Starting around a man’s mid-30s, total testosterone generally declines at a rate of approximately 10 percent each decade. And as many as 20-30% of men over the age of 45 years have symptoms of low testosterone. It is common for men to experience symptoms of low testosterone as they age.
Testosterone plays a role in many biological processes in the body. Low testosterone levels can have a detrimental impact, and may be associated with increased risk of cardiovascular disease, insulin resistance and diabetes, decreased lean muscle mass, lower bone density, a sharper decline in sexual function and libido, brain health and cognitive function (i.e. mood).
RISK FACTORS FOR DEVELOPING LOW TESTOSTERONE
In addition to aging, your likelihood of having low testosterone increases if you have any of the following health conditions:
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Obesity
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Diabetes
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High blood sugar (pre-diabetes)
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Metabolic Syndrome (combination of high blood pressure, high blood sugar and excess fat around the belly)
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Autoimmune diseases
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Testicular damage
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High blood pressure (hypertension)
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Sleep apnea
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Fat around the waist
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Genetic conditions including Noonan or Klinefelter syndrome
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Medication side effects
LOW TESTOSTERONE: COMMON SYMPTOMS
Men with low testosterone may experience the following symptoms:
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Fatigue, lack of energy
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Decreasing or no libido (i.e. sex drive)
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Difficulty initiating or maintaining an erection
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No morning erection
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Decrease in muscle mass
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Change in fat distribution (especially around the middle)
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Weight gain unrelated to diet
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Achy joints or muscles
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Poor sleep, sleep disturbances, sleep apnea
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Poor memory
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Decrease in motivation or drive
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Difficulty concentrating or brain fog
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Feeling “past your prime”
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Depression or anxiety
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Lack of self-esteem
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Night sweats
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Gynecomastia (enlargement of men’s breasts)
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Body hair loss
https://www.webmd.com/men/guide/testosterone-replacement-therapy-is-it-right-for-you
THE IMPACT OF LOW TESTOSTERONE ON ERECTILE DYSFUNCTION
Leading urologist Dr. Abraham Morgentaler from Harvard Medical School states, “Testosterone has two important actions to help with erections. One is its actions on the sexual centers within the brain to convert arousing thoughts and sensations into nerve signals … The second is its direct actions within he penis to produce chemicals that contribute to creating an erection.”
Recent research has found that there are receptors for testosterone in the corpora cavernosa – the two chambers of the penis where erections occur. Specifically, testosterone controls some of the chemical signals that encourage blood flow during the erection process, enabling the chambers to effectively trap blood and create an erection. Another research study found that optimal testosterone levels increased the number of smooth muscle cells essential for an erection. Conversely, a lack of testosterone led to fewer smooth muscle cells and increased fatty deposits in the penis.
In summary, testosterone is critical to how the brain responds to sexual thoughts and stimulation and plays a role in the physiology of achieving an erection. Specifically, testosteorne affects the penis’s ability to get hard, to release the necessary chemical signals, and to maintain the proper types of cells essential for good erectile function.
There are multiple etiologies for erectile function – the health of the blood vessels or vascular function is affected by more than just testosterone. Poor cardiovascular health or disease play a major role in erectile function regardless of a man’s testosterone status. While optimal testosterone levels play a key role in erection function – it is important to evaluate all health variables when determining the course of treatment. At our clinic, we believe that a comprehensive approach is always advisable – you can read more about this on our Men’s Sexual Health page.
CONTROVERSIES AND ADVANCES IN TESTOSTERONE REPLACEMENT
According to Dr. Morgenthaller, “Testosterone therapy (TTh) has become highly controversial. There are important health consequences of testosterone deficiency, and meaningful benefits with treatment. There is level 1 evidence that TTh improves sexual function and desire, body composition, and bone density. Concerns regarding cardiovascular risk were based on two deeply flawed retrospective studies and are contradicted by dozens of studies showing cardiovascular benefits of TTh or higher endogenous testosterone, including placebo-controlled studies in men with known heart disease (angina, heart failure). Prostate cancer should no longer be considered a risk of TTh. Testosterone is neither scourge nor panacea—it is just good medicine.” (UROLOGY 89: 27–32, 2016)
So many men shy away from testosterone replacement therapy because of the widely-held fear of cardiac impairment associated with TRT. However there is simply no evidence of this causation. Sadly, as Dr. Morgentaler states, “once a dominant narrative has been established, it can be exceedingly difficult to return to an objective stance where the evidence again becomes paramount.”
A COMMITMENT TO A HIGHER QUALITY OF LIFE – THE BENEFITS OF TESTOSTERONE THERAPY
For the appropriate patient at the appropriate age, Dr. Kass believes that testosterone replacement can be a life-changing tool – improving vitality and quality of life despite growing older. There is compelling evidence to suggest that, when delivered safely and effectively, testosterone can not only improve symptoms but also reduce the risk of various diseases and degenerative issues, such as muscle loss (or sarcopenia), associated with aging.
Patients don’t have to resign themselves to feeling less active, social or interested in life as they age. Testosterone therapy, especially when combined with other healthy lifestyle interventions, often improves a man’s sense of well-being, motivation to exercise or participate in activities, socialize and have a healthy sexual relationship with his partner.
CHOOSING A PRACTITIONER AND TREATMENT OPTIONS
Dr. Kass has extensive training and experience in safe, effective methods of evaluating and treating testosterone deficiency. She has completed advanced hormone replacement training with one of the leading hormone experts in the U.S. and is committed to understanding and studying the nuanced hormone literature. Dr. Kass is well-versed in all testosterone delivery options and strives to find the optimal delivery for each patient’s health and lifestyle. She is one of the few practitioners trained to offer testosterone via pellet implantation in the Northwest. Dr. Kass is committed to close and careful monitoring of hormone replacement when applied and requires regular follow up and lab testing in addition to mandatory cardiovascular and prostate screening.
We seek to partner with patients who are proactive and interested in working on changing their health trajectory by taking a comprehensive approach to wellness. Dr. Kass believes there is no “one size fits all” solution and works closely with you to tailor treatments specific to you.
If you suffer from erectile dysfunction, Dr. Kass offers additional advanced therapies, including GAINSWave (aka Shockwave) Therapy, the P-Shot (Priapus Shot) and specialized compounding solutions for premature ejaculation. She also offers effective solutions for adult human growth hormone (HGH) deficiency.
