Testosterone and Spinal Cord Injury
by Stanley Ducharme, Ph.D.

Most people are familiar with the hormone testosterone and know that it is essential for normal male development. In high school, we learned that testosterone is essential for the growth spurt seen in teenage boys and regulates the sexual drive. In recent years, testosterone has been the focus of a great deal of research. As a result, scientists have learned that testosterone has health related benefits that go far beyond male sexual drive and sex related characteristics.

Testosterone is the most important of the male hormones and is known as an androgen. The chemical building blocks for these androgens are steroids and have many important physiological actions in the adult Testosterone has an important impact on muscle mass, strength, mood, bones, hair growth, voice, energy level and sexual drive

In the man, testosterone is produced in the testicles and in the adrenal glands. The body begins to produce testosterone before birth and it is at its highest level during adolescence. This is why young men typically have morning erections during adolescence and young adulthood. Testosterone levels are at their daily highest point in the morning.

Unlike women however, who abruptly stop producing hormones as they age, the man gradually slows down the production of hormones as he ages. One study, The Baltimore Aging Study, found that hormone deficiency was present in 9% of men surveyed in the age group of 50 to 59, 34% of men aged 60 to 69 years and 68% of men aged 70 to 79 years. Over time, testosterone levels show a continual, gradual decline. Many scientists feel that this decline in testosterone is responsible for many of the symptoms that we normally associate with the aging process. It is also responsible for what has been defined as the "male menopause".

Age is not the only factor that lowers testosterone. Some studies have suggested that medical conditions such as being overweight and diabetes may lead to lower testosterone levels. Unfortunately, spinal cord injury also has been shown to dramatically decrease testosterone levels. Taken together, age and spinal cord injury can create havoc on normal hormonal levels.

Men with Spinal Cord Injury

For men with spinal cord injury, lower testosterone levels also seem to be common early after injury. Some studies at the University of Missouri have reported that up to 70% to 80% of men with spinal cord injuries have decreased hormone levels. In men, the specific hormone that decreases is testosterone. As a result, men with spinal cord injury can also experience many of the physical and psychological symptoms of lower testosterone levels. This can create an unhealthy situation.

For the man with spinal cord injury, the symptoms of lower testosterone can be especially debilitating. A loss of muscle mass and strength can affect mobility and functional independence. Fatigue, loss of energy and moodiness can ultimately impact on areas such as pressure relief, medication compliance and health maintenance. Motivation, dry skin and wound healing can also be affected if hormone levels are diminished. Finally, many scientists are currently questioning whether the presence of osteoporosis in people with spinal cord injuries may be related to lower testosterone levels along with other factors. Several medical centers are currently conducting bone density studies to better understand osteoporosis, testosterone and spinal cord injury. Thus far, the results are inconclusive but it appears that testosterone clearly plays a role in the development of osteoporosis in men with SCI.

In addition to the above issues, the loss of sexual interest, associated with lower testosterone levels, can add to the sexual problems already being experienced for the man with a spinal cord injury. For these individuals, sexual activities are often seen as added work or as a burden that requires additional efforts. Naturally, relationship or marital issues can emerge as the romantic, affectionate and intimate qualities of a relationship disappear.

Testosterone and Women

For women, the role of testosterone is much less understood. Nevertheless, for both women with spinal cord injuries and non disabled women, testosterone, as well as estrogen, is also important for a healthy libido and sexual functioning. Women with low testosterone often feel fatigued, have no energy and lack a sense of wellbeing. Lower testosterone levels are often associated with lower sexual interest, decreases in lubrication, painful intercourse and difficulty in achieving an orgasm. The entire sexual experience becomes diminished and less fulfilling. Depression is common.

For women, as well as for men, the presence of testosterone is important in maintaining energy levels, bone density, mood and strength. Although the level of testosterone may drop suddenly at menopause, medications have been shown to interfere with the woman's ability to produce adequate levels of the hormone. For example, birth control pills and most anti-depressant medications can reduce the body's ability to produce an ongoing supply of testosterone.

Testosterone Replacement Therapy

To determine if hormone levels have decreased after injury, a simple blood test is usually required. This can be completed at the doctor's office and the results are then compared to men of the same age group who do not have a spinal injury. If the doctor determines that testosterone therapy is the best course of action to treat the problem, he or she will recommend one of the several available delivery methods. Generally, these include injections, patches or various gels. For men with spinal cord injury, many doctors have found that a monthly injection of testosterone significantly decreases the symptoms of androgen deficiency.

It is important to remember that there are risks associated with testosterone therapy and that it is a medication designed to treat a disorder. It's not a substance to enhance a lifestyle or to be taken for an energy boost. Receiving testosterone therapy is always conducted under careful medical supervision and requires ongoing monitoring of blood levels. Taking testosterone may be beneficial to many people but can also aggravate sleep disorders, stimulate enlargement of the prostate gland and trigger urinary problems. It can also cause more minor issues such as an increase in facial hair and acne.

More Research is Needed

In conclusion, hormones and especially testosterone play a critical role in maintaining a healthy body and a healthy sexual appetite. Lower levels of testosterone have been recently identified in individuals with spinal cord injury and more attention is now being given to the adverse affects of lower levels on the aging process. Scientists are concerned about poor wound healing and unhealthy bones when hormone levels are too low in people with spinal cord injuries.

Testosterone replacement therapy for people with spinal cord injuries is till somewhat controversial but gaining much more acceptance among medical professionals. In larger medical centers, this is a physiological condition which is being treated by, endocrinologists, urologists and physiatrists. Testosterone replacement is one more area in which we will continue to see research on this topic. In the meantime, if symptoms are present, it is certainly worth discussing with your doctor.

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