Testosterone is not a static presence in the blood. Its normal concentration varies among age groups, races, individuals; even in the same person, it not only varies from season to season, but hour to hour! If a man’s serum (blood) testosterone concentration were plotted on a graph, it would have as many ups and downs as the stock market has shown these past months. To complicate matters further, the effects of testosterone are not dependent solely upon the concentration of testosterone in the blood (serum), but also on androgen receptor density, structure, converting enzymes, co-factors (both activators and suppressors), genotype, nutritional status, non-genomic receptors, etc. Even when restricting the evaluation of a man’s androgen status to serum testosterone measures, there remain a number of variables, including: sex hormone-binding globulin (SHBG); albumin; etc.
Few people understand the greater scope of testosterone’s roles and action in human physiology. Certainly, there has been no call by academics, professional journals, the popular media or even the public to pursue, let alone fund, investigations into the role of testosterone and its benefits to society and individuals. This would contrast too sharply with the emotion-laden reactionary messages about the ethical violations of doping and challenges of high-risk youths abusing anabolic steroids that are so effective in gaining media attention and political backing.
Looking at testosterone objectively, one must admit that the illicit (illegal) distribution and use of testosterone and related anabolic steroids (collectively called AAS) is problematic. Despite the fact that most users are socially responsible adult men who report surprisingly moderate use, regulations need to be in place to prevent and punish illicit trafficking of AAS. Failure to do so results in the administration of abusive levels by uninformed and unsupervised users, administration of the drugs to unsuitable candidates who may have overt or covert contraindications.
It is important to know that this article addresses testosterone deficiency in men who entered adulthood with a normal testosterone status. Conservative professional societies have published treatment guidelines, dictating when androgen replacement therapy is appropriate in their consensus opinion. Licensing boards, malpractice attorneys and professional liability insurance carriers rely upon these societies, trusting them to provide authoritative standards of professional practice.
Symptoms and signs of Testosterone Deficiency
• Low count or absent sperm
• Reduced sexual desire (libido) and activity
• Decreased spontaneous erections
• Breast discomfort, gynecomastia
• Loss of body (axillary and pubic) hair
• Reduced need to shave
• Testicular atrophy
• Loss of height, easily broken bones
• Low bone mineral density (osteoporosis)
• Reduction in muscle strength and mass
• Hot flushes, sweats (similar to a woman’s hot flash)
• Loss of energy, motivation, initiative
• Lessened aggression, self-confidence
• Depressed mood, feeling “blue”
• Memory and concentration problems
• Sleep disturbance, fatigue, sleepiness
• Mild anemia (low red blood cell count)
• Increase in body fat or BMI
• Exercise intolerance, poor work performance