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Erectile dysfunction: Testosterone replacement therapy

If low testosterone is diagnosed as causing a man's erectile dysfunction, hormone replacement therapy may be recommended.

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, a sense of well-being and sexual function.

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, infection or loss of the testicles
  • Chemotherapy or radiotherapy treatment for cancer
  • Genetic abnormalities such as Klinefelter’s syndrome (extra X chromosome)
  • Haemochromatosis (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?

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 on the skin
  • Testosterone gel
  • Mucoadhesive material applied on the gums twice a day
  • Oral tablets

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 with a digital rectal examination (DRE) and PSA ( prostate specific antigen) blood test to check the size and nature of the prostate gland.

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