HRT is a long-established and common treatment for women experiencing dropping levels of the female sex hormone oestrogen.

Although it can be prescribed in a variety of circumstances, it is usually given to women at the onset of the menopause when it can help alleviate symptoms such as hot flushes, sleep disturbance and mood swings.

However, it’s not just women who can suffer from the effects of low hormone levels.
Increasingly, a condition known as Testosterone Deficiency Syndrome (TDS) is being recognised in men.

There are a number of medical causes of TDS, including pituitary tumours, absence of testes, certain genetic syndromes and, of course, advancing age. Stress can also be an important factor.

Symptoms can include, among other things, erectile dysfunction (ED) and loss of libido, lethargy and fatigue, hot flushes and sweating, loss of body muscle and strength, and reduction in bone mineral density.

And because irritability and a depressed mood can also be a sign, those stereotypical “grumpy old men” could in reality be suffering from TDS.

In addition to the health implications, low testosterone can also have an impact on personal relationships and self-esteem. Studies suggest that ED is thought to affect 10% of men, rising to 50% in men aged between 40 and 70.

Testosterone is an important factor in sexual function and up to 37% of men with ED will have levels low enough to cause or contribute to their problem.

But lack of awareness of TDS means that many older men simply assume that their symptoms are due to the ageing process. Although this may be true to an extent, it can be worth having a blood test to measure testosterone levels and possibly receive treatment.

However, half the problem is getting men through the door of their local health centre or surgery and figures show that only 6% of men who have one or more symptoms of testosterone deficiency have had their levels checked.

To try to rectify the situation and raise awareness, the pharmaceutical company Bayer HealthCare recently piloted a drop-in TDS testing programme at the new Aldershot Health Centre and at Farnham Hospital.

It turned out to be well worth doing because of all the men who went along to have their testosterone checked, 86% were found to have lower than normal levels. Of course, many of these men would have been prompted to attend because they were already suffering from symptoms of TDS to some extent, but even so, the results suggest that the condition is relatively widespread.

Harry Naerger, consultant urologist at Frimley Park Hospital, believes testing is important because TDS can be linked to other serious health conditions which may otherwise go unnoticed.

“Over the last four or five years, we have become more aware of the health problems associated with falling test-osterone levels,” he said.

“We now know it is associated with several other conditions, such as late onset diabetes, heart disease, an underactive thyroid and metabolic syndrome, which is characterised by increased ab-dominal fat.”

This is borne out by recent research which has correlated increased mortality in men with TDS and has also shown that 50% of men with type 2 diabetes often have low testosterone.

“The exact cause and effect situation is not easy to pin-point, but there is a clear link between TDS and several conditions,” said Mr Naerger.

“As a result, if a man has TDS, he should have a couple of other checks to eliminate conditions such as high blood pressure and diabetes.

“But low testosterone doesn’t automatically mean a man has something wrong with him. A man with TDS who has put on weight might not necessarily have metabolic syndrome.

“He might just be less inclined to exercise because he feels tired and lethargic. But in other cases, testing will allow us to give the appropriate treatment for any underlying condition and supplementation can play its part, too.

“For example, it can make diabetes easier to manage.”

However, obtaining an accurate reading is not an exact science because testosterone levels fluctuate during the day, reaching a peak at around 4am.

Mr Naerger continued: “You can’t get a true reading of levels and you would also really need to know what is normal for the specific individual.

“But despite this you can get a good idea of whether they have TDS or not. If you suspect they have, you can try giving treatment to see if it makes any difference.

“We do this by giving a short-term boost and if it makes the patient feel better, then we can start ongoing treatment.”

Once TDS has been diagnosed, treatment can be carried out at the GP’s surgery and generally takes the form of long-acting injections or subcutaneous pellets which gradually release the hormone.

While over the years there have been a number of contradictory reports and scare stories surrounding female HRT, there appears to be few disadvantages to testosterone supplementation.

“Testosterone is sometimes associated with increased aggression, but it’s important to bear in mind that with supplementation, we are simply restoring levels to normal, so this is not going to be an issue,” said Mr Naerger. “In fact, there are very few side-effects with testosterone supplementation.

“Some men lose a bit of hair, others find they have slightly increased BO and some get a few spots, but that is about it.

“There had been an assumption that giving testosterone could increase the likelihood of developing prostate cancer, but it seems as though the opposite could be the case and it could, in fact, offer protection.

“However, it is not recommended for men who already have prostate cancer.

“Getting men to become more aware of their health is difficult, but in time, as awareness increases, we could see testosterone testing becoming a mainstream screening programme carried out in the same way as cholesterol testing.

“That would be good news because TDS is easy and cheap to correct.

“Furthermore, because TDS  is a marker for a number of serious, life-threatening conditions, widespread screening could make a big difference to the lives of a large number of men.”

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