Hypogonadism, Testosterone and Your Sex Life
There was a very interesting and important study that came out in 2010 almost
unnoticed from the New England Journal of Medicine. These fine scholars
asked the question, "What is the strongest predictor of middle and senior age
hypogonadism ("male andropause")?
One of the reasons I find this study so fascinating is that there are SO many doctors out there
who still think that low testosterone makes little difference. I get letters all
the time with horror stories from guys who have struggled for years while their
doctor completely ignored (or didn't know how to handle) their problem.
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The study authors found that there were really only three key predictors
of hypogonadism.  Notice that all three were
sexual in nature. I list them below:
- Morning Erections
- Low Libido
- Erectile Dysfunction (Impotence)
This means that low testosterone should simply be called The Great Sex Life Killer:
it removes sexual desire, makes you limp and destroys the long term health of
your penis by reducing morning erections. What's left, eh? And,
if you've read my site at all, you know that Sex is Very, Very Good for Males,
regardless of age.
So here's the bottom line, at least according to the study: if you have
the above symptoms, you should ask to get tested for low testosterone since
these are by far the most strongly correlated. Of course, I cover some of
the other studies in my link on Low Testosterone Symptoms,
but according to the NEJM, your sex life is the best indicator.
Furthermore, realize that doctors are often reluctant to identify and treat low
testosterone. Consider this fairly recent 2007 study where the researchers
1) defined low testosterone as total below 300 ng/dl and free below 5 ng/dl. 
These are very low numbers and guys will very often experience problems in the
300's and even 400's in some cases.
The study authors go on to argue, subtly, that many guys with low testosterone do
not "complain", i.e. don't report the classic symptoms. To me this is
dangerous thinking. Don't a lot of cancer patients report notice their
cancer in advanced stages? Don't we all have different thresholds of pain,
suffering and symptomatic difficulties? Guys are taught all their life not
to complain - is it any wonder some of them don't talk about symptoms relating
to low testosterone?
This is also what I find disturbing about the study. The researchers had a
Clinical Practice Guideline from the Endocrine Society that had the following
very rigorous guideline for treating low testosterone or hypogonadism:
Low total and free testosterone plus the presence of
Osteoporosis or Fracture
plus two or more of the following symptoms:
Diminished physical performance
This seems much too conservative to me. I mean you might as well just say
that you don't want to treat hypoganadism, because you've set the testosterone
level astronomically low, required osteoporosis and other questionable and
ill-defined symptoms before you treat. I ask the question:
If a guy has a couple of low testosterone readings, what else do you need,
especially considering the many dangers of low
testosterone, including increased risk of Metabolic Disorder, heart disease and
1) "NEJM, 2010; 363:123-135, "Identification of Late-Onset Hypogonadism in
Middle-Aged and Elderly Men"