Disappearing muscles, lack of energy, mood swings, snoring…?
Tired? Prone to weight gain? It might not just be lack of sleep or simple greed that’s the problem. If you’re a man, your excuse could be low testosterone.
For years, many medics regarded the idea of low testosterone as a bit of a joke. Now it is increasingly being recognised by the medical profession as a key factor in men’s health.
Scientists at the University of California, for instance, have found that low levels may drastically increase the risk of death in men aged over 50.
Testosterone levels fall by around one per cent a year by the time a man is 30 – age-related low testosterone is commonly referred to as the male menopause
A study of 800 men found that those with low levels had a 33 per cent increased risk of dying over an 18-year period than those with higher levels.
As many as ten per cent of British men are thought to suffer from low testosterone — or testosterone deficiency syndrome. Yet many men may not be aware that it is even a problem.
Three-quarters of men have not heard of the condition, according to a study of more than 1,000 British men presented last week at the Men’s Health World Congress in Vienna.
Furthermore, while 85 per cent of the 220 British GPs also questioned in the study considered it a medical condition worthy of treatment, 90 per cent admitted they were not aware of how it should be treated.
Testosterone deficiency syndrome is caused when the testicles, which produce testosterone, do not function normally, or when the body’s overall hormone production is out of balance.
Age is a risk factor (testosterone levels fall by around one per cent a year by the time a man is 30) — age-related low testosterone is commonly referred to as the male menopause, or andropause.
Other causes of low testosterone include diabetes, obesity and excessive alcohol consumption, explains Professor Tom Trinick, consultant physician at the Ulster Hospital in Belfast, a leading authority on testosterone deficiency.
Obesity, diabetes and alcohol lead to fat forming around the middle — this pumps out the female hormone oestrogen, counteracting testosterone.
‘Other men produce testosterone but may be resistant to it, just like diabetics are resistant to insulin,’ says Dr Malcolm Carruthers, founder of The Centre for Men’s Health in London.
But men don’t have to be fat to get testosterone deficiency syndrome, says Dr Geoff Hackett, a consultant in the urology department at the Birmingham Heartlands Hospital, a GP, and one of the co-authors of last week’s study.
‘I have a patient with low testosterone who is extremely fit — he runs triathlons and is perfectly slim.’
Damage to the testes as a result of mumps or chemotherapy for cancer can also affect testosterone levels, adds Pierre-Marc Bouloux, professor of endocrinology at University College London and The London Clinic.
As well as raising the overall risk of premature death, low testosterone is a risk factor for type 2 diabetes — which can, in turn, lead to lower testosterone, explains Dr Hackett.
‘Just like raised cholesterol can cause high blood pressure and high blood pressure can cause high cholesterol, you just treat both rather than ask which came first.’
Low testosterone is linked to other, more immediate problems — men need the hormone for muscle strength, healthy bones, positive mood and energy.
Too little can lead to weight gain, loss of facial and body hair, and joint pain. Low testosterone also causes hot flushes.
It’s also, not surprisingly, vital to a man’s potency and sex drive, says Hugh Jones, honorary professor of andrology at Barnsley Hospital and the University of Sheffield.
‘Many men in the UK blame their age or their relationship for problems with their sex lives, when actually it could be due to a hormonal imbalance.’
Under guidelines drawn up last year by the British Society for Sexual Medicine, diagnosis of the condition should be based upon symptoms such as weight gain, poor morning erection, low sexual desire and erectile dysfunction, combined with a blood test taken in the morning on more than one occasion.
Often the diagnosis and treatment are not clear cut, so a short-term trial on testosterone replacement therapy for three to six months is used to help clarify what’s wrong.
Gels and injections are the most common means of application; a single jab can last three months.
‘When testosterone replacement therapy is prescribed, it can change the lives of patients and their wives,’ says Dr Hackett.
‘Your GP should always be your first port of call with any concerns about low testosterone.’
However, others have yet to be convinced that the problem is as widespread as some say.
