Testosterone Diabetes Now

What is Testosterone

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The Symptoms of Low Testosterone

Typical symptoms of low testosterone are actually very non-specific. Symptoms can include just general lethargy, not feeling themselves, depression, low energy. There can be increased weight, particularly increased abdominal obesity.

More specific things can include low libido or erectile dysfunction. But many of these symptoms are actually quite non-specific, so it’s important for men who have these to not only look for a low testosterone as a possible cause, but for other possible causes as well.

Men will often present to their doctor with concerns about erectile dysfunction, low libido, thinking it might be a problem with low testosterone. And while it may be, and it’s important to test for that, it’s also important to remember that there are many other causes for low libido and erectile dysfunction outside of low testosterone. So generally speaking we should test for that and make sure that’s either a problem or if it’s not a problem that men seek other potential causes for their symptoms.

So for more information about the proper assessment of low testosterone, men can see their family doctor, get the appropriate testing as we’ve discussed or perhaps refer to an endocrinologist if deemed necessary.

Presenter: Dr. Loren Grossman, Endocrinologist, Toronto, ON

Local Practitioners: Endocrinologist

Diagnosing Low Testosterone

So if men are concerned about having a low testosterone, then there are a number of tests that can be done to check for that. They can have blood tests done. It’s important that the tests are done early in the morning, because testosterone does exhibit a circadian rhythm, and higher levels are in the morning.

So they need to go to their lab as soon as the lab opens—6, 7 o’clock to have the blood test done. Later in the afternoon is not sufficient, because levels will drop off, and the normal range that is shown on the lab result is based on an early morning sample.

Other testing to be done as well to help confirm the diagnosis and look for potential causes. Total testosterone by itself is not sufficient to diagnose low testosterone, because testosterone circulates in the blood, bound to other proteins like sex hormone binding globulin and albumin.

So it’s important to measure what’s truly available to the tissues, and that would include a free testosterone, and most importantly, a bioavailable testosterone. As well we need to look at other hormones that control testosterone, so we also need to test for the LH and the FSH, which are the pituitary control hormones, as well as other potential causes of dysfunction, including an estradiol, a prolactin, thyroid function with the TSH, as well as at least the ferritin to look at iron stores and ensure that elevated iron stores are not a cause for anything that may show up in these lab results. And that’s a good general basic assessment for low testosterone and its potential causes.

So for more information about the proper assessment of low testosterone, men can see their family doctor, get the appropriate testing as we’ve discussed, or perhaps refer to an endocrinologist if deemed necessary.

Presenter: Dr. Loren Grossman, Endocrinologist, Toronto, ON

Local Practitioners: Endocrinologist

Low Testosterone Verses Erectile Dysfunction

It’s important to realize the difference between low testosterone, or medically we call that hypogonadism, and erectile dysfunction.

It’s often mixed up. Not just by the lay public, but by healthcare practitioners. Erectile dysfunction is when the penis isn’t working, and it’s, again, related primarily to vascular issues; the blood vessels have been damaged inside the penis.

Low testosterone, on the other hand, is a more global condition where testosterone, which has most of its effects in terms of erectile function on the brain and interest in sex or libido, will have some effect on erectile dysfunction but it’s that plus more. A man who has low testosterone will often have the symptoms of low energy, low libido or interest in sex, so profound sometimes that it doesn’t even enter their minds.

They’re going to feel fatigued, their muscles are going to be weaker, they’ll sometimes describe muscle pain, decreased endurance for activities of a physical nature. It can have effects on the mind in terms of almost at times producing a depressive type of thought processes. It’s been shown in studies that these men are often very irritable and grumpy.

Testosterone also has effects on the bones; it makes your bones stronger. It affects the bone marrow where you get blood produced, and so you’re hemoglobin level will be low if you’re low in testosterone. There’s effects on the kidney, the liver, your skin, and the sexual function as well includes effects on the prostate and the genital organs. So, a testosterone deficiency syndrome is very different from simply erectile dysfunction. That’s important in terms of treatment as well.

Many people think, well, I just need some testosterone or more testosterone and it’s going to fix my erections. Well, it will help if you’ve got the testosterone deficiency syndrome, but if it’s just purely erectile dysfunction that’s not the problem. Again, erectile dysfunction is usually a vascular problem.

So, to differentiate erectile dysfunction from low testosterone you’ll need to sit down with your primary care practitioner, have a history, a physical, do blood tests to measure the blood levels of testosterone, and then come to a conclusion as to what’s going on, which will help guide treatment in your particular case.

Video Title: Low Testosterone Verses Erectile Dysfunction

Presenter: Dr. Richard Bebb, Endocrinologist, Victoria, BC

Local Practitioners: Endocrinologist

Erectile Dysfunction and Testosterone Levels

Men can have difficulties with their sexual function when they have changes to their testosterone level.

Testosterone is necessary in order for men to have normal sexual function and it even helps with some of the oral medications for erection. So, when your testosterone levels begin to fall, the first thing you will note is that your sexual drive diminishes.

The second thing is you may have a delay or more difficulty reaching orgasm. The third thing is your morning or rapid eye movements sleep – erections – REM sleep erections will be affected because they’re more sensitive to testosterone than your daytime or your visually-induced sexual erections.

So, as your testosterone levels fall from normal levels the first thing you will see is a drop in sexual drive, maybe a delay in orgasm, then you will lose your morning or REM sleep erections, and then finally your visually-induced or erotic erections. This is what happens as levels fall.

For example, if you’re on hormone medication for prostate cancer, this is the progression you’ll see, or if you slowly lose your testosterone levels – even some athletes do this – that’s the progression that you will see.

If you have more questions around your testosterone level, the first person you should see is your physician to measure those levels and to take your symptom complex to be sure that’s really what you have.

You can either be replaced with testosterone, or maybe it’s part of your other medical condition such as metabolic syndrome, or diabetes, or something else that needs to be looked at and have your levels returned back to normal.

Presenter: Dr. Stacy Elliott, Psychiatrist, Vancouver, BC

Local Practitioners: Psychiatrist

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