Time to ask the doctor whether your testosterone ’s flagging

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Q: I AM a 61-year-old man in generally good health, but Ive been experiencing some worrying symptoms lately. I just dont seem to have the vigour I once had, I feel fatigued much of the time, as though my mind were in a fog, and my enthusiasm for work and recreation isnt what it once was. Could I be suffering from testosterone deficiency? If so, is testosterone replacement safe and effective at my age? What tests should I undergo? What are the risks of the therapy?

A: You ask some important questions, ones I hear all the time from men in my integrative urology practice. Lets see if we can shed some light on this important issue.

First, testosterone deficiency (or "low T", as some TV ads put it) is real. There has been a gradual decline in average testosterone in men around the world over the past few decades. In industrialised nations, as many as 10% of men have testosterone below the "normal" level; that number rises to 15%-30% in diabetic or obese men.

Testosterone deficiency is unfortunately under-diagnosed; too many men have their symptoms written off as "normal ageing" or depression, when in fact there may be a chance to intervene favourably. In fact, fewer than 10% of men with testosterone deficiency receive treatment.

For reasons not yet entirely worked out, we see testosterone levels begin to decline in adult men at about the age of 30, after which levels fall by about 1% a year. So by the time you are 61, your testosterone levels are likely to have fallen nearly a third compared with what they were in your youth.

Naturally, not all men experience testosterone decline at precisely the same rate, but when levels drop as they may have in your case, its not at all unusual for there to be some changes that you can see and feel.

Although testosterone is produced by both men and women, it is traditionally thought of as a male hormone, and in men, about 90% of it is produced in the testes. We see the effects of testosterone in men after puberty in the form of so-called secondary sex characteristics: facial and body hair, a deepening of the voice, clear muscle definition, etc.

So, with decreasing testosterone levels, the changes you may see have to do with some of those features: diminished muscle mass or definition, decreased strength, and so on. Men in my practice frequently complain that their workouts arent as effective as they once were; it takes them longer and they have to work harder to maintain their "buff" look.

Widespread influence of testosterone

But testosterone is also a neurohormone, with profound effects on our behaviour and mood. So the things you may feel with declining testosterone are a decrease in sex drive and performance; sleep disturbances, including trouble getting to sleep or staying asleep; loss of concentration; irritability; and a general loss of drive for work and play, just as you report.

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Time to ask the doctor whether your testosterone ’s flagging