CONDITIONS

Low Testosterone

What Is Low Testosterone

Low testosterone (Low T) is characterized by a deficiency of the male sex hormone testosterone. The effects of testosterone on the body include:

  • Increased libido and frequency of erections
  • Penis enlargement
  • Increased muscle mass
  • Increased bone density
  • Hair growth (with the exception of scalp hair)
  • Aggression
  • Increased energy

Low T can be caused either by an error in the communication between the brain and the testes, or by a malfunction of testosterone synthesis within the testes. Low testosterone can cause a variety of symptoms, including a reduced sex drive, mood changes, and erectile dysfunction. The incidence rates of low T increase with age, form 20% from men 60 and above to 50% for men over the age of 80.

While we typically associate testosterone with men, women also produce testosterone, which plays an important role in sexual health for both men and women. Testosterone stimulates sexual desire, libido, arousal, and increases sexual satisfaction—it also helps women maintain optimal body function by helping maintain bone density, muscle mass, and a healthy energy level. Women with low T can experience many of the effects that men do, like decreased libido, chronic fatigue, and low mood, but most often to a lesser degree than men. Due to serious side effects, doctors are very cautious about prescribing testosterone to women, and when they do, are extremely conservative with dosing.

What Causes Low Testosterone

Testosterone is produced when the brain signals the testes to make the hormone.  If there is an error in this communication or if the testes malfunction and cannot produce the normal amount of testosterone, a person’s testosterone levels may fall to low levels. This failure to produce a sufficient amount of testosterone is known as hypogonadism. If low T occurs due to a malfunction in the testes, it is known as primary hypogonadism. If low T occurs due to an error in brain/testes communication, it is known as secondary hypogonadism.

According to a 2010 study published in the Journal of Advanced Pharmaceutical Technology and Research, the causes of hypogonadism are as follows:

Primary Hypogonadism:

  • Certain genetically-linked diseases such as Klinefelter’s Syndrome
  • Undescended testicles (testicles that have not fully developed in the scrotum)
  • Certain infectious diseases, such as mumps
  • Hemochromatosis (excess of iron in the blood)
  • Testicle Injury
  • Radiation therapy and/or chemotherapy
  • Aging

Secondary Hypogonadism:

  • Kallmann syndrome, which is characterized by the abnormal development of the hypothalamus, the section of the brain that signals the hormone-producing pituitary gland.
  • Abnormal functioning of the pituitary gland. This can be caused either by pituitary disorders or damage to the pituitary gland (injury, radiation exposure, chemotherapy, etc.)
  • Inflammatory diseases such as sarcoidosis, histiocytosis, and tuberculosis.
  • HIV/AIDS
  • Certain medications, such as opiates.
  • Obesity
  • Stress
  • Rapid weight loss
  • ­­­­­Excessive physical activity

Risk Factors For Low Testosterone

The following factors may influence your risk of developing low testosterone:

  • The risk of developing Low T increases with age. According to the Urology Care Foundation, the incidence of low testosterone is about 20% for men over the age of 60, 30% for men over the age of 70, and 50% for men over the age of 80.
  • High blood pressure. Approximately 40% of men with high blood pressure will experience low testosterone levels at some point.
  • According to the Urology Care Foundation, 50% of obese men are affected by low testosterone.
  • Approximately 50% of men with diabetes will be affected by low testosterone.
  • Opioid use. 75% of men that are chronic users of opioid pain relievers will experience low T.
  • HIV/AIDS. 30% of men with HIV will experience low T. 50% of men with AIDS will experience low T.
  • Certain genetic conditions affecting the pituitary gland, hypothalamus, or testes raise the risk of developing low T.

Diagnosing Low Testosterone

Before arriving at a diagnosis of low T, your doctor may conduct the following tests:

Physical exam and medical history to assess your risk of developing low testosterone as well as record any symptoms and/or physical signs of the condition.

Blood tests to measure the level of testosterone in the blood. There are three forms of testosterone in the blood:

  • Testosterone bound to albumin (a blood protein), which accounts for 68% of bodily testosterone.
  • Testosterone bound to sex hormone binding globulin (SHBG), which accounts for 30% of bodily testosterone.
  • Testosterone that is free in the blood, which accounts for 2% of bodily testosterone.

The normal range for testosterone levels is 300-1200 nanograms per deciliter (ng/dl). Testosterone levels below 300 ng/dl are considered to be low T.

