Few Treated for Low Male Hormones

Most men who have symptoms of low male hormone levels are not being treated, a study has found. The condition is called androgen deficiency. It is treated with testosterone. The study included 1,486 men. About 5.5% had untreated androgen deficiency. Another 0.8% were being treated. Only about 1 out of 8 men with low hormones was getting treatment. HealthDay News wrote about the study May 27. It was published in the journal Archives of Internal Medicine.

What Is the Doctor's Reaction?

Androgens are male hormones. The best known is testosterone. It's not routine to measure these hormones. However, doctors may recommend tests for men with certain symptoms or medical problems. Examples include problems with sexual function or osteoporosis.

In the current issue of the Archives of Internal Medicine, researchers looked at androgen deficiency. They found that only 12% of men with this condition received replacement hormones.

The study's findings were based on a survey of more than 1,400 men in the Boston area. They were asked about their symptoms and medical problems. A sample of blood was tested for hormone levels.

The researchers considered study subjects androgen deficient if they had a low blood testosterone level and symptoms that often go with it. Of 97 men with low androgens, only 11 were receiving treatment.

This finding surprises me. If lack of treatment is widespread, we need to figure out why. It can't be due to a lack of treatment options. There are now many ways to provide testosterone treatment. They include injections, patches, creams and gels.

For a man with symptoms or signs of androgen deficiency, the benefits of treatment generally outweigh the risks. These risks include fluid retention, prostate enlargement, or worsening of a sleep disorder.

So why were so many men in this study not treated? A careful reading of the study may provide clues. Researchers found that a man needed treatment if he had low testosterone and any one of the following:

• Osteoporosis (low bone density)

• Problems with sexual function (erectile dysfunction)

• Low sex drive (libido)

However, a man was also classified as deserving treatment if he had low testosterone and two or more less specific symptoms. They included:

• Sleep problems

• Low energy

• Reduced physical performance (as assessed by a standard survey)

These definitions are supported by the Endocrine Society. This group includes more than 13,000 experts from 85 countries. Still, this definition could overestimate how common androgen deficiency is.

Testosterone levels can vary over time. It's also possible that some symptoms were not caused by low testosterone. In this study, more than half of the men with untreated androgen deficiency met the definition because of the less specific symptoms.

It's notable that men considered to have untreated androgen deficiency saw their doctors, on average, 15 times each year. So, limited access to medical care does not seem to explain the findings.

Those with normal androgens had fewer than seven visits per year. This raises the possibility that other medical problems were a bigger priority for those with low androgens. Their doctors also may have worried about the risk of side effects from androgen replacement.

Whatever the reasons, the findings of this study are worrisome. Androgen deficiency may cause bothersome symptoms or medical problems. Many of these could be improved or prevented with hormone treatment.

Then again, some "undertreatment" may be unavoidable. As mentioned, androgen deficiency can be hard to define. Doctors don't fully agree about who should be tested or treated.