Getting answers to common questions

Men can develop TDS for a number of reasons, often the cause is not identified. However, typical causes of TDS include Type 2 diabetes, damage to the testes through illness, surgery or sport, or genetic causes such as Klinefelter’s syndrome.

If you’re rarely in the mood for sex, often feel tired, have disturbed sleep and perhaps have difficulty getting an erection, you may have Testosterone Deficiency Syndrome (TDS). TDS is defined as having a low testosterone level (usually below 12 nmol/L). There are other signs such as increased fat around the stomach, depression, decreased lean body mass and body hair. ^{36, 50} But TDS is often undetected because the symptoms are quite general and usually put down to ‘getting older’.

Testosterone not only enables a man to have an erection and experience sexual desire (libido), it is also important for maintaining muscles, healthy bones, positive mood and physical energy. Because of this, the effects of low testosterone span a whole range of symptoms such as lack of energy, depression, loss of libido, loss of facial and body hair and, potentially, increased risk of developing osteoporosis^36,1.

Testosterone replacement therapy is effective for treating the symptoms of TDS and is available in a number of formulations, which include: trans-dermal gels, long or short-acting injections, patches, oral tablets and subcutaneous implants.

Over time, you should find that your mood, sex drive and muscles are improved. Growth of body hair will also show that your treatment is working. However it is important not to expect rapid improvements; several months of treatment may be required before changes are apparent.

Your testosterone level and symptoms will be monitored a few weeks after you begin therapy to check that you are getting the right amount of treatment. Your GP should also check your testosterone levels, red blood cell count and prostate specific antigen (PSA) levels at three monthly intervals for the first year and annually after that^36,1.

The most common side effects are skin reactions in the area where the treatment is applied or injected. Other potential side effects include aggravation of existing prostate cancer, suppressed sperm production, raised red blood cell count, fluid accumulation and weight gain.

There is no clear evidence to show that restoring testosterone levels causes prostate cancer in men with TDS³. Incidence of prostate cancer is at its highest when testosterone levels are at their lowest, in later life³². However, testosterone replacement therapy can lead to an increase in the size of the prostate gland. Testosterone replacement therapy should not be used in patients with known or suspected prostate cancer or breast cancer⁵⁰. So before you start therapy, your prostate gland and/or PSA will need to be examined to check for prostate cancer. Your doctor should also make checks on your prostate and/or PSA regularly during treatment, generally annually^36,1. However, this may increase or decrease in frequency depending on age.