Testosterone is the primary androgen hormone responsible for the development of male physical characteristics and the regulation of various bodily functions. These include muscle mass, bone density, red blood cell production, libido, and mood regulation. Testosterone imbalances can have widespread effects on physical and mental health.

Testosterone production typically peaks in early adulthood and gradually declines with age. While ageing-related changes are often natural, significant reductions may indicate an underlying androgen deficiency.

Androgen deficiency occurs when the body produces insufficient levels of testosterone, the primary male sex hormone. This deficiency can result from various factors, including damage to the testes, genetic conditions, or problems with the pituitary gland or hypothalamus (which regulate hormone production).

Androgen deficiency may present at any age, but it is most commonly observed in older men or as a consequence of certain medical treatments, such as chemotherapy. Clinicians also identify congenital causes, such as Klinefelter syndrome, which can lead to lifelong testosterone insufficiency.

The symptoms of androgen deficiency can vary widely between individuals, depending on the severity of the hormone imbalance. Common symptoms in men may include:

Physical Symptoms:

• Decreased muscle mass and strength

• Increased body fat, particularly around the abdomen

• Reduced bone density, leading to osteoporosis

• Fatigue or reduced energy levels

• Reduced body and facial hair

Reproductive and Sexual Symptoms:

• Low libido

• Erectile dysfunction

• Reduced fertility

Psychological Symptoms:

• Mood changes, including irritability or depression

• Impaired concentration and memory

• Decreased motivation

Doctors should always consider the broader clinical picture, as these symptoms can overlap with other medical conditions. Accurate diagnosis involves thorough history taking, physical examination, and laboratory testing. To confirm low testosterone levels, two blood tests are required to be taken on seperate days and both must show a lower than normal testosterone level.

Treatment for androgen deficiency focuses on restoring testosterone levels to improve symptoms and overall quality of life. Recommendations for individuals in Australia align with guidelines from the Andrology Australia network and other reputable health organisations.

Testosterone Replacement Therapy (TRT)

TRT is the primary treatment for androgen deficiency. It involves supplementing testosterone to achieve normal hormone levels. Common forms of TRT used in Australia include:

• Injectable Testosterone – Administered every few weeks to maintain consistent hormone levels.

• Testosterone Gels or Creams – Applied to the skin daily for gradual absorption.

• Testosterone Implants – Long-acting pellets placed under the skin to release testosterone over several months.

• Oral Capsules – A less common option, depending on specific clinical circumstances.

Patients prescribed TRT require ongoing monitoring to ensure optimal hormone levels and to manage potential side effects, such as polycythaemia (high red blood cell count) or prostate health concerns.

Lifestyle Considerations

For some men, lifestyle modifications can complement medical therapies. Encouraging a balanced diet, regular exercise, and weight management helps to optimise overall health and may improve mild symptoms of androgen deficiency.

When is TRT Not Recommended?

TRT is not suitable for all individuals. It is contraindicated in men with:

• Prostate or breast cancer

• Severe sleep apnoea

• Significant cardiovascular risk without specialist evaluation

Doctors must undertake a full clinical assessment and discuss risks before initiating treatment.