Pete Evans knew something was wrong when he had sudden problems getting an erection. At 52, he had always had an active sex life. Even the bone marrow transplant he underwent in the summer of 2009 had little effect on his libido. Then, six months after the transplant, he lost his ability -- and his appetite -- for sex.
"After the operation, I had tons of energy, great libido. Then suddenly, things just stopped working," Evans (not his real name) says. "I was kind of depressed, too. After all I'd been through and now this."
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Finding himself unable to perform was an alarming first for him. When Evans, a retiree who lives in Amherst, Ohio, told his doctor, he received a prescription for Viagra. That didn't help. At a follow-up appointment, he had some blood work done. It showed that his testosterone level had tanked, likely a side effect of one of the post-transplant medications he was taking. This time, his doctor sent him to a urologist, who prescribed a testosterone skin patch to boost the levels of the hormone in his blood. He's now been using patches for about five months.
"I'm feeling more and more confident," Evans says. "Bringing up my testosterone has brought up my mood dramatically. I feel normal in every way."
Normal Testosterone Levels
Evans needed his bone marrow replaced because he has a rare blood disorder called aplastic anemia. His low level of testosterone, however, is a condition he shares with many men his age. The big difference is that Evans's testosterone levels plummeted almost overnight due to complications with his medication.
Age-related loss of testosterone, on the other hand, is gradual, dropping by about 1% to 1.5% per year beginning at age 40. The low testosterone levels that result can leave men feeling less energetic, less self-assured, and less manly.
In some labs, the normal levels (determined by a simple blood test) of a man's testosterone will measure 300 to 1,000 nanograms per deciliter. However, it's important to confirm low levels of testosterone since many men will have normal levels on repeated testing due to fluctuations of the hormone.
"I felt like something had been taken away from me," Evans says, and it wasn't just about the sex. "I didn't have the strength I once had, and I was not able to build muscle mass."
The Role of Testosterone
Evans's description resonates with Edmund Sabanegh, chair of the urology department and director of the Center for Male Infertility at the Cleveland Clinic in Ohio. "I look at testosterone as jet fuel. It keeps men running. Diminished mental clarity, motivation, drive -- all of these things can be related to low testosterone."
Testosterone plays a big role throughout a man's life. The hormone is the prime driver of puberty, responsible for the deepening of the voice, the development of muscles, and the growth of pubic hair. Without testosterone, there would be no beards or mustaches since it regulates facial hair. Sperm production falls under testosterone's control. In sum, it's the hormone that makes a man a man, and it is what gives men their appetite for sex.
While a decline in blood testosterone may be a normal part of aging and the most common cause of low testosterone, it is not the only one. Testicular cancer as well as the chemo and radiation used to treat it and other forms of cancer can deplete a man's levels of the hormone. Excess alcohol and certain medications may also be the cause. Pituitary and thyroid diseases as well as injuries to the testes can also drain your testosterone.