Testosterone overdrive: Too much of a good thing

Dear Dr G,

I am 45-year-old man and happily married – until recently, anyway.

My wife noticed my libido is dwindling and my energy levels have diminished.

I get it – I am getting older, fatter and unhealthier, and cannot expect to have the zeal of a teenager.

However, both my wife and I agree the decline in my sex drive is rather out of character and suspect this is due to onset of male menopause.

I went to a specialist and learned that my testosterone level was within the normal

range, albeit on the “low normal” side.

The doctor also described the difficulties in relying on testosterone levels to diagnose male menopause.

He did suggest boosting my testosterone levels, but warned me of several risks associated with “testosterone overdrive”.

What exactly is testosterone? Is male menopause a real phenomenon? Why is diagnosing menopause so complicated? How is testosterone given to men for hormone replacement? And lastly, what are the risks I would face with testosterone overdrive?

Yours truly,

Overdriven Oliver

Testosterone is the essential hormone that is made in the “male powerhouse” – the testicles. It is important for male sexual development and reproductive function during puberty. In later years, the hormone is also crucial for maintaining the masculinity and libido in men. A decline in testosterone in men is called male menopause (with variations of the terminology describing the same condition). Many doctors use the term “andropause” to describe aging symptoms related to the declining hormone. Other commonly used names include Testosterone Deficiency Syndrome, Androgen Deficiency of the Aging Male and Late Onset Hypogonadism.

The decline of the hormone below a certain threshold can be associated with a barrage of symptoms, including a decline in libido and erectile dysfunction. Many men also describe increase in body fat (the beer belly), reduced muscle mass and decrease in bone density. The loss of bodily hair and the emergence of “moobs” (gynecomastia) are also common complaints. Lastly, low testosterone is also well-recognised to contribute to decreased motivation, insomnia, irritability and loss of self-confidence.

Testosterone level thresholds differ greatly amongst men as the hormone affects each individual differently. Even experts from International Urological and Endocrinological Associations cannot agree on the low testosterone threshold for the diagnosis of male menopause. Therefore, when the level of the hormone is in the lower range of the norm, the diagnosis is dependent on both medical history and laboratory investigations.

Testosterone replacement therapy (TRT) for men with borderline low testosterone is not unreasonable and can be administered in several ways. These include oral tablets, patches, gels, creams and injectables. Oral capsules are thought to be unwelcome as the variable hormonal absorption can result uncontrollable fluctuation of effects and can also adversely affect liver function. Topical application of testosterone is also not ideal as the hormone may be accidentally transferred to female partners, resulting in undesirable male characteristics. Lastly, injectables can potentially cause testosterone overdrive.

Supraphysiological levels of testosterone is known to provide the “fountain of youth” and allows recipients to relive the vigour of puberty.

On the flip side, excessive amount of testosterone can also result in short- and long-term complications. Minor side effects such as acne and oily skin are common complains.

Prolonged TRT is also associated with hair loss and shrinking testicles. Other intermediate risk include worsening of urinary symptoms due to enlarging prostates.

On a more serious note, testosterone can increase the amount of haemoglobin causing polycythaemia and the lethal complication of deep vein thrombosis.

TRT can also result in increased snoring due to the exacerbation of obstructive sleep apnoea and the onset of prostate cancer, especially in men with family history of such malignancy.

As a man progresses in his journey of life, declining testosterone is quite a dampener indeed. A verse from William Shakespeare’s Much Ado About Nothing goes: “A man loves the meat in his youth that he cannot endure in his age.”

Dr G’s view is “If a man cannot endure the looming acne, shrinking balls, dribbling pee, thinning crown, snoring sleep and even the risk of prostate cancer, then the love for meat and temptation for testosterone overdrive will just need to take a pause!” On that note, wishing all a normally driven and healthy CNY!