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Low Testosterone in Men

Low testosterone (Low T) can happen to any man, and its occurrence increases with age. Most men already produce less testosterone by age thirty than in their early twenties. Testosterone levels decline approximately 1% to 2% each year after that, resulting in a 10% to 20% deficit by age forty. That doubles to 20% to 40% less testosterone in the bloodstream by fifty years of age.

As time progresses, low testosterone levels can lead to fatigue, muscle and bone loss, anemia, poor focus, memory problems, thinning hair, weight gain, sexual decline, depression, and other unwanted symptoms.

While most men will not notice these changes until well into their forties, fifties, or later, some males experience signs of decreased testosterone levels much earlier, including in their thirties. Low T levels interfere with natural cellular and physiological functions that rely on testosterone signals to the androgen receptors. Without adequate signaling, a man may find that his mood, health, appearance, motivation, performance, and quality of life begin to suffer.

Testosterone deficiency is a treatable condition that requires blood analysis to check various hormones and other blood levels. Hormone doctors personalize the treatment to each male’s needs for optimum results.

What is low testosterone?

Low testosterone occurs when the testes do not produce enough testosterone to support the many androgen receptors throughout the body. Also called hypogonadism or andropause, Low T can signal aging, loss of masculinity (virility), and decreased self-esteem and self-confidence.

Decreased testosterone levels can make a man feel tired, depressed, and anxious about how his body will hold up in the future. Some men report less motivation and trouble feeling productive and useful at work and home. Declining sexual desire and performance may impact relationships.

As many as one out of every four men in the US over age thirty may suffer from low testosterone levels. That translates to roughly thirteen million men. By age forty-five, that percentage jumps to thirty-nine, with up to forty-nine percent of men in their eighties diagnosed with hypogonadism.

In the past, 300 ng/dL was used as the “cutoff” to define testosterone deficiency, with hormone doctors using their judgment to determine if symptoms in men with slightly higher testosterone levels also signaled Low T.

Some men with testosterone levels below 300 ng/dL do not experience Low T symptoms. Others with higher than that may still exhibit undesirable signs of testosterone deficiency that require treatment.

The Journal of Urology recently provided age-specific cutoffs highlighting testosterone deficiency in men under 45 based on The National Health and Nutrition Examination Survey from 2011-2016.

The overall mean total testosterone level for men between 20 and 44 is 466 ng/dL, which is also around the goal of treatment. Normal testosterone levels in men can go as high as 950 ng/dL without creating the worry of having high testosterone.

The chart below highlights the “new” normal reference range for men 25 – 44 years of age:

Having reduced testosterone levels can create significant health problems if not treated.

Why is testosterone important for men?

Testosterone is the primary male sex hormone, but that is not all it does. While testosterone is vital for spermatogenesis and sex drive, it is also crucial for maintaining healthy bones, muscles, circulation, and cognitive functions.

A lack of testosterone can influence how a man feels, performs, and reacts to situations in all areas of his life. Low T can increase stress, fatigue, mood swings, anxiety, and depression, making it hard to get through the day.

Maintaining balanced T levels is crucial for men to support testosterone’s many bodily functions as they age.

The main functions of testosterone include:

  • Stimulating erythropoiesis (red blood cell production) in bone marrow – prevents the development of anemia
  • Promoting osteocytes and osteoblasts (essential bone cells) to maintain healthy bone turnover – reduces the risk of osteoporosis and fractures
  • Stimulating various areas of the brain to support cognitive functions and memory – reducing the risk of Alzheimer’s disease and dementia
  • Supporting spermatogenesis (sperm cell maturation) – aids in fertility
  • Helping regulate the metabolism of food – increasing energy and reducing body fat accumulation
  • Supporting lean muscle mass and strength – helps protect the skeletal system from injury
  • Maintaining sex drive and healthy sexual functions – to improve sexual responses, pleasure, and endorphin release
  • Keeping other hormones in balance – testosterone has effects on human growth hormone production, lowers cortisol (stress hormone) levels, and provides the source for dihydrotestosterone (DHT) and estradiol (estrogen) conversion
  • Supporting positive mood and emotional well-being – reduces feelings of anxiety, depression, and irritability
  • Improving cardiac functions, lipid profiles, and circulation – benefits for heart health and reducing cardiovascular risks

Maintaining adequate testosterone levels helps men enjoy better health as they age and reduces the risk of potentially debilitating medical concerns throughout their lives.

What causes low testosterone in men?

As we previously mentioned, testosterone levels decline with age, and that is called late-onset hypogonadism. Aging is one of the causes of low testosterone, others are primary or secondary hypogonadism, divided into congenital (starting at birth) or acquired (developing later in life).