‘Some men do have low levels, but the root cause may be lifestyle factors such as obesity and lack of exercise,’ says professor Bouloux.
‘We must be careful that this is not being driven by the drug industry. Obese men, for example, often find that once they lose weight, hormone levels bounce back.
‘The notion of just giving testosterone to paper over the cracks, rather than undoing the damage, is quite wrong.’
Another common argument against testosterone replacement therapy has been that it may increase the risk of prostate cancer.
However, a new study by Dr Carruthers and Mark Feneley, a consultant urological surgeon at University College London, which followed more than 1,500 men who had received testosterone replacement therapy for up to 15 years, found men taking it were at no more risk of cancer than those not given the treatment.
This would suggest doctors should feel happy to recommend testosterone therapy.
Here, four men who were diagnosed with low testosterone — each with very different causes — share their stories…
‘I lost all my energy — and then put on weight.’
‘Three years ago, my legs felt like jelly and I was stumbling around like an old fool,’ said John Savage
As someone who used to spend his spare time hiking 30 miles a day, John Savage was baffled when he began suffering from extreme tiredness three years ago.
‘I’ve always been a very active person but as I stopped training so much the weight crept on,’ recalls the 69-year-old from Chapeltown, South Yorkshire.
By 60, he had type 2 diabetes (at 5ft10in he weighed 16 st) and sleep apnoea (this causes patients to stop breathing momentarily as they sleep; it is linked to snoring).
‘Then, three years ago, I found I had no energy; my legs felt like jelly and I was stumbling around like an old fool,’ he recalls.
He was diagnosed with very low testosterone while at a routine diabetes check.
His testosterone replacement therapy started with patches, ‘which weren’t great’. He now has injections every three months.
‘Everyone can notice the difference in me — I’m not 100 per cent, but I’m definitely a lot better.’
WHAT THE EXPERTS SAY: Around 40 per cent of men with Type 2 diabetes have low testosterone levels, according to a study published last year by Professor Jones.
It’s rather a chicken and egg situation; in some men, low testosterone might cause diabetes, in others diabetes may cause low testosterone.
Snoring and sleep apnoea can also affect testosterone levels, says Dr Shahrad Taheri, lead clinician in weight management at Birmingham Heartlands Hospital.
‘With sleep apnoea, you can stop breathing several times a night without realising it, causing oxygen levels in the body to drop. This in turn blocks the pituitary gland in the base of the brain from telling the testes to produce testosterone.’
Those most at risk of sleep apnoea are men over 50 who have a large waist and neck — however, around a third of patients are not overweight, but have abnormalities such as with the positioning of their tongue.
‘Low testosterone left me totally depressed.’
‘I became nasty and moody,’ said Paul Pennington
Until earlier this year, Paul Pennington had spent 13 years thinking he was suffering from depression. In this time he piled on 5 st and ‘lost friends, clients and money’.
‘My staff hated me and, looking back, I can see why,’ says Paul, 48, a broadcast journalist from North London.
‘I became nasty and moody.’
He initially blamed it on splitting up with his partner. Thinking diet and exercise would help, he desperately tried to get himself in shape again.
‘But I just didn’t have the energy,’ recalls Paul.
It was only when he saw a TV programme about testosterone deficiency that it suddenly clicked.
‘I booked a consultation and a simple blood sample confirmed I had low testosterone,’ he says. He believes the hectic, stressful lifestyle he lived in his 20s and 30s could be to blame.
Paul was prescribed a low-dose gel to apply on his shoulders twice a day.
‘Within 24 hours I felt alive again, and the brain fog had lifted.’
He is so passionate about the treatment that he recently became chief executive of the Andropause Society to raise awareness of the condition.
‘I want other men with this condition to know there is liberation from it and you can live a normal life again,’ he says.
WHAT THE EXPERTS SAY: Physical or mental stress can affect the pituitary gland and reduce the amount of testosterone produced, explains Dr Carruthers.
Stress also increases levels of the stress hormone cortisol, which also reduces testosterone secretion. Alcohol — which so many of us turn to when stressed — also plays a role.
