1. Tiredness
We all look back at our twenty-year-old self and appreciate we don’t have the same limitless energy we had back then, but age is not the only reason we become more tired. Testosterone is a major metabolic hormone and significantly contributes to our energy, drive, and motivation. For example, one of the classic signs someone might be suffering with TD is reliance on caffeine. Some patients who attend clinic say that they feel they need coffee just to get through their day. Clearly this is not just normal ageing, but something more significant. Some patients with TD also say that they fall asleep after dinner while watching TV and just getting through the day feels like a daily struggle. Again, these are classic signs of the hormone deficiency.
2. Sex Drive
High levels of testosterone are synonymous with an increased sex drive, but the converse is also true. Many patients with TD tend to find they lose interest in sex, and that desire or spark that once was begins to die away. As testosterone levels continue to drop, men may also experience true erectile dysfunction and this can have a devastating effect on relationships. Often partners of someone with low testosterone can feel shunned and unwanted and this can make sex and a close relationship very hard. It doesn’t matter if it is a hormonal problem, sexual dysfunction causes an instant feeling of rejection and can really strain a relationship. The other thing to consider is morning erections. When did you last get one? With TD comes a loss of the early morning secretion of testosterone, and so does the loss of “Morning Glory”. This is an important marker that hormone levels may be dropping.
3. Mental Health
While we know that testosterone is linked to how we look and perform in the bedroom, it is also connected with how we feel. Just as we see by comparison in menopausal women, a loss of testosterone in men causes irritability, grumpiness, and can lead to depression and anxiety. In severe cases of TD, men may also describe “brain fog”; the feeling that they have trouble concentrating or focusing on tasks, become more forgetful and work performance often drops. Some men also complain that they lose that drive and motivation they had which has a further knock-on effect at work and at home.
4. Physical Changes
As we get into our forties and fifties, it can be harder to maintain the same body we had in our twenties. A lot of this is due to lifestyle commitments; we tend to have less free time to ourselves, exercise less, eat less well, have broken sleep with children and jobs, and generally less “me time”. But this should not be confused with a loss of testosterone. TD results in men losing muscle mass, increasing their body fat and various other adverse metabolic changes. These changes are often quite subtle at the start, but men often complain that their efforts at the gym become less rewarding, everything becomes a little harder, and keeping or making gains becomes an up-hill struggle. Diet also becomes much more influential and sadly the number of “cheat days or meals” afforded become less and less. Overall, TD results in more effort for less reward.
5. What you don’t see
While the physical changes in TD of body image or sexual function are clearly concerning, what occurs inside our bodies as a result of low testosterone is much more worrying. The way to think about healthy testosterone levels is as a gaussian curve of health. That is, too much makes us unwell, and so does too little. Low levels of testosterone are associated with negative effects on our metabolism and cardiovascular health. Patients with TD have an increased risk of high blood pressure, abnormal cholesterol, type 2 diabetes, memory problems, osteoporosis (bone thinning), and heart attack and stroke.
