All about testosterone and sexuality in men.
TESTOSTERONE is a hormone produced naturally in the body. In men, it comes mainly from the testis. The adrenal glands also produce small amounts of testosterone. Many do not know this but testosterone is not exclusively a male hormone. Testosterone is also produced in women, mainly in the ovaries, but the amount of testosterone is much lower as compared to men. Testosterone causes increased muscle bulk as well as the growth of bones. In men, it helps in the development of male sex organs (penis and prostate). The deepening of the voice in men as well as growth of beard is also caused by testosterone.
Testosterone Deficiency Syndrome
When testosterone levels in the body drops below normal (less than 12 nmol/l), symptoms like lethargy, mood disturbance, irritability, loss of muscle mass, depression, loss of concentration and obesity (increased waist circumference) may occur.
This is known as testosterone deficiency syndrome (TDS). Other names for it include hypogonadism, andropause, androgen deficiency in ageing males (ADAM) and partial androgen deficiency in ageing males (PADAM). The rate of decline of testosterone levels in the body is about 1% annually after the age of 30. Testosterone deficiency may also give rise to sexual issues like loss of interest in sex, decreased arousal, low desire, low libido, erectile dysfunction and infertility in men.This will inadvertently reduce quality of life.
Treatment of TDS
The deficiency of testosterone in the body can be addressed by synthetic testosterone. There are many different preparations of testosterone. It can be swallowed as pills (oral tablets), be injected into the muscle (intramuscular) or fat (subcutaneous pellets), applied to the gums (buccal tablet), and applied on the skin as gels or patch. The intramuscular injections as well as gel preparations are more commonly used worldwide. Studies have shown conclusively that for men with low testosterone levels, when they are given testosterone supplementation, quality of life improves as the testosterone levels pick up to the normal range. The change can be quite dramatic; there is increased energy, increased muscular tone and improved mood. There is also better control of the cholesterol and sugar levels in the blood.
Effects of testosterone on sexuality
When a man falls in love, his testosterone level decreases, but the opposite is true for a woman. Men producing less testosterone are more likely to be in a relationship and/or married, and men producing more testosterone are more likely to divorce. Men producing more testosterone are also more likely to engage in extramarital sex. Higher levels of testosterone are associated with periods of sexual activity within subjects. Men who have sexual encounters with unfamiliar or multiple partners experience large increases of testosterone the morning after.
When testosterone is given to men who have testosterone deficiency syndrome (TDS), it has been shown that their sexuality improves. The enhancement of the mood and energy levels, boosted by the change in body image (as there is less body fat, decreased waist circumference and more muscle tone) will further restore their virility. Studies done in men have proven that testosterone improves sexual drive, desire and arousal.
Similarly, the quality of erection is also much improved when testosterone is administered to those with TDS. These changes can be seen as early as three weeks, though for quality of erection, it may only be noticed after six months. The effect of testosterone on sexuality in women is still controversial and much debated.
Synthetic testosterone administration is not without its side effects. It may cause acne, virilisation (excessive hair growing on all parts of the body), excessive increase in the red blood cells and worsening of sleep apnoea (a sleep disorder that results in frequent night time awakenings and daytime sleepiness), among others. Administration of synthetic testosterone may also cause the testes t shrink. This in turn will cause decreased production of sperm and may result in infertility.
Treatment of infertile men with TDS
Men who plan to start a family but have low levels of testosterone are generally not advised to take testosterone. There are other options to increase their testosterone levels without compromising their fertility. These include gonadotropin releasing hormone (GnRH), human chorionic gonadotropin (hCG), human menopausal gonadotropin (hMG), follicle stimulating hormone (FSH), anti-oestrogens (like clomiphene) and aromatase inhibitors. Two herbal medications that have undergone trials to test their effects on infertile hypogonadal men are Withania somnifera and Mucuna.
If a man is already on testosterone supplements, most studies have shown that sperm production may return to normal within a year if it is discontinued. If all fails, the last option is artificial reproductive techniques, which include extraction of a single sperm from the testis of the father and injecting it directly into the egg (oocyte) of the mother. This happens moutside of the body. When the oocyte is successfully fertilised, it is then re-implanted into the womb (uterus) of the mother. Testosterone and sexuality in men are inter-related. Replacement of testosterone in men with testosterone deficiency syndrome may overcome sexual dysfunction issues. However, those who plan to start a family should refrain from using synthetic testosterone preparations. Other options are available to increase testosterone naturally in the body.
> This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail starhealth@thestar.com.my. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.