‘Even a couple of glasses of wine a day can affect your testosterone, particularly if you are overweight,’ says Professor Trinick.
‘Something else that’s often overlooked are painkillers that contain opiates, especially if you take a lot of them. A very common one, cocodamol 30-500, is a common culprit.’
‘I felt really anxious, tired and aggressive.’
‘Some days I’d be OK, other days I’d get really anxious and feel tired and lethargic,’ said Julian Cousins
After the devastating diagnosis of cancer, Julian Cousins was one of the many thousands of men who suffered from low testosterone following chemotherapy treatment. Julian, 47, a tennis coach from South-West London, was diagnosed with testicular cancer in 2002 after finding a lump while showering.
He underwent an intensive course of chemotherapy to shrink the cancer, before undergoing surgery to remove what was left and preserve the testicle. The treatment was a success, but left him feeling dreadful.
‘Some days I’d be OK, other days I’d get really anxious and feel tired and lethargic, then wound up and aggressive,’ he says,
‘I wasn’t offered testosterone replacement, so I decided to take a herbal testosterone stimulant called Tribulus from a health food shop to boost my testosterone levels and my doctors seemed OK with this.
‘Since then I’ve been lucky enough to marry and become a dad naturally to my two girls, Emilia and Georgie.’
WHAT THE EXPERTS SAY: ‘In terms of treatment, it can take between one and two years for the hormones to recover after chemotherapy,’ says Julian’s oncologist Tim Oliver, professor Emeritus of medical oncology at St. Bartholomew’s and The Royal London School of Medicine.
‘Chemotherapy basically poisons the cancer cells, so they die. But this poisoning also affects normal cells in the body, diminishing their function and reducing the production of hormones. Some men may also find they have an earlier decline of testosterone as they age.’
In a study published in the journal Cancer, researchers from Sheffield University said that around 15 per cent of male cancer survivors develop testosterone deficiency for which they may need treatment.
Young male cancer survivors in particular experienced a marked impairment in quality of life, as well as reduced energy levels and quality of sexual function.
These experiences were exacerbated in survivors with testosterone deficiency.
‘My wife was suspicious as I lost interest in sex.’
‘Even lifting a shopping bag or picking up a tennis ball was too much in the end,’ said Paul Bearley
As the tears streamed down his face while watching the X Factor, Paul Bearley knew something was very wrong.
‘I couldn’t believe I’d gone from a fit, strong PE teacher to this,’ says the father-of three-from Sutton Coldfield. ‘I was having mood swings.’
Over the next few months, Paul, 5 ft 5 in and 11 st, gained 6 st.
‘One moment I was crying, the next lashing out at my wife and daughters. If one of the children squared up to me at school I had to hold back the tears,’ he recalls.
‘One of the most upsetting things was that my wife Susan was convinced I was having an affair, because I didn’t want to have sex.
‘It wasn’t anything to do with her — I didn’t have the energy or inclination to do anything. Even lifting a shopping bag or picking up a tennis ball was too much in the end.’
As a result, last year he was forced to retire early from work on medical grounds, aged 57.
Finally, a new GP referred him to Dr Geoff Hackett, who is based at his local hospital, to have his hormone levels checked, which were found to be low.
Now Paul receives an injection of testosterone (in the buttocks) every three months.
‘After about ten weeks Susan commented that I was being more affectionate. As time went on, we were able to get back to normal and now we’re closer than ever. She says I’m like the man she married now.’
WHAT THE EXPERTS SAY: Just how many men suffer testosterone deficiency with age is not clear — estimates vary from between eight per cent of men aged 50-79 to as high as 20 per cent.
Many middle-aged men develop erection problems and automatically turn to Viagra or similar drugs such as Levitra or Cialis.
‘But men for whom Viagra isn’t working adequately need to have their cases reviewed,’ says Dr Hackett.
‘If low testosterone is the problem then Viagra won’t be the answer on its own.’
For more information visit andropausesociety.org or orchid-cancer.org.uk