When it comes to health, men rarely talk. When it comes to sexual health and libido, the conversation just doesn't exist. Men are notoriously difficult to deal with when it comes to expressing concerns about their masculinity and libido. As they age the amount of testosterone in a man's body reduces and this can lead to loss of sexual appetite, stress and feelings of insecurity. In this short guide, we'll explain what Testosterone Deficiency Syndrome is and what can be done to reassert a decent quality of life.
Testosterone is a hormone that is produced by the body in the testes.3 It is required by all men for a healthy life physically and psychologically.1,4,5 Testosterone is the hormone responsible for stimulating sperm production and sex drive, as well as supporting the development of muscle and bone mass.3,5
What is Testosterone Deficiency Syndrome (TDS)?
Testosterone Deficiency Syndrome or TDS is when the level of testosterone drops to an unusually low level, or stops being produced altogether and symptoms occur.1 Signs of TDS are often subtle and can be mistaken as a part of ageing.6
Who does TDS affect?
TDS most commonly affects 8% of men aged between 50 and 79 years old.1 The prevalence of TDS increases with age and has been linked to certain risk factors, these include: chronic illness (diabetes mellitus, chronic obstructive lung disease, inflammatory arthritic, renal and HIV-related diseases), obesity, prolactinoma, excessive alcohol consumption, metabolic syndrome and haemachromatosis, as well as chronic opiate therapy and androgen deprivation therapy (for prostate cancer).1
What are the symptoms of TDS?
The symptom most associated with TDS is low libido, however, the absence of morning erections is one of the most recognisable symptoms.1
Symptoms of TDS include:
- Low libido
- Erectile dysfunction
- Ejaculatory dysfunction
- Reduced muscle mass and weakness
- Reduced well-being
- Loss of concentration
- Hot flushes and sweats
- Reduced body hair
How is TDS diagnosed?
Assessment of low testosterone may be undertaken over several consultations with a GP or specialist, who will take a patient’s history, clinical examination along with completion of a questionnaire, and serum testosterone tests (blood tests to measure testosterone levels in the patient’s blood).1 The diagnosis of this condition is based on the presence of appropriate symptoms, combined with a reliable measurement of testosterone levels taken in the morning, on more than one occasion.1
How is TDS treated?
There are many treatment options available for men who have testosterone deficiency syndrome, including changes to diet and lifestyle.1,8 Treatment is aimed at restoring the normal level of testosterone to improve wellbeing, sexual function, and quality of life.9 Testosterone replacement therapy options are available, and may be in the form of gels applied to the skin, injections and oral formulations.10
1 British Society for Sexual Medicine (BSSM). Guidelines on the Management of Sexual Problem in Men: The role of Androgens. 2010 (p.4A, 5A, 5B, 5C, 5D, 5E, 5F, 6A, 6B)
2 Office of National Statistics. 2011 Census: Population Estimates for the United Kingdom. 2011. (p.9A, 10A)
3Men’s Health Forum. Testosterone FAQs. 2014. Accessed February 2015 from: http://www.menshealthforum.org.uk/testosterone-faqs (p.1A, 1B)
4 Dandona, P. and Rosenberg, M.T. A Practical Guide to Male Hypogonadism in the Primary Care Setting. The International Journal of Clinical Practice. 2010. 64(6): 682-696 (p.688A)
5 Andropause Society. About Andropause (Testosterone Deficiency Syndrome). 2014. Accessed February 2015 from: http://www.testosteronedeficiency.org/downloads/Prof-Tom-Trinick-TDS-Q&A.pdf (p.1A, 1B)
6 NHS Choices. The 'male menopause'. 2014. Accessed March 2015 from: http://www.nhs.uk/conditions/male-menopause/Pages/Introduction.aspx (p.1A)
7 Sternbach, H. Age-associated testosterone decline in men: clinical issues for psychiatry. American Journal of Psychiatry. 1998. 155(10):1310-1318 (p.1311A)
8 Huefelder, A.E. Fifty-two–Week Treatment with Diet and Exercise Plus Transdermal Testosterone Reverses the Metabolic Syndrome and Improves Glycemic Control in Men With Newly Diagnosed Type 2 Diabetes and Subnormal Plasma Testosterone. Journal of Andrology. 2009. 30(6): 726-733 (p.730A)
9 Maggi, M. et al. The burden of Testosterone Deficiency Syndrome in Adult Men: Economic and Quality of Life Impact. Journal of Sexual Medicine. 2007. 4(4): 1056-1069 (p. 1A, 3A, 3B, 3C, 3D, 4A)
10 MIMS. Hypogonadism and other sexual disorders. 2015. Accessed February 2015: http://www.mims.co.uk/drugs/endocrine/hypogonadism-other-sexual-disorders (p.1A)Last modified: June 10, 2021