Ten signs and symptoms of low testosterone levels in adults

  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

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

Short Frenulum (Tight Frenulum, Frenulum Breve)

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 ?

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

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.

Tight foreskin/Phimosis – causes, symptoms and treatment

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.


  • 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).

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.

Prostate enlargement diagnosis

Prostate enlargement diagnosis starts with the history and examination of the patient. Symptoms are scored to assess the severity of disease. (Read symptoms of prostate enlargement at BPH (Enlarged prostate) Symptoms). Per rectal examination in office room gives the initial clue to the enlargement of prostate. Since the urinary symptoms are not exclusive for prostate enlargement in men, few basic investigations are often required to reach final diagnosis before initiating treatment.

  1. Urine examination – patient provides a sample of freshly passed urine in a sterile container. This test tells about presence of any infection in urine.
  2. Uroflowmetry – In this test, patient need to hold urine till he gets urge to pass urine. Patient is asked to pass urine in a machine, which then generates a report about the flow of urine. After patient finished passing urine, the presence of any residual urine in bladder is checked by ultrasound.
  3. Ultrasound abdomen – ultrasound is done to see the kidneys, bladder and size of prostate. Kidneys are part of urinary system and prostate enlargement can affect kidney function.
  4. Serum creatinine – creatinine is marker of kidney function. Long term disease can lead to kidney damage and hence need for checking creatinine.
  5.  Blood PSA – PSA is test done to screen patients aged 55-70 years to rule out presence of prostate cancer. Patient with prostate cancer have raised blood PSA levels. However PSA can be raised in other conditions also such as urine infection, prostate infection, urine retention, large prostate etc. Read more about serum PSA at Prostate cancer and PSA testing
  6. TRUS – Trans rectal ultrasound (ultrasound probe passed through rectum) is conducted in office setting under local anaesthesia as it provides the more accurate size of prostate enlargement compared to abdominal ultrasound.
  7. Endoscopy – Flexible endoscopy through urethra may be ordered by physician as per the symptoms of patients and ultrasound findings.  Patients having severe symptoms with normal prostate size on ultrasound may need this test. Flexible endoscopy is done under local anesthesia in office setting which gives visualised information about intraurethral prostate protrusion, and whether it is causing any mechanical obstruction. Sometimes physician advices about prostate operation based on endoscopy report even if size of prostate is normal on ultrasound.
  8. Urodynamics – This test is selectively performed for patients who are suspected of having poor bladder contractility as the cause of his symptoms. These patients include those having symptoms of bed wetting, spontaneous urine leakage, neurological disorders, having previous prostate surgery etc.

After these tests the decision is taken by the doctor for treating the patient with either medicines or with surgery. Read treatment of enlarged prostate at Treatment of Benign Prostatic Enlargement

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