What Is Testosterone and Why Does It Decline?
During puberty, testosterone helps build a man's muscles, deepens his voice, and boosts the size of his penis and testes. In adulthood, it keeps a man's muscles and bones strong and maintains his interest in sex. In short, it's what makes a man a man (at least physically).
After age 30, most men begin to experience a gradual decline in testosterone. A decrease in sex drive sometimes accompanies the drop in testosterone, leading many men to mistakenly believe that their loss of interest in sex is simply due to getting older.
"Some say it's just a part of aging, but that's a misconception," says Jason Hedges, MD, PhD, an urologist at Oregon Health and Science University in Portland. A gradual decline in testosterone can't explain a near-total lack of interest in sex, for example. And for Hedges' patients who are in their 20s, 30s, and early 40s and having erectile problems, other health problems may be a bigger issue than aging.
"A lot of the symptoms are mirrored by other medical problems," Hedges says. "And for a long time, we were not attributing them to low testosterone, but to diabetes, depression, high blood pressure, and coronary artery disease. But awareness and appreciation of low testosterone has risen. We recognize now that low testosterone may be at the root of problems."
Doctors will want to rule out any such possible explanations for symptoms before blaming them on low testosterone. They will also want to order a specific blood test to determine a man's testosterone level. "The blood test is really the thing," Mezitis says.
Low Testosterone: How Low Is Too Low?
The bottom of a man's normal total testosterone range is about 300 nanograms per deciliter (ng/dL). The upper limit is about 800ng/dL depending on the lab. A lower-than-normal score on a blood test can be caused by a number of conditions, including:
- Injury to the testicles
- Testicular cancer or treatment for testicular cancer
- Hormonal disorders
- Chronic liver or kidney disease
- Type 2 diabetes
Some medicines and genetic conditions can also lower a man's testosterone score. Aging does contribute to low scores. In some cases, the cause is unknown.
Ref: Web MD: Jason Hedges, MD, PhD, Urologist, Oregon Health and Science University, Portland, Ore.
The Hormone Foundation: "Low Testosterone and Men's Health."
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The prostate is a small gland in men that is part of the reproductive system. It's about the shape and size of a walnut. The prostate rests below the bladder and in front of the rectum. It surrounds part of the urethra, the tube that carries urine from the bladder. The prostate helps make semen, which carries sperm from the testicles when a man ejaculates.
Enlarged Prostate: As a man ages, the prostate can grow larger. When a man reaches the age of 40, the prostate gland might have increased from the size of a walnut to that of an apricot. By the time he reaches the age of 60, it might be the size of a lemon. Because it surrounds part of the urethra, the enlarged prostate can squeeze the urethra. This causes problems in the passing of urine. Typically, these problems passing urine don't occur in men until they are age 50 or older. They can, though, occur earlier.
An enlarged prostate is also called benign (noncancerous) prostatic hyperplasia or BPH. It is common and cannot be prevented. Age and a family history of BPH are risk factors. Eight out of every 10 men eventually develop an enlarged prostate. About 90% of men over the age of 85 will have BPH. About 30% of men will find their symptoms bothersome.
Symptoms of an enlarged prostate may include:
- Trouble starting to urinate or urinating freely
- Having to urinate frequently, particularly at night
- Feeling that the bladder is not empty after urinating
- Feeling a sudden urge to urinate
- Having to stop and start repeatedly while urinating
- Having to strain to urinate
To maintain prostate health, it is important for men who have early symptoms of BPH to see their doctor. BPH is a progressive disease. It can lead to serious, although rare, health problems, such as kidney or bladder damage.
Watchful waiting: Patients who have an enlarged prostate but who are not suffering symptoms or whose symptoms are not bothersome may be advised by their doctor to merely get an annual checkup, which might include a variety of tests.
Lifestyle changes: Changes could include limiting drinking at night and before bedtime, especially drinks containing alcohol or caffeine.
Drug therapy: Two common treatments for BPH are alpha-blockers, which alleviate BPH symptoms, and 5 alpha-reductase inhibitors, which help shrink the prostate. Many men take them together. The FDA is revising labels on several BPH drugs -- Proscar, Avodart, and Jalyn -- to include a warning that the drugs may be linked to an increased risk of prostate cancer.
Surgery: This is generally used for men with severe symptoms who haven't been helped by other treatment.
Supplements that may help: Pygeum Africanum, Beta Sitosterol (plant sterols), Lycopene (tomato extract), Pumpkin seed and fatty acids from saw palmetto are some of the well-known botanical ingredients that have been used by dietary supplement companies for their products promoting prostate health.
Ref: WEB MD