DEFICIENCY & TREATMENT
What are Male Hormones?
Causes of low Testosterone
Indications of treatment
Side Effects & Precautions
What are Male
Hormones: Males have following male hormones namely
testosterone, androstenidione, dehydrotestosterone &
dehdroepiandrostenidione in the body. These male hormones are either
produced from testis or adrenal glands.The testosterone is produced
in testis by leydig cells. The secretion of testosterone is under
control of L.H. & F.S.H. & Gonadotropin releasing hormones, Thyroid
hormone & growth hormone. Additionally any significant & prolong
diseases of other body organs also decreases the formation of
various male hormones. After production from testis it circulates in
blood in two forms, most of it remains bound to genital hormone binding
globulin, which works as store for testosterone. Very small
percentage of total testosterone remains free in blood circulation
this free testosterone is active hormone. It binds with various
tissues of the body as hair of face leading to development of beard
& moustache, with pennis tissue leading to its enlargement of pennis &
erection, with body muscles leading to enlargement of body muscle i.
e. muscular body typical of men. It also works on genital centers in
brain (hypothalamus) leading to normal genitaldesire. There are many
conditions in which the protein which binds the testosterone (i.e.
genital hormone binding globulin) concentration increases leading to
increase in total testosterone concentration but free testosterone
concentration decreases. Thus overall free testosterone decreases
leading to less effect of testosterone on body. Testosterone also
has many effects on testis functions leading to improvement in
spermatogenesis. Thus there are many factors which may either
decrease the testosterone production in the body or decrease its
effectiveness. To complicate the matter further there are certain
condition in which even if every aspects of testosterone is normal,
there may be less male hormone receptor.
Causes of Low Testosterone:
The various causes for low testosterone are:
Hypogonadotropichypogonadism: (hypothalamic or
Idiopathic GnRH deficiency, Kallman syndrome, Hypogonadism,
Hypothyroidism, hyperprolactinemia, Prader-Willi syndrome,
Laurence-Moon-Biedl syndrome , Hypothalamic deficiency, pituitary
hypoplasia, Trauma, post surgical, postorradiation, Tumor (Adenoma,
craniopharyngioma, other), Vascular (pituitary infraction, carotid
aneurysm), Infiltrative (Sarcoidosis, histiocytosis, tuberculosis,
fugal infection, hemochromatosis),Autoimmune hypophysitis,
drug-induced hyperprolactinemia, Untreated endocrinopathies,
Uncontrolled Diabetes mellitus, Chronic Glucorticoid excess,
Hypopituitarism, Cushing disease, Addison diseases multiple
pituitary hormone deficiencies, Idiopathic pan-hypopituitarism,
Pituitary dysgenesis, Space-occupying lesions, cranial irradiation,
CNS chemotherapy, inflammation, Infiltrative or destructive
processes (autoimmune, hemosiderosis)
Testicular failure, development defect, drugs, trauma, congenital
defect, congenital adrenal hyperplasia, Chromosomal defect,
testosterone hormone biosynthetic defect, Mumps orchitis leading to
testicular atrophy,Primary testicular defect-disorders of testicular
differentiation or inborn errors of testosterone synthesis,
Klinefelter syndrome, Other X polysomies (i.e. XXXXY, XXXY) Rainbow
Andropause (for detail information read andropause webpage
of this website)
Delayed or Absent Puberty due to various cause (for detail
information read Absent genital development webpage of this website)
Investigation & Diagnosis:
For diagnosis of cause of low testosterone following tests are
Complete male hormone profile:
This profile includes all the male hormone tests, which affects
testicular development, growth & other genital organ development as
well as genital functions.
Ultrasound of testis
Then we do test for functional capacity of testis in this we
inject single injection of gonadotropin as intramuscular injection
then we measure the rise in concentration of serum total
testosterone. This test confirms whether testis has capacity to
function normally or not.
Chromosomal analysis is done to see the genetic structure of
testis, because there are many chromosome disorders lead to
Gene tests for various genetic disorders
Capacity of generation of active testosterone end product i.e. DHT
is tested. This DHT generation test is abnormal in some cases of
Tests to locate testis as ultrasonography or C.T. Scan abdomen is
needed if testis is not palpable.
Serum inhibin is tested which tells that whether hypogonadism is
temporary or permanent.
Serum Iron, T.I.B.C. & ferritin concentration tested for
hypogonadism due to hemochromatosis.
