Clinical Symptoms and Signs of Age-Related Low Testosterone Production

A steady decline in testosterone levels after age 40 is a normal occurrence and virtually all men experience some decline in testosterone by the time they reach middle age and older. The normal rate of testosterone decline is relatively small -about 1% to 2% percent per year.

A relatively small percentage of aging men see a rate of decline in testosterone production that is outside the range considered normal for their age. Men whose testosterone levels drop below the normal range, can experience a wide array of symptoms some of which may not strike them as testosterone-related.

Clinical Symptoms of ADAM (experienced by patients):

  • Reduced or loss of libido: the most well recognized symptom. This symptom in particular can lead to a breakdown of relationships and marriages. It also results in loss of self-esteem and confidence. A fall in libido can, however, be commonly associated with other medical conditions, such as depression, anxiety, and acute and chronic disease states.
  • Reduction in the strength and robustness of erection as well as the loss of early-morning erection: the importance of normal testosterone levels in achieving an erection has been demonstrated in cases of men who fail to respond positively to ED medications such as Viagra (Sildenafil) due to sub-optimal testosterone levels. Testosterone substitution has been effective in converting approximately 60% of Viagra (Sildenafil) non- responders to responders. It is important to note that besides low testosterone, a number of other health conditions such as vascular disease, hypertension, neuropathy, psychogenic disorders as well as side-effects of certain drugs such as beta-blockers can cause erectile dysfunction (ED). The coexistence of testosterone deficiency with one or more of these causes of ED can exacerbate the condition.
  • Fatigue: a common symptom of ADAM is persistent tiredness. This type of fatigue can be profound and equivalent to that found in patients presenting with low thyroid function (hypothyroidism). The clinical history usually reveals a type of fatigue consistent with an organic (physiologic) rather than psychological causes. The nature of this type of fatigue, unless there is a psychological component, is that the individual usually sleeps well and on waking feels refreshed, but as the day progresses he feels gradually more and more tired and lethargic. There may also be a tendency to fall asleep during the day particularly after meals; classically after the evening meal.
  • Reduced ability to undertake physical tasks: very often, the male individual experiencing a marked reduction in his testosterone production may find it more difficult to engage in activities that require physical force or endurance. Some examples of such activity are sports such as tennis and distance walking or common household activities like gardening. This loss of physical endurance is consistent with reduced muscle strength as well as a decrease in motivation and lowering of mood.
  • Timidity and Anxiety: the well-known fearlessness of male youth is likely related to high testosterone levels. That is why very often the best, bravest, soldiers\firefighters\policemen are young men. Since anxiety is a component of fear, it is possible that low testosterone would have an effect on chronic anxiety.
  • Depression: Depression in a midlife male is not uncommon, but it can be difficult to diagnose. In almost every culture around the globe, men are taught from an early age, to control their emotions quite often by hiding them. If a man does show any signs of feelings, very likely they will not be signs of a depressed mood. Indeed, even when such signs to make their way to the surface, men do not show signs of depression the same way as women do. The weepiness and\or emotional outbursts of profound sadness the make up the female language of depression, are seldom, if ever, present in men. Instead, excessive irritability and moodiness, self-medication with alcohol or drugs, excessive sleep or sleeplessness, difficult time making decisions or enjoying former activities might be signs of depressed mood in men.
  • Irritability: mood swings can manifest themselves in the individual becoming grumpy and sometimes more aggressive. Some men, however, appear to be more placid. Testosterone deficiency is also associated with more negative than positive thoughts.
  • Poor Concentration and Memory: key areas of brain function and mental acuity are in part dependent on optimal levels of testosterone. Difficulty in maintaining concentration, sometimes perceived as a low attention span, as well as trouble remembering ordinary day-to-day items and tasks can be a simple side-effect of age-related low testosterone production.

Clinical signs of ADAM (observed by healthcare provider):

  • Decreased muscle bulk and strength.
  • Decreased bone mineral density.
  • Decreased height and low trauma fracture.
  • Shrinking testes (less than < 5ml).
  • Decreased rate of facial hair growth.
  • Increase body (abdominal) fat.
  • Increased body mass index.
  • Wrinkling of the facial skin especially around the mouth and eyes.

Note: In most cases, the specific psychological symptoms which a person manifests, may be determine by and related to their individual psyche prior to developing hypogonadism (low testosterone production) as well as life circumstances, among a host of other factors. In cases where less than optimal psychological health maybe a possibility, we strongly recommend that you consult with a professional in the field in order to ascertain the existence of a mental health issue.

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