate Cancer”.) There is really no such thing as adverse reactions to properly replacing any missing hormone. (See “New Findings, New Thoughts” / “A View on Estrogen Replacement.”)

        Testosterone therapy does not involve the taking of a stimulant drug to make us feel better. It does involve the replacing of a missing vital hormone to make us healthy again. Perhaps then the most basic question of all is whether our bodies find testosterone replacement to be biologically desirable or undesirable.   (See: “New Findings, New Thoughts” / “A View on Testosterone Deficiency”.)

E. Barry Gordon, M.D.

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