Post pubertal loss of testicular function results in slowly developing and very subtle clinical symptoms and signs. Particularly in aging men, these symptoms and signs may be difficult to assess because they are often attributed to “getting older” by both patient and physician. The growth of body hair usually slows, but the voice and size of the penis are usually not affected. The temporal hair recession and balding are not manifestations that would prompt a patient to seek medical attention, but occur progressively.
TDS is characterized primarily by:
1. Lower sexual interest or desire for sex (libido) reduced sexual activity and poor quality erections that occur less frequently, particularly during the night. The quality of orgasm may also change and may not be as intense. Ejaculation is also weaker and the volume of the ejaculate is reduced. A common symptom is losing the erection before or during penetration and the subsequent fear of failure. This may cause men to lose confidence. In some men their self-esteem is so severely affected that they may begin to avoid any sexual contact. Therefore, quite often the partner will be the one complaining about “loss of sexual interest” and the physician will gain useful information by interviewing the spouse.
2. There are also changes in mood such as depression, irritability, anger and fatigue
3. This may accompanied by decreased intellectual activity, cognitive functions, and the ability of spatial orientation.
4. Sleep disturbances often occur. This also contributes to a lack of motivation and difficulties with short-term memory – “I am not what I used to be”.
5. An increase of central abdominal obesity, with associated reduction in muscle volume and strength.
6. Decrease in body hair and skin lesions of aging develop.
7. Decreased bone mineral density resulting osteopenia, osteoporosis, increased risk of long bone or vertebral fractures.
It should be noted that the symptoms of TDS overlap considerably with those of major depressive disorder. These include a reduction in libido, a lack of energy, decrease in strength and/or endurance, decreased enjoyment of life, feeling sad and/or grumpy, weak erections, reduced ability to work and play sports, and changes in sleep patterns. Scientists recently found that testosterone concentrations of men above the age of 45 years who suffered from a major depressive disorder were statistically significantly lower than an age-matched control group without depression. Depression in aging men is in all likelihood, both under-diagnosed and under-treated in men with TDS.
By Prof Riana Bornman (MB ChB, DSc Physiology, MD Physiology) Sept 2015