Androgen deficiency in men

Androgen deficiency in men means the body has lower than normal amounts of male hormones – most importantly, testosterone. This deficiency may be caused by problems in the areas of the brain that control the function of the testes (pituitary gland and hypothalamus) or by problems in the testes themselves. Treatment involves testosterone replacement therapy.

Androgen deficiency in older men is sometimes called ‘male menopause’, but this is misleading.

Male hormones
Hormones can be thought of as chemical messengers. They communicate with tissues in the body to bring about many different changes. Androgens are the group of sex hormones that give men their ‘male’ characteristics. They are crucial to sexual and reproductive function. They are also responsible for the development of secondary sexual characteristics in men including beard and body hair growth and bone and muscle development.

The major sex hormone in men is testosterone, which is produced mainly in the testes. The pituitary gland is a small gland located in the brain that controls the testes. This gland regulates the testes via two hormones – luteinising hormone and follicle stimulating hormone – which are also known as the gonadotrophins. The pituitary gland is under the control of a nearby area of the brain called the hypothalamus.

Lower levels of hormones result in deficiency
Androgen deficiency means the body is exposed to lower than normal amounts of androgens, particularly testosterone. The effects depend on how severe the deficiency is, its cause and the age at which the deficiency begins.

When related to ageing, androgen deficiency is sometimes called ‘male menopause’. This is a misleading term because it suggests that, like women, all men experience a dramatic drop in hormone production. This is not correct.

Functions of testosterone
The major androgenic hormone is testosterone. Some of the functions of testosterone in the male body include:

• Starting and completing the process of puberty
• Bone and muscle development
• Growth of body hair, including beard
• Change of vocal cords to produce the male voice
• Sexual drive (libido) and sexual function
• Prostate gland growth and function
• Sperm production.

• Reduced sexual desire
• Hot flushes and sweating
• Breast development (gynaecomastia)
• Lethargy and fatigue
• Depression
• Reduced muscle mass and strength
• Increased body fat, particularly around the abdomen
• Weaker erections and orgasms
• Reduced amount of ejaculate
• Loss of body hair
• Increase in ‘bad’ blood cholesterol (low density lipoproteins) and associated drop in ‘good’ blood cholesterol (high density lipoproteins)
• Reduced bone mass, increased risk of osteoporosis.

• Testes – medical problems that begin in the testes can prevent sufficient testosterone production. Some of these conditions are present from birth: for example, Klinefelter’s syndrome – a genetic disorder that affects the sex chromosomes. Other conditions may occur at various stages of a boy’s or a man’s life: for example, undescended testicles, loss of testes due to trauma or ‘twisting off’ of the blood supply (torsion), complications following mumps and the side effects of chemotherapy or radiotherapy.
• Pituitary gland – the most common condition that affects the pituitary gland and leads to low testosterone levels is the presence of a benign tumour. The tumour may interfere with the function of the gland or it may produce a hormone that stops the production of the gonadotrophins and prevents the pituitary gland from signalling the testicles to produce testosterone.
• Hypothalamus – particular conditions, such as tumours or congenital abnormalities, can prevent the hypothalamus from prompting the pituitary gland to release hormones. This will inhibit testosterone production by the testicles. This is a rare cause of androgen deficiency.

• Medical history – a full history is taken including details about fertility, sexual function, symptoms of androgen deficiency, other medical problems, occupation and drug use (prescribed and non-prescribed).
• Physical examination – a thorough general examination is performed, including measuring the size of the testicles and checking for breast development (gynaecomastia).
• Blood tests – are taken to determine the level of testosterone in the blood. Ideally, a blood test should be taken in the morning in order to detect the body’s peak release of testosterone. Testosterone should be measured on two separate mornings. The pituitary hormones should also be measured.
• Other tests – may be required to determine if testosterone deficiency is due to another underlying medical condition. This may include blood tests to check for iron levels, genetic tests (to diagnose, for example, Klinefelter’s syndrome), or CT scans of the brain (to examine the pituitary gland). Semen analysis will help to determine the potential fertility of men with androgen deficiency.

• Weight gain
• Mild acne
• Mood changes and increased aggression
• Male pattern baldness
• Breast development
• Older men may experience problems with urine flow.

• Your doctor
• Andrology Australia Tel. 1300 303 878

• Androgens are the hormones that give men their ‘male’ characteristics.
• Androgen deficiency means the body is exposed to lower than normal amounts of testosterone.
• Causes of androgen deficiency include problems and conditions of the testicles, pituitary gland and hypothalamus.
• Androgen deficiency and its treatment in older men require more research.
• Androgen deficiency is treated with testosterone replacement therapy.

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