Author: Dr Varinder Attri

MS MCh (PGI Chandigarh), Urologist, Andrologist and Laparoscopic surgeon
Andrologist, Urologist

Testosterone and Testosterone deficiency syndrome

Dr Varinder Attri

What is testosterone ?

Testosterone is the male hormone which helps in the physical, sexual and psychological well being of the person.

What is the role of testosterone hormone in male body ?

Testosterone helps in development of male secondary characters at puberty such as growth of facial hairs, penis and testes enlargement, deepening of voice, bony and muscle growth etc. In grown adults, this hormone helps in maintaining muscle and fat mass, safeguarding cardiovascular health and producing blood cells, keeping emotional stability, maintaining sexual life while keeping libido, sexual desire, penile erection and fertility normal.

What are sign and symptoms of testosterone deficiency in men ?

Sexual symptoms – Decreased libido; erectile dysfunction; decreased frequency of
morning erections; decreased performance

Physical symptoms – Increased visceral body fat/obesity; decreased lean muscle mass;
decreased strength; fatigue/loss of energy; decreased physical activity/
vitality; low bone mineral density; anemia; flushes; loss of facial, axillary
and pubic hair/slow beard growth; decline in general feeling of well-being

Psychological symptoms – Depression/depressed mood; mood changes; irritability;
inability to concentrate; insomnia/sleep disturbances

Which persons are at risk of developing testosterone deficiency syndrome ?

Persons with poorly controlled diabetes, high BMI, kidney failure on dialysis, chronic alcohol consumer, liver disease, on cancer chemotherapy , drug addicts, COPD etc are at risk for testosterone deficiency and its symptoms.

How to check and evaluate for the testosterone deficiency ?

Testosterone is checked by the blood sample, taken in fasting state early morning between 8 am to 11 am. Normal levels of total testosterone in adult male is usually between 275 ng/dl – 875 ng/dl. Level below this range suggests testosterone deficiency.

How to treat if someone having low testosterone levels ?

If someone is having low serum testosterone levels, complete history and examination for sign and symptoms is must for such patients, as only low testosterone levels does not warrants its treatment. If there are corroborative sign and symptoms along with low testosterone level, the treatment is usually initiated with either intramuscular (i.m.), oral and gel preparations.

Whom to consult for if someone has low testosterone levels ?

You should meet Andrologist for the evaluation and treatment of low testosterone levels.

Andrologist, Urologist

Ten signs and symptoms of low testosterone levels in adults

Dr Varinder Attri
  1. Sexual symptoms – Most prominent symptom, Decreased erections, loss of erectile function (erectile dysfunction), decreased semen volume, decreased frequency of ejaculations
  2. Hair loss
  3. Cognitive symptoms – Low mood, low sexual desire, memory impairement, sleep disturbances, concentration difficulties, decreased motivation
  4. Reduced muscle mass, increase in body fat
  5. Decreased physical strength/activity, decreased energy
  6. Increased risk of heart diseases
  7. Hot flushes
  8. Gynecomastia/increased breast tissue
  9. Persistent fatigue
  10. Loss of bone tissue, increased risk of osteoporosis
Testosterone deficiency syndrome

Read more about testosterone and testosterone deficiency syndrome at Testosterone and Testosterone deficiency syndrome

Andrologist, Urologist

Short Frenulum (Tight Frenulum, Frenulum Breve)

Dr Varinder Attri

What is frenulum ?

Frenulum is the elastic fold of skin that joins the underside of the glans of the penis with the inner surface of the foreskin.

What are risks of having short frenulum ?

A short frenulum (also called frenulum breve) is when the frenulum is so short in length that there is restriction in free and smooth retraction of the foreskin. This often leads to the pain and discomfort during sexual intercouse. Also, it can increase the risk of infections, as it is difficult to clean under the foreskin. Short frenulum can also get torn while sexual activity and hence can lead to bleeding. Read how this condition is different from Phimosis

Short Frenulum/Frenulum breve

What is the treatment for short frenulum ?

It can be managed conservatively if not causing any discomfort or pain. In some cases, steroid creams and stretching exercises can be enough to sufficiently elongate the frenulum. However in majority of cases, surgery is required to alleviate the symptoms. Frenuloplasty (Frenular release) is the mainstay of surgery. Sometimes, the resection of the frenulum (frenulectomy) or circumcision (removal of foreskin) is required. This surgery is done on day care basis with same day discharge of the patient after surgery.

