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Erectile Dysfunction
Testosterone Replacement Therapy
Testosterone
is a hormone produced by the testicles and is responsible
for the proper development of male sexual characteristics.
Testosterone is also important for maintaining muscle bulk,
adequate levels of red blood cells, bone growth, sense of
well-being and sexual function.
Inadequate
production of testosterone is not a common cause of erectile
dysfunction; however, when ED does occur due to decreased
testosterone production, testosterone replacement therapy
may improve the problem.
What
Causes Testosterone Deficiency?
As a man
ages, the amount of testosterone in his body gradually declines.
This natural decline starts after age 30 and continues throughout
life. Other causes of lowered testosterone levels include:
Injury
or infection to the testicles
Chemotherapy or radiation treatment for cancer
Genetic abnormalities such as Klinefelter's Syndrome (extra
X chromosome)
Hemochromatosis (too much iron in the body)
Dysfunction of the pituitary gland (a gland in the brain that
produces many important hormones)
Inflammatory diseases such as sarcoidosis (a condition that
causes inflammation of the lungs)
Medications, especially hormones used to treat prostate cancer
and corticosteroid drugs
Chronic illness
Chronic kidney failure
Liver cirrhosis
Stress
Alcoholism
The significance of testosterone decline is controversial
and poorly understood.
What
Are the Symptoms of Testosterone Deficiency?
Without
adequate testosterone a man may lose his sex drive, experience
erectile dysfunction, feel depressed, have a decreased sense
of well-being, and have difficulty concentrating.
What
Changes Occur in the Body Due to Testosterone Deficiency?
Decrease
in muscle mass, with an increase in body fat
Changes in cholesterol levels
Decrease in hemoglobin and possibly mild anemia
Fragile bones (osteoporosis)
Decrease in body hair
How Do I Find Out if I Have a Testosterone Deficiency?
The only
accurate way to detect the condition is to have your doctor
measure the amount of testosterone in your blood. Because
testosterone levels fluctuate throughout the day, several
measurements will need to be taken to detect a deficiency.
Doctors prefer, if possible, to test levels early in the morning
since this is when testosterone levels are at their highest.
How
Is Testosterone Deficiency Treated?
Testosterone
deficiency can be treated by:
Intramuscular
injections, generally every two or three weeks
Testosterone patch worn either on the body or on the scrotum
(the sac that contains the testicles)
Testosterone gel
Mucoadhesive material applied above the teeth twice a day
Each of these options provides adequate levels of hormone
replacement; however, they all have different advantages and
disadvantages. Talk to your doctor to see which approach may
be right for you.
Who Shouldn't
Take Testosterone Replacement Therapy?
Men who
have prostate cancer or breast cancer should not take testosterone
replacement therapy. All men considering testosterone replacement
therapy should undergo a thorough prostate cancer screening
prior to starting this therapy.
What
Are the Side Effects of Testosterone Replacement Therapy?
In general,
hormone replacement therapy is safe. It is associated with
some side effects, including:
Acne or
oily skin
Mild fluid retention
Stimulation of prostate tissue, with perhaps some increased
urination symptoms such as a decreased stream or frequency
Breast enlargement
Worsening of sleep apnea (a sleep disorder that results in
frequent night time awakenings and daytime sleepiness)
Decreased testicular size
Laboratory abnormalities that can occur with hormone replacement
include:
Changes
in cholesterol concentrations
Increase in red blood cell count
Decrease in sperm count, producing infertility (especially
in younger men)
If you are taking hormone replacement therapy, regular follow-up
appointments with your doctor are important.
Like any
other medication, directions for administering testosterone
should be followed exactly as your doctor orders. If you are
unsure or have any questions about testosterone replacement
therapy, ask your doctor.
Reviewed
by the doctors at the Glickman Urological Institute at The
Cleveland Clinic.
Edited
by Charlotte Grayson, MD, WebMD, May 2004
Portions of this page © The Cleveland Clinic 2000-2004
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