Combined Pituitary hormone tests are performed when suspecting
Molecular genetic studies done in some special cases.
Serum estrogen increased whenever testicular function decreased.
Serum DHT is low in some conditions when generation of
dihydrotestosterone is decreased.
Assessment of androgen receptor
Dynamic tests as HCG test
Response to antiestrogen & gonadotropin releasing hormone tests.
Other tests which may be required depending on likelihood on
any of the above causes.
Tests may show low testosterone. L.H. & F.S.H. may be decreased or
increased. Thyroid test may show low free T3 & free T4 & TSH may be
increased or decreased. Similarly prolactin hormone may be low or
high. But for interpretation of all above tests one need to be
expert of hormone diseases with good experience. Based on above test
result diagnosis of cause of low testosterone is made. Once the
cause is found treatment becomes very simple.
The various treatments for testosterone deficiency
Indications for male hormone
testosterone therapy are testosterone replacement in male
hormone deficiency cases, in males with less beard & moustache,
delayed puberty & absent puberty & for enlargement of small pennis or
micro pennis. It is also very effective in patients with low genital
desire & erection problem. People also use these for improvement of
body muscle & athletic performance, for gain in height but for this
indication it should be used under specialist observation.Other uses
are treatment of anemia, male osteoporosis, replacement in women
with loss of desire for genital & replacement therapy in ageing males
i.e. ADAM i.e. Androgen deficiency of ageing male. For weight &
muscle gain in wasted conditions
1) Male Hormone Replacement: Treatment
with male hormone testosterone is one of the modes of treatment of
male hormone testosterone deficiency. It is available as oral
tablets, skiin patch, skiin gels or injection is given with very good
preparation of testosterone
& route of administration are:
a) Oral preparation that is available in
capsule form. It needs to be given one to three capsules daily.
These have no side effects.
b) Transdermal Testosterone given as
testosterone gel preparations. It need to be applied any part of
skiin once a day.
It is very effective & has no side effects.
c). Transdermal Testosterone scrotal patch are
also available which are very effective even if used in small doses
. It is very effective & has no side effects.
d) Sublingual Testosterone cyclodextrin is
now available which is very fast acting & very effective is fast &
genital organ secondary genital character
development. It is used as one tablet daily to be kept under the
tongue for few minutes. It has no side effect and it is very very
e) Local application of D.H.T. gel available
as Andractim gel is a new preparation for male hormone replacement.
f) Injection Testosterone esters these
includes Testosterone enanthate & testosterone cypionate given
injections every 10 to 14 days.
g) Long acting testosterone as testosterone
bucilate given once in 4 months.
h) Testosterones implants are now available
which once injected remain effective for up to six months.
2) Gonadotropin therapy is
also very effective in low testosterone. This has no side effects
with very good results. After start of treatment testosterone level
start rising in three months time. With in one year time
testosterone value becomes normal in blood circulation. Testis
function also normalizes in most patients. Later testis starts
producing normal level of male hormone testosterone. Once
testosterone production normalizes in turn it leads to better
production of semen also. The normalization of testosterone values
leads to reversal of all symptoms of testosterone deficiency. Thus
all the symptoms normalizes. Bone strength recovers. Testosterone
treatment is harmless if given by expert in hormone in proper doses.
Thus almost all patient are cure in one-year time.
2) Gonadotropin Releasing hormone
therapy is effective in many cases of testosterone
deficiency even when gonadotropin therapy has failed in normalizing
testicular function & testosterone level.
3) Growth hormone therapy in
many cases where somatrop deficiency is found.
4) Growth Factor,
Mineral & Micronutrient Therapy
NOTE: Many times testosterone
deficiency is temporary. In these cases after correct diagnosis we
can permanently cure the testosterone deficiency in short time. In
these patient with in one-year patient achieves normal testosterone
& testicular function. offending drugs cure the problem.
In some long-term treatment with androgen as testosterone is
It has no side effects if given in proper disease and in-patients
when it is really indicated. This it is absolutely safe.
drugs are those drugs, which are derived from male
hormone & used for improving body muscles & weight. If they are
given under supervision of hormone specialist they are safe. But
many boys take it for developing body muscle or by sports person in
wrong dosing or without any medical supervision. This should not be
used without doctor’s supervision. Thus it should be taken under
consultation & treatment (by appointment / or online) click How
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