Primary hypogonadism has to do with testicular causes of low levels of testosterone. Secondary hypogonadism is due to issues surrounding the hypothalamus or pituitary glands and the hormones they secrete.

Here are the leading causes of primary hypogonadism:

Congenital conditions:

  • Testicular absence at birth
  • Undescended testicles
  • Klinefelter’s syndrome
  • Myotonic dystrophy
  • Noonan syndrome
  • Leydig cell hypoplasia

Acquired conditions:

  • Tumors, including testicular
  • Radiation or chemotherapy affecting the testes
  • Orchitis (testicular inflammation often due to mumps or other infections)
  • Injury or removal of the testes
  • Anabolic steroid use

Here are the leading causes of secondary hypogonadism:

Congenital conditions:

  • Kallmann syndrome
  • Isolated hypogonadotropic hypogonadism
  • Prader-Willi syndrome

Acquired conditions:

  • Head or brain injury
  • Hyperprolactinemia
  • Hypopituitarism
  • Cushing’s syndrome
  • Kidney failure
  • Cirrhosis of the liver
  • Hemochromatosis
  • Obstructive sleep apnea
  • Alcohol use disorder
  • Certain prescription medications
  • Obesity
  • Mis-managed diabetes

Another condition, late-onset hypogonadism, occurs in response to normal aging as the body decreases testosterone production. Poor lifestyle habits, such as lack of exercise, unhealthy foods, excessive alcohol consumption, insufficient sleep, and weight gain, can further reduce testosterone levels.

What are the symptoms of low testosterone?

Low testosterone levels do not necessarily mean a man has testosterone deficiency. A lack of symptoms shows that the body is adjusting well to the decline in testosterone production. Conversely, the presence of symptoms, even when a man’s testosterone levels fall in the “normal” range, may indicate Low T.

Testosterone deficiency can make you tired, moody, depressed, and lethargic. You may have no “get up and go” or motivation. Low T often causes reduced libido and a lack of sexual desire.

As an androgen hormone, testosterone works on the body’s many androgen receptors to stimulate their functions. Without enough testosterone supply, many symptoms can occur – some specific to testosterone levels, others non-specific yet also linked to testosterone decline.

The following specific symptoms of testosterone deficiency may occur:

  • Reduced sex drive, premature ejaculation and erectile dysfunction
  • Reduced bone mineral density
  • Joint pain
  • Anemia
  • Sleep problems
  • Depression, Stress and Anxiety
  • Reduced lean muscle mass
  • Balding and loss of body hair
  • Weight gain
  • Fatigue and reduced endurance
  • Sluggish metabolism
  • Infertility, testicular atrophy and low sperm count
  • Increased male breast tissue (gynecomastia)
  • Hot flashes/night sweats
  • Cardiovascular concerns and high blood pressure
  • Headaches

These are some of the non-specific signs of testosterone deficiency:

  • Irritability
  • Lethargy
  • Forgetfulness
  • Slow mental processing
  • Trouble concentrating
  • Decreased strength
  • Reduced motivation
  • Lack of productivity

If none of these symptoms are present, there is likely no concern over testosterone deficiency. However, if you recognize one or more of these issues as present, it could be due to Low T levels.

The more symptoms you have, the greater the deficiency might be. Contacting a hormone specialist is crucial to uncover the source of your concerns.

Many of the symptoms listed above also indicate other health concerns, including HGH deficiency. Please do not assume it is Low T until you receive a diagnosis from a hormone doctor. Only then can you receive safe and effective treatment to boost your T levels.

How to diagnose low testosterone

Numerous factors go into diagnosing low testosterone, the first of which is a medical consultation with a hormone specialist. You will discuss your symptoms during the consultation and any other medical issues, medications, and treatments. The doctor will also want to know about your family health history and any other concerns.

Following the consultation, you will likely complete a health history questionnaire, physical examination, and blood analysis.

The health history questionnaire allows you to provide detailed information about any medical treatments, medications, vitamins, and supplements you have received or used in the past or present.

A physical examination is essential as it helps rule out other potential causes of your symptoms. Information provided during the exam is used during the diagnostic and treatment formulation.

Blood analysis is the most crucial part of the diagnostic process. It gives the hormone doctor a look inside your body to see how your endocrine system performs.

How to test testosterone levels

Blood analysis is the best way to measure testosterone levels. The doctor will also check other hormones, blood cell count (for anemia, infections, blood cancers, and immune system diseases), lipid profile for cholesterol levels, and other hormones that could influence testosterone levels or cause your symptoms.

A comprehensive metabolic panel measures 14 blood substances, including calcium, glucose, protein, sodium, and potassium. These measurements provide vital information about your metabolism and chemical balance.

