Orgasm does not increase testosterone
Testosterone deficiency (hypogonadism)
(Testosterone deficit, syn: hypogonadism or late onset hypogonadism- LOH)
From the biological functions of testosterone explained in detail on the previous pages, it becomes clear that testosterone is a very important hormone for men and that a lack of testosterone inevitably often leads to clinical symptoms. Most often, men with a testosterone deficiency suffer from the following clinical symptoms:
Disorders of the sexual functions with testosterone deficiency
This particularly affects the Libido (sexual aversion), the sexual excitability (Men with low testosterone are often difficult to sexually excite) who Erection (erectile dysfunction or erectile dysfunction) as Ejaculation and orgasm (reduced semen volume, decreased orgasm intensity).
If there is a pronounced testosterone deficiency, such as that caused by hormone withdrawal in prostate cancer, it also comes to a Death of the erectile tissue cells (called apoptosis), which is clinically in a Penis shrinkage precipitates.
Muscle strength disorders due to a lack of testosterone
Men with low testosterone levels often notice one Decrease in muscle strength, which can be attributed to the decreased muscle protein synthesis in the presence of testosterone deficiency.
Osteoporosis due to a lack of testosterone
As already mentioned, testosterone and the dihydrotestosterone and 17 beta-estradiol formed from it are jointly responsible for bone formation and healthy bone structure. Men with long-term, untreated testosterone deficiency often develop increasing bone fragility (osteoporosis), which then increases in old age (65 years and up) Bone fractures such as femoral neck / spoke or vertebral body fractures manifested. Several studies have shown that older men with fractures of the femoral neck, for example, are mostly deficient in testosterone (hypogonadism) (sources: Leifke, E. et al: Exp Clin Endocrinol Diabetes, 113, 208-213, 2005, Fink, HA et al: J Clin Endocrinol Metab. 2006, 91, 3908-3915, Shahinian VB, et al. N Engl J Med. 2005; 352: 154-164, LeBlanc ES et al J Clin Endocrinol Metab. 2009, 94, 3337-3346 , Crawthon PM et al J Clin Endocrinol Metab. 2009, 94, 3806-3815)).
Anemia due to a lack of testosterone
The body needs testosterone to synthesize the hormone Erythropoietin, which in turn is used for the synthesis of the red blood cells (erythrocytes) and des Hemoglobins is required. Men with long-term, untreated and more severe testosterone deficiency with testosterone values of <2.5 ng / ml develop anemia with hemoglobin values of <12 mg% and erythrocytes of <3-4 million / ml over time. The anemia leads to rapid fatigue with shortness of breath as well as to increasing drowsiness in the affected men.
Testosterone Deficit Metabolic Syndrome
As already mentioned, men with a testosterone deficit (hypogonadism) often suffer from a metabolic syndrome Insulin resistance and increased blood sugar levels (Diabetes), high blood pressure and lipid metabolism disorders.
Changes in mood and psycho-vegetative functions with testosterone deficiency
Men who have to be deprived of testosterone for therapeutic reasons (advanced prostate cancer) or men who have developed pronounced hypogonadism for other reasons often tend to depressive moods, Tearfulness and like to be emotionally unstable. They are mostly general low-drive and not enterprising ("couch potato"). Many complain of a decline in the ability to concentrate and remember. So-called psycho-vegetative dysfunctions such as pronounced ones are often very pronounced Hot flashes and Sweatswhich are very similar to the menopausal symptoms experienced by menopausal women.
In a more recent study it was also shown that the incidence of endogenous depression is highest at low, i.e. hypogonadal testosterone values (Fig. 7). If the testosterone values measured in the serum were <1.5 ng / ml, the two-year incidence of depression was 29 % (p <0.05)
Frequency (prevalence) of hypogonadism
Typical hormonal changes in aging men are reflected in the following laboratory constellation:
- Free testosterone
- Estradiol / testosterone quotient
- Growth hormone and insulin like growth factor
The Total testosterone decreases by approx. 1% per year from the age of 40. That falls even more free testosterone (fT) not bound to protein from since that Sex hormone binding globulin (SHBG) increases with age due to an increase in synthesis in the liver and can bind more testosterone. For the biological functions of testosterone, however, it is precisely the free testosterone and the testosterone bound to albumin (both also as bioavailable testosterone responsible). Depending on the selected cut-off values for total and free testosterone, 10-45% of older men have decreased testosterone values depending on age (see Tab. 4). In 2006, Mulligan et al (Int. J Clin Pract. 2006, 7, 762-769) published the results of a study from the USA: In 130 of 2,650 randomized general practices in the USA, all men who received A testosterone level was determined between 8:00 and 12:00 for various reasons. A total testosterone value of <300ng / dl was chosen as the cut-off value for the diagnosis of hypogonadism, which is generally recognized worldwide as hypogonadism. Hypogonadal values with T <300 ng / dl were measured in 836/2162 (39%) of the patients who were screened for the existence of hypogonadism! between 1987 and 2002, the incidence of testosterone deficiency (hypogonadism) depending on the cut-off values for testosterone was as follows:
- T <200 ng / dl: 7%
- T <300 ng / dl: 23%
- T <346 ng / dl: 34%
- T <400 ng / dl: 48%
Diagnostics of testosterone deficiency (hypogonadism)
The diagnosis of hypogonadism is made if:
- typical clinical symptoms as described above are present and
- the testosterone values measured in the blood are decreased at two different measurement times (total T <3.0 ng / ml or <10.4 nmol / l)
The measurement of testosterone levels in the morning hours between 8 a.m. and 11 a.m., which is required by many hormone experts, is no longer justified due to the latest study results:
The working group around Morgentaler (source: Morgentaler, A. et al, JSM 2006, 3, Suppl. 1, p. 47, abstr. 106) analyzed the results in 3006 men (Ø 60.4 , 40 - 94 years) measured testosterone values and assigned them to the 4 time intervals 6-10 a.m. (n = 632), 10-12 a.m. (n = 812), 12-14 p.m. (n = 388) and 2-6 p.m. (n = 1,174). They found that the average T values did not differ at all in the first 3 time intervals and were only 13% lower in the 4th time interval (2:00 p.m. to 6:00 p.m.).
In another study published in 2005, the authors (source: Axelsson et al, JCEM 2005, 90, 4530-4535) found that the measured testosterone values do not depend on the time of day but exclusively on the Sleep-wake rhythm depended on the individual. If there was night sleep, the maximum testosterone concentrations were detectable between 5:00 and 9:00 in the morning, but if there was daytime sleep, the highest testosterone levels were found between 12:00 and 15:00.
Taking these latest findings into account, the following applies in practice:
The time of measurement of the testosterone value is of secondary importance for the diagnosis of hypogonadism and does not have to be between 8 a.m. and 11 a.m., as is still often required today. If possible, the testosterone levels should always be measured in the same individual at a similar time of day, i.e. either in the morning or in the afternoon depending on their lifestyle (sleep-wake rhythm!). (Tab. 5)
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