What you need to know:
- Testosterone levels which are too high or too low can cause various problems. For instance, too high male hormone levels can trigger puberty in boys under the age of nine.
- It is also linked to aggression and can increase the risk of prostate enlargement and cancer.
If your male child is not showing signs of puberty by the age of 14, seek medical help for them. A number of men are struggling with symptoms associated with low testosterone levels because of age or injury to the testes or pituitary gland and yet they continue to suffer in silence.
What is testosterone?
According to Dr Vincent Karuhanga, a general physician at Friends Poly Clinic, testosterone is the male sex hormone and is mostly made in the testicles in men, but can also be produced in adrenal glands, which are near the kidneys. This hormone determines the male sex characteristics, which are also sometimes slightly found in women.
“In men, the hormone causes the voice to deepen, body hair to grow and the genitals to become larger during puberty. It is also responsible for sperm production, prominent muscles, maintaining bone density and red blood cell production, affecting sex drive and how the body distributes fat,” Dr Karuhanga says.
Women also create small amounts of the hormone in the ovaries and adrenal glands, which affects their fertility and causes them to have masculine features such as beards and prominent muscles. It also arouses their desire to have sex.
“The hormone is at its peak in women during ovulation and menstruation and while it is present in women, it is 20 times higher in men Generally, the peak time for this hormone in men is during puberty because the body needs it to develop the secondary sex characteristics in boys,” he remarks.
Male testosterone levels tend to be highest when a man is around 20 years old, and decline naturally with age.
According to Dr Martin Nsubuga, an endocrinologist at the Surgery Uganda, from around the age of 25 years, males begin to lose testosterone at about one percent per year. This is a slow but steady drop that can later cause a deficiency of the male hormone.
Testosterone levels which are too high or too low can cause various problems. For instance, too high male hormone levels can trigger puberty in boys under the age of nine. It is also linked to aggression and can increase the risk of prostate enlargement and cancer.
“Low levels of testosterone in men can cause erection problems, low sex drive, infertility, weakened muscles and bones, body fat gain and hair loss. Low male hormone levels may result in increased neuro-degeneration and decline in brain function since the male brain highly depends on appropriate levels of testosterone for healthy function,” Dr Nsubuga says.
Testosterone increases the release of dopamine, which is a neurotransmitter in the brain responsible for feelings of pleasure. This is why a deficiency of the hormone is linked to depression.
Low testosterone is a condition in which the testicles do not produce enough of the male hormone. Low levels are defined as less than 8.7 nmol/l while a healthy reading is 12 or higher (a measure of how much hormone there is in a litre of blood).
“Aging brings several bodily changes and both men and women are impacted by this factor of life differently. Men may experience graying hair, decreased muscles, low libido and with time, a decline in the level of the male hormone,” says Dr Nsubuga.
Although the decline in this hormone is a natural and gradual process, many men are distressed by it and end up with broken relationships if they do not know what is happening.
Ordinarily, women have been known to undergo menopause when they stop getting their periods and thereafter, develop hot flashes, night sweats, mood swings, headaches, lack of sleep, vaginal dryness and urinary problems, fatigue, and decreased libido are much more common.
Today, men are also emerging as likely candidates of the same symptoms dubbed as andropause, which is caused by a decline in testosterone according to Dr Karuhanga. Men go through a progressive decline in male hormone testosterone and it may be difficult to tell that an aging man has definitely reached male menopause.
He says, “The testicles do not all of a sudden stop producing the male hormone or sperms. A healthy male is able to make sperm even when they are 80 years or older.”
There are other factors in life that may bring about symptoms that resemble andropause in men. According to Dr Karuhanga, diseases such as diabetes and stress that give the same symptoms of depression, mood swings, fatigue and sexual problems just like male menopause occur more commonly at this time.
“If a man has low testosterone levels, accompanied by sexual problems including impotence, a sweaty upper body, mood swings, lack of sleep, then, he is in his andropause stage,” says Dr Karuhanga.
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There are several other causes of low testosterone levels such as conditions or injuries that affect your testicles and pituitary gland. Congenital abnormalities such as absence of testicles at birth or testicles that do not descend into the scrotum, removal of the testicles, inflammation of one or both testes, chemotherapy or radiotherapy, tumors, certain medications, viral diseases during childhood that affect the testes such as mumps.
Signs and symptoms
Low testosterone levels cause different symptoms at different ages because it can affect men at any age from birth through adulthood. It is more likely to affect older men, those who are obese, have poorly managed diabetes or have chronic medical conditions like kidney dysfunction.
The symptoms can include reduced sexual drive, erectile dysfunction, armpit or pubic hair loss, shrinking testicles, male infertility, hot flashes, depressed mood, increased body fat, fatigue, decreased muscle strength, and enlarged breast tissue.
Dr Nsubuga remarks that young adolescents with low male hormone levels experience a delay in the development of secondary sex characteristics which are meant to start not later than 14 years of age. They may not develop any pubic hair, have no deepened voice, reduced growth of the penis and testicles.
“If you have the above symptoms and signs,” Dr Nsubuga remarks, “a healthcare provider will take your medical history, examine you physically and thereafter, order your blood sample to determine the male hormone levels. The test costs about Shs60,000 and the samples may be collected between 8am and 10am when the testosterone levels are at their highest.”
How bad is a deficiency?
Low testosterone levels can cause extreme fatigue, low libido and weight gain, low sexual urge, erectile dysfunction, low sperm count, impotence, male menopause signs; a crisis that is affecting many men but they continue to suffer in silence. This is because a man with erectile dysfunction is likely to suffer low self-esteem, stress and depression.
Not having enough of the male hormone increases visceral fat stored around the abdominal organs, which can raise the risk of type II diabetes according to Dr Nsubuga. Also, low testosterone levels could increase the risk of Alzheimer's disease and dementia in older men.
There is no one time fix for low male hormone levels but consistent hormone replacement therapy can help to improve sexual drive, ease symptoms of depression and fatigue, boost muscle mass and bone density.
“For children with congenital hypogonadism at birth, hormone replacement therapy helps to prevent problems related to delayed puberty. This is why mothers must be vigilant to check their newborn babies for any defects in their testes,” Dr Martin Nsubuga, an endocrinologist at the Surgery Uganda, warns.
But, as with hormone replacement in women, testosterone replacement therapy has some potential risks and side effects. Replacing testosterone is known to worsen prostate cancer risks.
Dr Vincent Karuhanga, a general physician, usually recommends the testosterone skin gel that is applied to clean, dry intact skin of the upper arm, shoulders, or abdomen once a day but the amount is prescribed individually, depending on the client. However, before prescribing this cream, your doctor should be able to warn you about the side effects such as acne, mood changes, headaches, depression, breast enlargement and sometimes shrinking of the testes.
There are also intramuscular testosterone injections administered into the muscles that may be taken every fortnight or after 10 weeks. One may also be prescribed oral pills containing testosterone. However, if you have prostate cancer or a lump that has not been evaluated, you cannot be put on this therapy.
The best recommendation, according to Dr Karuhanga, is a lifestyle change. This includes a balanced diet plan limiting fat, sugar and salt intake. Also, a suitable exercise programme is handy in improving depression and mood swings but once this fails, one will need medication such as antidepressants to help relieve some of the symptoms of male menopause.