A decrease in sexual desire and weaker orgasms, among other things, in a men might be due to a drop in androgen levels. It is also known as androgen deficiency (male sex hormone).
The prevalence of symptomatic androgen deficiency in men between 30 and 79 years is 5.6 per cent and increases substantially with age, according to a population-based, observational survey conducted in the US.
What is androgen?
Androgen is like the sex hormone testosterone. Being a hormone, androgen develops in the body when puberty kicks in. Both genders, male and female, make androgens. In males, it is the testicles that make androgens and in females, it is the ovaries.
“But it is the males who make more of it, particularly in the 10-19 age bracket, which is from puberty to adolescence,” says Dr Rajan Bhonsle, professor and head of the department of sexual medicine at KEM Hospital & Seth GS Medical College, Mumbai. Bhonsle is also the author of ‘A Practitioner’s Guide to Erectile Dysfunction – A Contemporary Clinical Approach’.
Testosterone is the most common androgen — up to 90 per cent — in all genders. The other androgens are androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate and dihydrotestosterone. This group of sex hormones plays an important role in an individual’s bodily development and reproductive health.
How important are androgens?
Male sex hormones play a crucial role in puberty, bone density, muscle development, fat metabolism, production of red blood cells, sexual desire and cognitive health.
In men, androgens help in shaping voice, sperm and bodily hair growth (including face, chest, genitals and underarms).
In females, other elements or body chemicals convert androgen into estradiol, which is a form of estrogen. This hormone helps in conception, pregnancy, regulating menstruation, growth of hair in the underarm and pubic areas, and reducing bone loss.
Effects of androgen
In men, the growth of prostate cancer is linked to male sex hormones . As part of prostate cancer treatment, patients are advised to consume hormone-lowering medication, which helps in reducing its natural production. If androgen is lower than normal limits, it can cause fatigue, depression, anxiety, concentration-related problems, low sex drive, erectile dysfunction and low exercise tolerance.
In females, abnormal androgen levels are likely to lead to obesity, polycystic ovary syndrome, ovarian tumour, abnormal menstruation, acne, excessive hair growth or hair loss, infertility and high blood pressure or cholesterol.
Lower androgen levels (or hypoandrogenism) in a person can lead to fatigue, lower sex drive and bone fractures or osteoporosis.
Identifying androgen deficiency
Mostly, a drop in androgen levels is seen in men in the age group of about 30 and above. But this fall is not seen in all the men.
“Decreased libido or reduced frequency and quality of erections, fatigue, irritability, infertility or a diminished feeling of wellbeing may be presenting complaints. However, a significant proportion of men with androgen deficiency will be identified when they present for unrelated concerns,” says a 2017 study by Raveen Kaur Sandher and Jonathan Aning.
According to a study in the British Medical Journal, “As men grow older, testosterone production and circulating concentrations of testosterone decline while comorbidities accumulate. Older men, even those in very good health, have lower circulating testosterone concentrations compared with healthy young men. Although results have been inconsistent, an increasing number of studies have reported associations of low endogenous testosterone concentration with poorer health outcomes, especially in older men. Therefore, it remains unclear whether testosterone is a biomarker of ill health or a causal factor for diseases of ageing.”
Causes of androgen deficiency
“Male hypogonadism is the condition wherein adequate hormones are not produced by the sex glands within the body. These are the hormones that play an important role in masculine growth, including sex drive and fertility,” says Dr Bhonsle.
According to him, there could be multiple causes for deficiency, right from birth (say, when the testicles do not descend) to later in life.
If the cause is from the time of birth, it could be corrected and brought down through procedures and this procedure should not be left unattended.
During one’s life, before hitting puberty, in case the child has met with an accident involving his testicles getting damaged.
Likewise, adults too face a deficiency of sex hormones (androgen) due to lifestyle-related issues. For example, those cycling regularly using hard seats can face the problem. Also, men wearing tight clothes such as undergarments, pants or shorts daily and for a long duration are most likely to face the problem.
“Prolonged exposure of testicles to heat also causes deficiency in testosterone,” says Dr Bhonsle. “[For example, among] truck and bus drivers and furnace workers. Long hot-water baths, regular steam and sauna, etc. — where temperature levels are high and there’s prolonged exposure to abnormal temperatures — are some of the common factors impacting testosterone quality.”
Another factor could be genetic conditions wherein there is a chromosome abnormality.
“This condition is also age-related, wherein middle-aged or older men experience symptoms that are similar to androgen deficiency without any certain pathological cause,” says Dr SS Vasan, a Bengaluru-based uro-andrologist with close to three-and-a-half decades of practice. “This is called late-onset hypogonadism or partial androgen deficiency in ageing men. In other words, it is andropause. Healthy men without any major illness also suffer from andropause.”
Treatment of androgen deficiency
The British Medical Journal study also says, “Currently, testosterone treatment is recommended for men who have symptoms and signs of androgen deficiency and low testosterone concentrations.”
If one is suspected to have lower androgen levels, the doctor would recommend a blood test. If the blood testosterone level is below 300 nanograms per decilitre, it means there is a shortfall and expert help is required.
“The mainstay of treatment in persisting androgen deficiency is to restore normal physiological levels of testosterone by using exogenous testosterone,” Sandher and Aning recommend in their study. “It may take at least three to six weeks to notice any clinical improvement in symptoms. Men receiving testosterone supplementation should be followed closely and have their testosterone, haematocrit and PSA [prostate-specific antigen] levels checked at three, six and twelve months after initiation of testosterone-replacement therapy. Men should then be reviewed at least annually thereafter.”
According to Dr Bhonsle, medications are prescribed in certain conditions to stimulate testicles to produce more testosterone. But if there is permanent damage, treatment may include injections, patches or application of gel, as per the direction of a sexologist.