By Nick Miller, Pharm D.
Hormones are messenger molecules. Their purpose is to convey a message from one part of the body to another. These messages are varied in their purpose, and their effect on their target cells. For sex hormones, such as testosterone, these hormonal messages cause the cell to activate sections of DNA and synthesize proteins. These proteins are critical for cellular maintenance, growth, and anti-aging effects.
As we age our production of these important hormone molecules naturally decreases, and thus we are unable to maintain our body at a cellular level. It has been estimated that testosterone levels in males drop by 1 to 2% a year starting in the mid-30’s. There are multiple reasons for this, ranging from decreased testosterone production by the testes caused by the death of Leydig cells, increased sex hormone binding globulin, and high levels of the stress hormone cortisol which results in a catabolic state. Obesity and the aromatization of endogenous testosterone to estradiol not only decreases testosterone, but increases estradiol – two things that do not help men as we get older. Low testosterone can also be medication-induced! It has been shown that medications such as statins (cholesterol lowering), SSRIs (antidepressant), opioids (pain), and neuroleptics (antipsychotic) can decrease the production of testosterone. This drop in hormones can lead to a myriad of symptoms:
- Feelings of withdrawal, sadness, anxiety, frustration, and being uninterested
- Depressed mood
- Decreased libido
- Lack of energy
- Diminished strength and/or endurance
- Loss of height
- Decreased enjoyment of life
- Decreased erectile function
- Drowsiness after dinner
- Deterioration in work performance
- Increased body fat (especially around the midsection)
- Decreased bone mineral density
Ultimately, the diagnosis of androgen deficiency should be made based on the lab levels of the androgens, and the clinical symptomatology of the patient. Providers should be familiar with the physical signs and symptoms of low testosterone, and provide screening and treatment options to males in need of replacement.
(Symptoms adapted from ADAM Questionnaire)
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