Low testosterone affects men differently: For some, it’s a devastating condition; for others, it’s little more than a nuisance. Urologists like me diagnose Low T, and gauge its severity, through a series of lab tests — but it’s by no means that simple.
Testosterone deficiency syndrome (TDS) is common, but it’s often poorly understood by doctors. A lot of men are thus misdiagnosed or get their concerns curtly dismissed when they inquire about being screened for Low T: “Welcome to middle age!” “Get more sleep and lose some weight.” “You can’t expect to perform like you did 10 years ago.”
Testosterone replacement therapy (TRT) has become big business for pharmaceutical companies — and, predictably, for disreputable health-care providers claiming to be hormone-replacement experts. Big Pharma, recognizing that men were being ill-served, developed a plethora of new Low T drugs, promoting them promiscuously — an ad blitz that naturally led men to wonder if they might be suffering from TDS.
I’m ambivalent at best about large pharmaceutical companies, but in this case they did a pretty good job of raising public awareness. The problem, though, was the broader medical community’s lack of understanding and training regarding TDS. Even some endocrinologists and urologists fail to master the topic during their education.
This dereliction by legitimate physicians opened the door to a rabble of hormone-pushing quacks. Some docs obtained “training” online or at a weekend hormone-therapy seminar. When it comes to TRT, I’ve seen it all: In my immediate area alone there are anti-aging doctors, weight-loss specialists, pediatricians, chiropractors and even OB/GYNs — who never see even a single man during their residency training! — prescribing testosterone therapy. The Web, of course, is a crackpots’ bazaar: Spend 10 minutes on Skype with some physician on the other side of the country, and he’ll send you Low T remedies by the bucketful.
As a urology resident, by contrast, I studied testosterone deficiency for six years; as an attending physician, I’ve honed my skills for an additional decade since. How do I determine whether you’re qualified for Low T screening? It starts with consideration of your symptoms. I separate Low T symptoms into three distinct categories:
- Decreased libido; lack of interest in sex
- Difficulty getting or maintaining an erection
- Lack of pleasure from sex or orgasm
- Numbness or other lack of genital sensation
- Fatigue or decreased energy
- Reduced motivation
- Depression or moodiness
- Decreased enjoyment from life
- Problems sleeping
- Reduced ability to concentrate
- Reduced endurance or muscle strength
- Difficulty shedding body fat
- Decreased ability in preferred sports
- Difficulty building muscle mass
Some men with TDS may exhibit symptoms from all three categories; others might have just one or two symptoms from only one category. There are no set guidelines — none — about how many symptoms you must be experiencing to qualify for Low T screening.
Bear in mind that knowing when to screen is only the beginning. A lab diagnosis can be extremely challenging to the inadequately trained. If you have any of the symptoms I list above, seek out a qualified urologist or endocrinologist, one with extensive experience in dealing with Low T. Get a complete evaluation so you can rule out any other causes that might explain your symptoms.
Then, if Low T is indeed the culprit, treatment must come from a physician with superb medical credentials — presumably the same one who tested you. Never ignore your symptoms, even if your family doctor thinks they’re insignificant. Don’t fall prey to dismissive physicians — or, worse, to outright charlatans — in your search for answers.
Posted on Mon, April 27, 2015
by Marc Richman, M.D.