TESTOSTERONE DEFICIENCY

Testosterone Deficiency: Getting the right help

Testosterone plays a critical role in sexual pleasure, as well as cardiometabolic, psychological and musculoskeletal health.

Increasing numbers of men accessing testosteorne therapy through testosterone clinics. But how do you know if you really do have testosterone deficiency? Are you being sold medication you don’t need? Is testosterone the only issue or is there more going on?

As an independent doctor I help men navigate these questions and challenges. I have no vested interest in ‘selling testosterone’ and give a balanced view based upon the best and most up to date evidence and a thorough assessment of you as an individual.

What is Testosterone Deficiency?

Testosterone deficiency is when your body isn’t producing enough testosterone. Testosterone is crucial to sexual function, so men with low testosterone often have sexual difficulties but it’s also important for many other aspects of health.

What are the symptoms of Testosterone Deficiency?

The three key symptoms are:

  1. Loss of sexual desire

  2. Erection difficulties

  3. Loss of morning erections

There are many other symptoms, but common ones include:

  • Lacking energy, loss of motivation, fatigue

  • Low mood & anxiety

  • Loss of muscle mass, increase in fat

  • Hot flushes

What causes Testosterone Deficiency?

There are lots of different causes of testosterone deficiency and a low testosterone level. A single low testosterone reading doesn’t mean you have testosterone deficiency.

Causes of testosterone deficiency include:

  • Primary or testicular causes: including previous infections, testicular cancer including it’s treatment, testicular injuries, haemachromatosis, Klinefelter’s

  • Secondary or hypothalamic-pituiary causes: e.g. prolactinomas, medications, previous anabolic steriod use, Kallman’s syndrome

  • Functional causes: Increasingly we see men who have no pathology of their testicles or pituitary but their low testosterone levels are the result of aging, obesity, and living with long term conditions such as diabetes and HIV.

Testosteorne levels do gradually decline with age, but for many men this doesn’t cause a problem, for others it reaches a point where they have symptoms, which many men are unaware relate to their testosterone levels.

Accurate diagnosis and thinking about underlying causes of low testosterone rather than just treating symptoms is important.

How is Testosterone Deficiency diagnosed?

Testosterone levels can vary over time, for many different reasons. Having at least two blood tests, 4 - 12 weeks apart, taken before 11am is important to diagnosis. British Society of Sexual Medicine (BSSM) guidance is that men with symptoms and a total testosterone level <8nmol/L are likely to benefit from treatment. Men with symptoms and total tesosterone level of 8-12nmol/L may well benefit from a trial of treatment.

However blood tests on their own are insufficient. Just treating blood tests is bad medicine. A careful history by an experienced clinician is important to working out whether testosterone is the cause of symptoms or not. Ruling out other diseases and exploring other aspects is important to a solid diagnosis and management plan.

How is Testosterone Deficiency treated? What is Testosterone Therapy (also known as TRT)?

There are multiple ways of treating testosterone deficiency. Some men opt for a trial of lifestyle changes with tracking of their symptoms and blood tests over time.

For men where fertility is a concern, the use of medications to stimulate your own testosterone production can be helpful.

However, for men with true testosterone deficiency, treatment with testosterone therapy can be life changing.

There are multiple types of testosterone therapy and you can find further details about different types of TRT here.

How I differ from most men’s health & testosterone clinics

There are many “testosterone clinics” filling the gap in care the NHS often leaves behind.

But there are problems with many “testosterone clinics”: There is often only one diagnosis: testosterone deficiency. Clinics are keen to fit men’s symptoms into a testosterone box and treat them with testosterone therapy whether that’s the cause of their symptoms or not.

I offer a very high standard of care, offering a unique combination of:

  • Highly qualified:

    • European certified sexual medicine specialist (FECSM)

    • Trained in both internal medicine (MRCP) & general practice (MRCGP)

  • Thorough, supportive follow up:

    • I see all patients at regular intervals ( at least 1, 3, 6 and 12 months in the first year) and more regularly if needed

    • All appointments are with me directly with adequate time to get to know each other, and explore any concerns

  • Comprehensive assessment and treatment

    • Thorough assessment of both medical and psychosexual issues

    • If testosterone is the issue, a full range of treatments, licensed and unlicensed can be discussed

    • If there are issues other than testosterone, either medical or psychosexual, these can be explored and treated too