The following blood panels are the most likely to be checked when testing for Low T:

  • Total testosterone
  • Complete blood count (CBC)
  • Lipid panel
  • Comprehensive metabolic panel (CMP)
  • Estradiol (estrogen)
  • Insulin growth factor 1 (IGF-1)
  • Free T4 (direct)
  • Thyroid-stimulating hormone
  • PSA
  • Follicle-stimulating hormone (FSH)
  • Luteinizing hormone (LH)

At-home tests are not helpful or accurate for diagnosing testosterone deficiency. You will still need to visit a laboratory for a complete blood draw to measure the above levels before receiving testosterone replacement therapy (TRT).

There is very little to do to prepare for your blood test. Because hormone levels are most accurate first thing in the morning, before you eat or drink anything other than water, that is when your test will take place. You will be instructed to stop eating by midnight before getting a good night’s sleep.

There is minimal risk involved with blood testing. Once you arrive at the lab, you will be taken into a private room where the lab technician will check your veins to select the best one – typically inside one of your elbows. A tourniquet is applied to the upper arm, and you may be handed something to squeeze to help pump the blood into the tubes.

After sterilizing the skin, the technician will insert the needle into your vein and draw a few different colored tubes of blood. Once finished, a gauze pad and bandage will be put over the spot for a few hours.

The hormone doctor will check the lab test report within a few days upon receipt and get back to you with any results and diagnosis. Remember, the doctor will also check the other test results to determine if an underlying factor contributes to a decline in testosterone production.

While 300 ng/dL total testosterone is the reference point for Low T, that is not the only factor involved in the diagnosis. If you have symptoms of testosterone deficiency and total testosterone in the lower end of the normal range, you may still receive a diagnosis and treatment plan.

How to treat low T

Treating Low T is a relatively simple process. The hormone doctor determines the level of deficiency after reviewing your blood test results and physical examination report. Upon calculating the recommended testosterone dosage, the next step is providing you with a testosterone prescription for your treatment.

Treatment for men with Low T typically involves injections of testosterone cypionate, testosterone enanthate, or a combination approach. Testosterone treatment can be administered once a week, every other week, or once a month, depending on the brand, testosterone type, and the prescribed dosage. Weekly injections of lower doses help many men avoid the highs and lows of administering larger dosages further apart.

Other treatment options include testosterone patches and gels, nasal gels, and implantable pellets. Oral testosterone should be avoided due to the higher incidence of liver toxicity. Transdermal testosterone patches and gels can increase the risk of cross-contamination to others, bring slower results at a significantly higher cost, and cause potential skin rashes or reactions.

Testosterone pellets are small rice-sized pellets inserted under the skin. This form of treatment has drawbacks such as difficulty removing the pellets if there is a bad reaction, pellets exiting the skin and reducing results, higher expense, and potential insertion site reactions.

Testosterone injections are the best option for most men, especially since they can be self-administered in the privacy of one’s home. The initial phase of treatment will be for six months, with follow-up blood testing around the third or fourth month. That allows the doctor to make any dosage adjustments to improve results. Many men continue with TRT for a year or longer without any problems.

Ignoring the signs and symptoms of low testosterone will not make it go away. They will only get worse as testosterone levels continue to decline. Untreated Low T can increase your risk of developing the following health conditions:

  • High cholesterol
  • Heart disease
  • Osteoporosis
  • Dementia
  • Obesity
  • High blood pressure
  • Metabolic syndrome
  • Type 2 diabetes
  • Infertility
  • Depression

Every medical treatment comes with risks, but under doctor supervision, most men never experience any side effects from TRT. The most common issue is injection site soreness, redness, irritation, or itching. These are issues that rectify themselves quickly.

Administering too much testosterone, or using it illegally, are the most likely causes of side effects. Testosterone levels should never go higher than their normal state. Doctor supervision is crucial when using testosterone to avoid side effects such as:

  • Infertility
  • Testicular atrophy
  • Acne
  • Oily skin
  • Changes in hair growth
  • Gynecomastia
  • Worsening of sleep apnea
  • Edema
  • Changes in behavior/mood
  • Headaches
  • Increased red blood cell count
  • Increased prostate-specific antigen (PSA)

Over-the-counter supplements, such as herbs, amino acids, and vitamins, do not produce the same effects that testosterone replacement can bring. Because supplements are not regulated, some products could be dangerous to use.

Our hormone therapy clinic provides men safe, legal, and affordable TRT. The hormone doctors at our clinic customize all treatments, providing you with the lowest dosages that will bring superior results. Please call for a free telephone consultation and additional information.