Androgenʼs have been shown to play an important role in several aspects of menʼs health, not just in sexual function. A wide range of metabolic processes are influenced by androgens, including glucose and lipid metabolism, changes in vascular responsiveness, and the maintenance of bone mineral density. There is evidence that cognitive function and mood also influenced by changes in androgen levels. Sexual response is affected at many levels: cognitive processing in the brain, pro-erectile signalling within both the central and peripheral nervous system, and cavernous smooth muscle structure and function are all influenced by androgens. Deficiency states are associated with diabetes, dyslipidaemia, hypertension, metabolic syndrome, fractures, depression and sexual dysfunction. Symptoms are non-specific (fatigue, reduced physical strength, low mood, poor concentration, irritability, hot flushes, sexual dysfunction, and others) and androgen deficiency often remains undiagnosed.

There are a wide range of causes of androgen deficiency, although ageing is the commonest. Androgen suppression for the treatment of cancer, trauma and genetic anomalies are also causes. Many men experience symptoms related to reduced production of sex steroids as they get older. These changes are inevitable, but affect individuals differently. Some experience very few symptoms, whilst others are completely disabled by them. It This change in sex steroid production is a natural process and not a “disease”. However, the effects of many unpleasant natural processes can be ameliorated by medical treatment. Modern androgen treatments are effective in reversing symptoms and the unwanted metabolic effects of deficiency; they are also well-tolerated and safe.

More clinician awareness of androgen deficiency is required, so as to reduce the health burden not only of sexual dysfunction but also a range of serious but preventable or treatable disorders.