Testosterone is the ultimate male hormone. The Leipzig urologist Dr. Tom Kempe explains what role it plays, how testosterone deficiency affects it, how it is treated and why a big belly can lower testosterone levels.

The main thing is healthy: what does testosterone do?

Dr. Tom Kempe: Testosterone is a very important hormone in the male metabolism. It does a lot of things. It is important for the muscle metabolism and for the bone metabolism, for the psyche, of course for the sexual function, but also for the blood composition and the immune system, i.e. for many functions all over the body. In short: it turns man into a man.

What happens if it is missing?

The typical things we see in the clinic are men with depression, with pre-diabetes or diabetes, fatigue, bone problems, muscle weakness, and sexual dysfunction.

What is the typical age for these symptoms to appear?

It is very diverse. There are many causes. It is also often not clear why. This occurs in young men, but also – let’s call it that – during the menopause, i.e. between the ages of 50 and 60.

Can you say how often men go to the doctor about these symptoms?

Men generally don’t like going to the doctor. So I see maybe five to six patients a week with such complaints, who either address this directly or come for something else and then say on the way out, by the way, I wanted to ask something quickly and that may have been the reason why they came here are.

Why do men find it so difficult?

We are so attracted to it, I think. That men are Indians and brave and if the head is not under the arm, then we men do not go to the doctor. That makes up a good part of the causes, which is why our life expectancy is a whole lot lower than that of women who are accustomed to go to the gynecologist regularly from adolescence.

When does a testosterone deficiency need treatment?

The funny thing is that in men it is not so much about the numerical value, but rather about the complaints. In any case, I would only treat if there is a feeling of suffering and, of course, this includes determining the testosterone in the blood. A value of about 10 is the normal value. There are men who are worth 8 and have significant problems. But there are also men who have a value of 3 and are completely symptom-free. I wouldn’t prescribe anything there either.

What are the common treatment options for testosterone deficiency?

Either a gel is prescribed. This is the variant that I usually prefer for my patients. Syringe therapy would be an alternative. If the findings are serious, if the deficiency is severe, or if you have a congenital testosterone deficiency, you would be more likely to go for a syringe treatment. These are depot syringes that have to be administered every three months. But they sometimes cause large fluctuations in the hormone level, so that a high dose “floods” first and then towards the end of the three months, the patients have almost withdrawal symptoms. This is much more balanced and has fewer side effects with the gel, which is administered daily through the skin in a small dose.

What are the side effects of testosterone substitution?

The prostate comes first. We regularly check the PSA level and make sure that no undetected prostate cancer develops, which might be forced by the hormone. Then it affects the composition of the blood components, the risk of thrombosis increases a little.

Can you influence your testosterone level without medication?

Of course, you can and I would recommend that in the first place. Healthy eating and exercise are important to keep the abdominal circumference at bay. This is because adipose tissue produces estrogens from testosterone. And that reduces testosterone levels.

So does a big belly lower testosterone levels?

Maybe yes.