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Men – Do you think you may have a low testosterone level?

Testosterone is a steroid hormone that helps regulate sperm development, maintain muscle mass, and boost energy. Both men and women have it, but men produce about ten times more of it than women. Low testosterone is sometimes known as androgen deficiency syndrome; androgen is the term for the male sex hormone and testosterone is the main sex hormone for men.

The bottom of a man's normal total testosterone range is about 300 nanograms per deciliter (ng/dL). The upper limits are 1,000 to 1,200 ng/dL.

A decrease in a man’s testosterone level is a natural function of aging similar to the decline of the female hormone estrogen in women. For each year over age 30, the level of testosterone in men starts to slowly dip at a rate of around 1 percent annually. This decline in testosterone and the symptoms it causes have sometimes been referred to as "male menopause."

However, at any age some men have a lower than expected level of testosterone which can be due to a number of reasons:

  • Hormonal disorders
  • Injury to the testicles
  • Testicular cancer or treatment for testicular cancer
  • Chronic kidney or liver disease
  • Infection
  • HIV / AIDS
  • Type 2 Diabetes
  • Obesity
  • Some medications
  • Some genetic disorders

Signs and symptoms of low testosterone include:

  • Decreased sex drive
  • Erectile dysfunction
  • Reduced energy level
  • Difficulty in concentrating
  • Reduced strength and endurance levels
  • Sleep problems
  • Increased breast size and tenderness
  • Decrease in the amount of body hair
  • Decreased penis or testicle size
  • Loss of muscle mass
  • Emotional problems including sadness, irritability, depression

Note that some men with a low testosterone level have absolutely no symptoms at all.


A diagnosis of low testosterone includes taking a complete medical history and having a physical exam as well as blood tests to confirm the diagnosis. Your doctor will want to make sure your low testosterone is not caused by medications you are taking or by a disease or condition that needs to be treated.


Even if you have no symptoms treatment may be advised as low testosterone scores often lead to drops in bone density, meaning that bones become more fragile and increasingly prone to breaks.

If a young man's low testosterone is a problem for a couple trying to get pregnant, testosterone injections are probably the best option. Given every few weeks, the injections stimulate sperm production and motility.

When fertility is not an issue, the ideal testosterone delivery method is a daily gel or patch. Because they are applied on a regular and frequent basis, these treatments keep a man's testosterone at a steady level and keep his symptoms at bay. If you are using testosterone gel on your skin, be careful not to expose other people to the gel.

There is also a relatively new method of treatment whereby several pellets are placed under the skin of the buttocks, which release testosterone over the course of about three to four months.

Testosterone treatment is not without risk

Testosterone treatment is not without possible side effects. It may raise the red blood cell count and can enlarge breast tissue. Therefore, men with any history of breast cancer should not have testosterone treatment.

Testosterone can also accelerate prostate growth, therefore treatment is usually not advised for men with prostate cancer although medical studies are currently looking into this association.

Recent studies suggest a link between testosterone therapy and an increased risk in heart disease. A 2010 trial of testosterone in older men was stopped early because the men receiving testosterone therapy had a higher frequency of heart problems than did the men receiving the placebo. A 2013 study found a higher frequency of death and heart problems in men who had coronary artery disease and received testosterone therapy. However, two recent studies have also reported a lower risk of death in men who were receiving testosterone than in those who were not. A 2014 study reported that testosterone therapy might increase the risk of a heart attack in men age 65 and older, as well as in younger men who have a history of heart disease. Further research is needed to determine the safety of using testosterone therapy to treat older men dealing with age-related declines in testosterone. Currently, the Food and Drug Administration (FDA) is investigating the risk of stroke, heart attack and death in men taking FDA-approved testosterone products.

If you wonder whether testosterone therapy might be right for you, talk with your doctor about the risks and benefits.

Testosterone treatment should never be self prescribed (ie: to improve your sex life). If you are taking testosterone, make sure your doctor is monitoring your response to treatment with regular blood tests.

If you and your doctor decide that you should try medication to treat low testosterone, remember that a healthy lifestyle including a healthy weight, not smoking, limited alcohol, and regular exercise are also important for managing testosterone levels.


Halitosis (bad breath) is not only embarrassing but can be a sign of ill health.

One of the most common causes (not attributed to a health issue) is smoking and the only way to solve that is to quit! If you do want to quit smoking seek advice from your local medical centre as there are now many, many ways to help you to become a non-smoker.

