Abstract
On any given week, a practitioner is going to have male clients who present with complaints seeking treatment for erectile dysfunction (ED). These practitioners also see countless cardiovascular, diabetic, and obese clients. Additionally, many clients present with vague and nonspecific signs and symptoms such as change in body composition, lethargy, and mood changes. Sadly, androgen deficiency will not be a consideration in the differential diagnosis process for many of these practitioners. Most primary care practitioners, and specialist such as urologist and endocrinologists, do not assess for androgen deficiency. This is true even though some researchers believe there is a link between androgen deficiency and increase in abdominal fat. There is also evidence that supports a direct relationship between androgen deficiency, cardiovascular disease, and diabetes and that these disease processes are common comorbidities of androgen deficiency (Hackett, 2009).
Prior to any ED prescription being written, the practitioner should assess for androgen deficiency. Any male who presents to the practitioner at or above the 30% body mass index obesity marker should be assessed for androgen deficiency. Every male client diagnosed with a cardiovascular and/or a diabetic disorder should be assessed for accompanying androgen deficiency. Assessing for androgen deficiency should become part of the routine assessment for every male client older than 40 years. Questions that explore changes in body composition, energy level, mood changes, libido, and ED should be part of every assessment for this population given the growing body of scientific evidence linking androgen deficiencies as a possible cause or comorbidity for these other disease process (Hackett, 2009).
Skeptical practitioners argue that there is not enough evidence supporting the link between low androgen levels with these other disease process. Some practitioners also prescribe androgen therapy with caution because of its link with hepatic dysfunction along with other side effects such as extreme mood swings, including aggressive behavior. There is a greater incidence of lower testosterone levels with male clients who present with a body mass index in the obese range and who are older than 40 years (Traish, Saad, & Guay, 2009). There is no significant evidence linking hepatic dysfunction for male clients diagnosed with androgen deficiency who receive testosterone therapy. There is some evidence linking androgen therapy with mood swings. However, improved drugs and carefully monitoring by practitioners and adjustments in therapy when necessary can minimize mood swings. Newer testosterone creams, salves, and buccal patch have a more sustained and even release throughout the day, which helps minimize mood swings. The key is to approach client individually and uniquely.
There is beginning to be more public focus on androgen deficiency. One example is the current marketing campaign being supported by Abbott to educate the public on testosterone deficiency, including signs and symptoms, treatment options, and the benefits of treating low testosterone levels. This marking campaign directs health consumers to the “Is it low T” website. This type of effort will help educate clients and practitioners on the impact of androgen deficiency on overall health and the importance of testosterone therapy.
Practitioners, who have male clients older than 40 years, should assess for androgen deficiency especially if these clients have the signs and symptoms and the comorbidities outlined throughout this editorial. As part of the assessment process, practitioners need to assess for body composition, lethargy, and mood changes. This assessment needs to occur in the form of direct questioning. For example, “has your pants size increased over the past 5 years and if so from what size to what size?” “Have you noticed that your energy level and endurance have declined in the past 5 years?” “Do you get tired quicker doing the same task that you did 5 years ago such as jogging a mile, mowing the grass, etc.”? “Do you find that you are more emotional than you were 5 years ago?” Practitioners need to explain in the beginning the purpose and importance of these questions so the client understands and hopefully will not feel that being honest makes him less masculine. Being proactive and assessing middle age male clients who are at risk for and who report symptoms of androgen deficiency is a holistic approach to medicine.