What Does “Low T” Look Like?

What Does “Low T” Look Like? That was the question asked by Kristen Gill Hairston, MD, MPH, associate professor of internal medicine at Wake Forest University School of Medicine, in a presentation at the American College of Physicians Internal Medicine 2014 meeting, held in Orlando from April 10 - 12. There, she shared findings from a study in which she addressed a series of clinical questions related to male hypogonadism.

In reviewing physiologic actions of testosterone, the signs and symptoms as well as therapy options for male hypogonadism, Hairston sought to determine the best clinical indicators, screening exams, and confirmatory tests of hypogonadism, as well as identifying which patients should receive testosterone replacement therapy, and the common side effects and complications of treatment.
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In her study, Hairston analyzed late-onset hypogonadism and the age-associated decrease in androgen production among men, noting that total and free testosterone decreases in males by approximately 1.2 percent per year between the ages of 40 and 70, and that 9.4 percent of men aged 60 to 80 are diagnosed with clinical hypogonadism.  

She also compared patients with type 2 diabetes to those without T2DM, finding that those with type 2 diabetes were twice as likely to be hypogonadal as a non-diabetic man. While noting that low testosterone can predict the development of type 2 diabetes, Hairston found that type 1 diabetes does not appear to be associated with hypogonadism.

In addition, Hairston pointed out in her presentation that hypogonadal men have small prostates, and that prostatic volume increases among men receiving testosterone treatment, but “to no greater volume than that of normal age-matched controls.”

In terms of testing and treatment options, Hairston ultimately recommended that testing should still be driven by symptoms, and clinicians should treat male patients with type 2 diabetes as “high priority.” She also suggested that diagnosis should only be made when unequivocally low levels and symptoms are both seen, adding that levels should be tested in the morning and multiple occasions. The resolution of symptoms, she said, should be seen in a finite period of time.  

“My goal [with this study],” says Hairston, “was to provide primary care clinicians with a more systemic, personalized approach to evaluating and treating the [low testosterone] patient. I also wanted to raise the awareness of the impact of type 2 diabetes and obstructive sleep apnea on testosterone levels.”

—Mark McGraw