Another non medical cause is diet – especially garlic and spicy foods which most of us love! This is not a problem if you and your partner both have a curry or bread & ali oli together!!

A dry mouth can also lead to halitosis. A dry mouth may be a sign of general ill health or a side effect of certain medications. Increasing fluid intake will help.

One of the most common causes of halitosis due to a health issue is tooth decay or gum disease. If you notice (or a friend is kind enough to tell you) that you are suffering from bad breath and you have not had a recent dental check-up the first person to see will be your dentist.

If you are given a clear bill of health and the problem of bad breath continues despite good dental hygiene, a person should visit their G.P. as persistent halitosis can be a sign of a simple health issue that can be easily corrected or a more serious medical condition such as:

  • Kidney disease.
  • Liver disease
  • Some cancers
  • Metabolic disorders
  • Reflux
  • Post nasal drip

There is a rare psychiatric condition called delusional halitosis whereby a person who may or who may not be suffering from bad breath brushes their teeth continually throughout the day and uses excessive mouth wash. If you are in doubt ask a trusted friend for their opinion.

If halitosis is suspected, lifestyle changes do not help, and there is no dental problem, do see your Family Doctor.

Risk factors for developing dementia

Studies have shown that dementia has overtaken cancer as our most feared disease. This is mainly because of the improvement in the outlook for people diagnosed with cancer due to the improvement in diagnosis and treatment.

Treatment for dementia can currently only slow the progress of the disease and alleviate some of the symptoms. Scientists are hopeful that new treatment will be developed in the next few years that may halt or even reverse dementia.

Alzheimer’s disease is the most common form of dementia and it affects more than 520,000 people in the UK. It is thought to result in a loss of connections between cells in the brain due to the build up of abnormal proteins. The second most common cause is vascular dementia. This is caused by death of brain cells due to an interruption in their blood supply caused by either a stoke or diseased blood vessels in the brain.

Symptoms of dementia

  • Memory loss
  • Difficulty completing familiar tasks
  • Problems with abstract thinking
  • Personality change
  • Mood changes
  • Disorientation with familiar things and places
  • Poor judgement which can place them in danger
  • Misplacing things
  • Loss of motivation and initiative
  • Lack of personal hygiene and care

Problems communicating

Risk factors

Research has uncovered some important factors that can affect our risk of developing dementia. The risk of us developing the disease depends on a combination of these. Some such as age and genes cannot be controlled but others can.

  • Genetics and family history - If there is a family history of Alzheimer’s then you are more at risk. Some studies suggest that if you have a parent or a sibling with the disease your overall risk is increased five or six fold.
  • Age – Dementia usually starts after the age of 65 and the risk increases with age. One in six 80 year olds are affected. As we age the brain becomes less agile and connections become weaker.
  • Obesity – One theory is that fat releases harmful hormones that damage brain cells. The other risks associated with being overweight such as high blood pressure, cholesterol and the furring up of arteries increase the risk of vascular dementia.
  • Diabetes – Type 2 diabetes raises the risk of dementia. This is because a raised blood sugar damages the blood vessels in the brain which increases the risk of stroke and vascular dementia. It also causes inflammation which may increase the abnormal proteins in the brain.
  • Smoking – Smoking may increase your chances of getting dementia and other vascular diseases.
  • Blood pressure – High blood pressure can cause stroke or cause inflammation which leads to a build up of abnormal proteins.
  • Stress – Chronic stress raises the levels of the hormone cortisol. There are cortisol receptors in the part of the brain which is important for learning and memory. If cortisol levels remain high these receptors become saturated which damages brain cells.
  • Depression – Late-life depression especially in men may be a risk factor or an indication of the onset of dementia.
  • High oestrogen levels – Women taking oestrogen and progesterone years after the menopause may be at greater risk of developing the disease.
  • Heavy alcohol intake – While a moderate amount of alcohol has been shown to be beneficial to health in some studies, Binge or heavy drinking have both been linked to an increased risk of developing dementia.

A leading dementia specialist has said that “dementia is not inevitable”. It is thought that in a quarter of people destined to develop the most common causes of dementia it can be stopped or significantly delayed. It is never too early or late to start thinking about what you could do to protect yourself.

The Core Team

Dawn Blythe

Clinic Director, Practice Midwife

Yvonne Evans

Clinic Director, Nurse

Dr. An Croonenborghs

General Practitioner

Jane Evans