Relationships 51              July 2006

Every month Maggi Stamp, a qualified and experienced relationship counsellor for Relate and in private practice, writes about some of the emotional challenges we meet in later life.

For reasons of confidentiality Maggi never writes about a particular person's problems unless you have sent one in to be answered, but all her examples are based on problems raised by clients, family and friends over the years.  

You can write to Maggi at maggi@laterlife.com for her to respond in the column.

Testosterone loss

K writes: As a result of my inability to have sex, my marriage broke up.
Last year I read an article that indicated that I had 19 of the 20 symptoms of male testosterone loss. I had this confirmed by a private physician, but as I live on a modest pension I sought treatment on the NHS. I took the test results and various articles on the condition to my own GP who said that no-one in the surgery knew anything about testosterone loss. She treated me for my depression, but not the underlying chemical imbalances due to the low levels of hormone.
Like prostate cancer, this condition receives little publicity, while HRT and breast cancer treatments for women have regular media attention. Why is that? Is it because men are so much worse at dealing with their health problems than women? Are men more ignorant about their bodies? Why are GPs ignorant of testosterone loss: surely they should know?


Maggi replies:

There are a whole range of symptoms and health problems that men, especially middle-aged men, suffer from. However, men are often reluctant to go to their surgeries, especially if their GP is female; perhaps this leads to a few GPs remaining ignorant of such issues. But it is important for all GPs to be knowledgeable about the symptoms and effects of low testosterone levels in men and of course the treatments.

Hardly anyone finds it easy to consult their doctor about symptoms of a sexual nature. Women’s bodies are more complex and many require regular examinations during and after pregnancy, so that most women are more used to the procedure and continue to have essential check-ups throughout life.

Men, on the other hand, are blessed with external ‘plumbing’ and therefore need fewer invasive examinations, except for regular and essential ones, such as to check the health of the prostate as middle age progresses - and I hope this is regular. It is not surprising that men find it harder to take their problems to the doctor. If they are lucky enough to have general good health, there are few reasons to go to the surgery.

Dr James Kennedy, a GP in Hayes, Middlesex and chairman of the Prescribing Committee of the Royal College of General Practitioners, agrees that men in general consult less with their doctor, are less attentive to their health and less informed about their bodies.
“They tend to come later rather than earlier over any health problems, so are more prone to present with greater health problems in later years, such as vascular degeneration”, he says.

He explains that one of the main symptoms of vascular disease is erectile dysfunction, or ED. Weakened blood vessels in the penis cannot maintain an erection, or in some cases do not achieve one at all. Problems of this kind cause a loss of confidence and, unless discussed with partner and doctor, a man may suppress or lose desire and stop sexual activity altogether. Relationship difficulties and depression are then very much on the cards.

Testosterone is the hormone that maintains healthy tissue in the male urinary and reproductive systems, promotes libido, sexual desire, aggressiveness, assists protein to build muscle, skin and bone, stimulates sperm production and regulates the production of prostaglandin, which controls prostate growth.

Some of the symptoms which might indicate low testosterone levels are:

• ED

• loss of libido and/or sexual desire

• lack of energy

• tiredness

• irritability

• weight loss

• joint aches and pains

• dry skin

• osteoporosis

• loss of deeper vocal range

• unexplained increase in emotional upsets

• loss of body strength and tone

• softer body shape e.g. less defined musculature

• breast tissue increase

• belly spread and body hair loss

Some of these symptoms, such as hair loss and paunch, are experienced by many men even though they maintain healthy levels of testosterone. Loss of desire might be due to other problems in a relationship, while lack of energy or tiredness could signal a variety of conditions. It is therefore important that these symptoms are assessed by a doctor so that other possibilities, serious or mild, can be ruled out before an accurate diagnosis is made. Diagnosis is complex, involving not only blood tests but taking a long, detailed look at many other factors.

Sex is usually so personal and private that few people are likely to discuss any difficulties with anyone other than the most trusted friend. Some of my clients take a long time to get round to talking about such matters. If your doctor is a stranger to you, then the task is even more stressful.

I don’t know whether you are in a relationship now. People in relationships should always tell their partners what their thoughts or worries are and be sure to ask what their partner’s worries are too. That is where you start. If you feel your doctor hasn‘t been able to help, it’s essential you ask to be referred to another, perhaps in the same practice.

You might consider seeing a Relate-trained sex therapist for help in dealing with the emotional effects of having very low sexual desire or libido, but you must take into account that it might not be the whole picture.

Dr Kennedy emphasizes that symptoms likely to be brought to the surgery can indicate other conditions, so care must be taken to check those out. Having established that there is a low testosterone level and that the symptoms could be alleviated by hormonal treatment, further care is needed to ensure these powerful agents are given safely.

It could be that lifestyle changes and dietary and emotional improvements might help. These, in some cases, can re-stimulate testosterone production to an age-appropriate level where good health, good energy and good sex can be enjoyed.
“I see a significant number of middle-aged patients presenting with ED, low libido and tiredness and will always look at what might be influencing their general health as well as check more for specific factors”, says Dr Kennedy.
 

You can write to Maggi at maggi@laterlife.com for her to respond in the column.