Monday, December 16, 2013

Testosterone deficiency may be striking early.....TOI

Testosterone deficiency may be striking early

Dipping testosterone threw Vipul Khanna's work and family life out of gear two years ago. "I had problems like tiredness, insomnia and low libido. I even had difficulty in concentrating and remembering things," says Khanna, now 38. Diagnostic tests revealed that his testosterone level had plunged down to below 200; normal range is 400-450. "Immediately, he was put on testosterone shots, to be taken once in 21 days in addition to a B12 supplement, as he was also deficient in this vitamin," says Dr Deepak Chaturvedi, his endocrinologist based in Mumbai. Gradually, his levels became normal. 

Like Khanna, 32-year-old Nishant Srivastava from Allahabad is being treated for low testosterone. He suffers from obesity and type 2 diabetes — risk factors for low testosterone. "He was prescribed T gel and now his symptoms have eased," says Dr Suneet Jha of Max hospital, Delhi, who says the number of younger men with this complaint has swelled in last 2-3 years mostly because of lifestyle reasons — smoking, obesity, stress and lack of sleep. 

Testosterone is dubbed as the sex hormone but it is also responsible for a strong heart and bones, muscle mass, sharp cognition and general well-being. Its deficiency can cause irritability, tiredness and slow cognition. With age, T levels tend to decline. According to a small 2009 study — the only such available right now — done by researchers at Lucknow's King George Medical College, testosterone deficiency syndrome (TDS) is present in 26.1% of Indian males aged between 40 to 60 years. 

Testosterone replacement therapy (TRT) is the standard treatment for deficiency of this hormone, however, in certain cases it can lead to complications. A major study published in the Journal of the American Medical Association in November this year showed a 29% increase in the risk of heart attack in older men, many of who had heart disease, when administered testosterone. Therefore, it is best to take testosterone supplements under medical supervision. 

In India, it seems lifestyle factors are leaving younger men testosterone challenged. Dr Prakash Kothari, well-known sexual health expert based in Mumbai, says that he regularly sees men in their 20s with this condition. Dr Chaturvedi claims that if anyone were to take a random sample of 1,000 men in the age group of 20 to 30 years, almost 10% would have T deficieny. 

Dr SK Wangnoo, a senior endocrinologist with Apollo hospital in Delhi, too, gets 3-4 patients in this age group every day. "The number is much higher than what it was a decade ago. I see many working couples with high levels of stress-induced prolactin," says Dr Wangnoo, who has been treating hormonal disorders for 25 years. Prolactin is a hormone present in both the sexes and its high levels inhibit testosterone. 

Strenuous exercise with no or little rest and extreme dieting too impact hormone levels. The standard treatment in such cases involves testosterone injections, transdermal gels, patches and oral tablets. Dr Kothari says that in certain cases he first puts the patient on a diet of urad dal (rich source of plant-based testosterone). "I advise consumption thrice a week. If the levels don't increase then I prescribe injectibles and gels," he says. 


Prostate cancer | TRT carries an inherent but low risk of prostate cancer. That's why it is very important to take testosterone medication/supplements only under medical supervision 

Liver damage | Testosterone supplements are often misused to bulk up. This can have adverse effects on the liver. Abuse of T supplements is rampant in India, say doctors. Gym trainers, reportedly, often give supplements sourced from grey market to aspiring bodybuilders 

Cardiac disease | Studies have shown an increased risk of heart attack in older men who are on TRT, especially if they already suffer from heart diseas

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