Symptoms of Low Testosterone

The following may be symptoms of low testosterone:

  • Decreased sex drive
  • Lowered sperm count
  • Erectile dysfunction (inability to get an erection or decrease in strength/frequency of erections)
  • Decreased energy
  • Weight gain (increase in bodily fat percentage)
  • Muscle loss
  • Loss of body hair
  • Decrease in bone density

Prognosis

Most cases of low T are treatable with testosterone therapy. The duration of the treatment depends largely on the cause of the low T. If the cause of low T is treatable, then it is possible that treatment will be temporary. However if the cause of low T is not treatable, testosterone therapy in some form may need to continue indefinitely.

Screening

Low testosterone is relatively hard to detect and is therefore not regularly screened for. Men at high risk for low T, such as:

  • those over the age of 70
  • those with certain inflammatory diseases,

may be tested for low T by their doctors at regular checkups. If you experience any of the symptoms of low testosterone, contact your doctor.

Prevention

Certain causes of low testosterone are unpreventable. However, there are several things that you can do to lower your risk of developing low T. These include:

  • Maintaining a healthy diet. High body fat percentages increase the likelihood of developing low T. Maintaining a healthy and balanced diet can help to prevent obesity, diabetes, and high cholesterol, all of which increase the chance of developing low T.
  • Exercising regularly, which will help maintain a healthy body weight and promote muscle and bone health.
  • Managing stress. Stress can increase the likelihood of developing low T.
  • Schedule regular visits to the doctor. This will help you and your doctor to detect any symptoms/signs of low T and keep your overall health in check.

Common Treatment

The main form of treatment for low T is testosterone therapy. Testosterone therapy comes in several different forms:

  • Testosterone gel. According to the Urology Care Foundation, this is the most common form of testosterone therapy, with just about 70% of patients choosing this method. Testosterone gel is typically administered daily, and is applied directly to the skin of the shoulders or arms after showering.
  • According to the Urology Care Foundation, this is the second most common form of testosterone therapy. 17% of patients choose this method. These injections can be done at home or in a doctor’s office and are typically administered every 1-2 weeks.
  • Patches. About 10% of low T patients use testosterone patches. These are stuck onto the skin daily, in a location that can be covered by clothing (if desired).
  • Buccal tablets. These tablets attach to the gum and slowly release testosterone throughout the day. They are typically applied twice daily.
  • Implantable pellet. In this form of testosterone delivery, capsules are surgically placed under the skin and release low levels of testosterone for months at a time. 

The following side effects may occur as a result of testosterone therapy:

  • Blood clots
  • Damage to the prostate
  • Lowered sperm count
  • Sleep apnea
  • Swelling
  • Enlarged breasts (gynecomastia)

Complementary and Alternative Treatment

The following alternative treatments may help boost testosterone levels:

  • Herbal therapy. The use of specific herbs in tincture or tea form could potentially help raise the production of testosterone in the body. These include:
    • Ginseng
    • He show u, also known as ho shou wu or fo-ti
    • Horny goat weed
  • Zinc. Studies have shown that men with hypogonadism are often deficient in zinc, a mineral that helps control bodily testosterone levels.
  • Acupuncture is a form of traditional Chinese medicine in which small needles are inserted at points throughout the body to restore the flow of bodily energy. Acupuncture has been proved to help reduce stress and tension in the body, and may also help to restore testosterone levels.
  • Mind/body therapies such as yoga, tai chi, and meditation help to reduce stress and center the mind and the body. This can help reduce low T, especially in cases where low T is induced by stress.

When To Contact A Doctor

If you feel that you are experiencing any of the symptoms of low T, contact a doctor.

If you are undergoing treatment for low T and experience any of the following, contact a doctor immediately:

  • Chest pain**
  • Pain in the legs or arms**
  • Damage to the prostate
  • Lowered sperm count
  • Sleep apnea
  • Swelling of the hands, feet, legs, or other areas of the body
  • Enlarged breasts (gynecomastia)
  • Sudden weight loss or gain
  • Extreme weakness/fatigue

**Contact emergency services, these may be signs of a heart attack

Questions For Your Doctor

To find a urologist in your area, visit The Urology Care Foundation

Questions For A Doctor

You may want to ask your doctor the following questions:

  • What is the cause of my low testosterone?
  • What are the available treatments?
  • What are the side effects?
  • How long will treatment last?
  • How will this affect my sex life?
  • What can my partner and I do to better our sex life with low T?
  • What lifestyle changes can I make to help my low T?