Whom to consult for short frenulum ?

Urologist and Andrologist are the doctors, who look after such problems.

Andrologist, Urologist

Tight foreskin/Phimosis – causes, symptoms and treatment

Dr Varinder Attri

What is phimosis ?

Phimosis is inability to completely retract the prepuce, otherwise called foreskin. This inability to retract is physiological and normal in children upto 3-4 years of age.

Read how phimosis is different from short frenulum Short Frenulum (Tight Frenulum, Frenulum Breve)

What are the causes of phimosis ?

It can be congenital (present since birth) or secondary (acquired during one’s life). Secondary phimosis can be due to the infections (in diabetes), iatrogenic, prolonged catheter placement, lichen sclerosis (where foreskin becomes whitish and hard).

With what symptoms phimosis patient present with ?

Children with phimosis present with crying episode while passing urine or there may be ballooning of foreskin while passing urine. Adult person with phimosis usually present with the difficulty in passing urine or painful intercourse. In cases of infection, patient may present with pus discharge or redness over the penis.

Is there non surgical treatment of phimosis in young children ?

In children after 2-3 years, if foreskin remain non retractile, mother may be taught to gently retract foreskin during every bath after applying lubricating jelly (petroleum jelly).

What is the treatment of phimosis ?

Phimosis is a surgical curable disease. Children after 3-4 years with non retractile foreskin may be surgically treated with removal of foreskin called circumcision. Adult patient may similarly be undertaken for circumcision if there is no infectious cause of phimosis. In cases of infections leading to phimosis, such patient are treated with antibiotics and maintenance of local hygiene.

What is circumcision surgery ?

Circumcision is a day care procedure and may be done safely under local anesthesia in adults. It can be done either using stapler technique or with absorbable sutures. There is no significant post operative complications associated with this surgery or any problems in attaining erection or sexual performance in adults.

Whom to consult if someone having phimosis ?

You should visit nearby Urologist or Andrologist for the treatment of phimosis.

Andrologist, Urologist

NOCTURIA

Dr Varinder Attri
  • Nocturia is waking up more than once in night for urinating after going to sleep.
  • Waking up more than once at night for urinating leads to sleeplessness, fatigue, poor concentration daytime, anxiety etc.
  • Nocturia can be due to increased urinary frequency at night-time or increased urine production at night (Global or Nocturnal polyuria).
Nocturia

Global Polyuria – Patient passes more urine during day time as well. Causes include uncontrolled blood sugars, diabetes insipidus (lack of vasopressin hormone).

Nocturnal polyuria – patient passes more urine only during night-time. Various reasons for increased urine output at night include congestive cardiac failure, varicose veins, sleep apnea, swelling lower limbs, drinking lot of fluid before sleep, taking certain medications that increase urine production etc.

Nocturnal frequency – Some patients may not be producing more urine at night but may wake up more often from sleep for urination due to urinary tract infection, OAB (overactive bladder), Prostate enlargement (Read BPH (Enlarged prostate) Symptoms) , small bladder capacity, stroke, interstitial cystitis etc.

Diagnosis is made by doctor after recording detailed history from patient. Patients are usually given a chart to record his drinking and urination habits over whole 24 hour, called bladder diary. Increased urine production need thorough workup to rule out heart condition, diabetes, snoring habits, lower limb edema etc. Certain conditions such as prostate enlargement need ultrasonography tests to look for prostate size. Urine infection is ruled out by taking urine sample for testing.

Treatment of nocturia is as per the underlying cause identified. Restricting fluid intake after evening and Passing urine immediately before sleep is advised. Changing the schedule of diuretic drug, wearing compression stockings during daytime, control of diabetes etc are helpful. Nocturia secondary due to cardiac dysfunction, snoring needs respective consult from cardiologist and ENT specialist. Symptoms due to prostate enlargement may need medicine or surgery for prostate. Patients experiencing increased frequency due to infection are treated with antibiotics. Certain medications such as anticholinergics and beta agonist are helpful in controlling increased frequency. Increased urine output at night is treated with desmopressin medication.