Testosterone is the primary sex hormone in men, and it is responsible for the development of many of the physical characteristics that are considered typically male, such as deep voice, hair growth, increased bone density, and many others.
Testosterone, part of a hormone class known as androgens, is produced by the testicles after stimulation from the pituitary gland, which is located near the base of the brain and sends signals to a male’s testicles that spark feelings of sexual desire, notes MedlinePlus.
While testosterone may be used to treat women, low levels of testosterone (also known as
low T or hypogonadism) is considered a male problem, according to a 2019 review.
Depending on the cause and age when low T first appears, symptoms can differ. Younger males should watch out for:
- Underdeveloped genitalia
- Delayed puberty onset
- Lack of secondary sexual characteristics, like a deeper voice and facial hair
According to the Urology Care Foundation, middle-aged or older men should be aware of:
- Fatigue
- Depression
- Sleep problems
- Low sex drive
- Inability to get or maintain an erection
- Low sperm count
- Enlarged or tender breasts
- Loss of muscle and bone
- Fertility issues
- Loss of body hair
Men can have low T but have no symptoms. Also, some symptoms, such as fatigue, sleep problems, and depression, can be caused by many underlying conditions that have nothing to do with testosterone.
Men’s testosterone levels start a natural decline starting around age 30, and then drop about 1 percent per year after that for the rest of their lives.
A variety of other medical conditions can cause significantly lower-than-normal testosterone levels in boys and men. These include:
Some drugs are also associated with low testosterone levels, including:
Sometimes the cause of low testosterone in a man is unknown, and many men have several different causes.
Low testosterone is diagnosed with the following tests to check:
- Total Testosterone Level
- Luteinizing Hormone (LH) Abnormal levels may mean a pituitary gland problem, which can cause low T.
- Blood Prolactin Level High levels can also signal pituitary problems or tumors.
- Blood Hemoglobin (Hgb)
Other possible tests are:
- Follicle Stimulating Hormone (FSH) This may be checked for sperm-making function.
- Estradiol Hormone Test This is performed if the patient has enlarged breasts.
- Glycosylated Hemoglobin (HgbA1C) Blood Test This test looks for diabetes by checking the level of hemoglobin attached to glucose.
- Thyroid Hormone Levels Assessing other hormonal abnormalities can contribute to diagnosis.
- Cortisol Level This is another potential hormonal abnormality.
- Magnetic Resonance Imaging (MRI) An MRI scan of the pituitary gland may be performed.
- Bone Density Tests Low T can promote bone loss.
- Karyotype (Chromosome Tests)
Prognosis of Low T
The long-term outlook is good, if diagnosed and treated early. Treatment can reverse symptoms, and reduce risk of muscle and bone loss, notes Urology Austin.
During and after treatment, you will need to be checked routinely to ensure that your levels stay normal. If you are responding appropriately to testosterone treatment, your levels should be checked every 6 to 12 months, depending on your physician’s recommendation.
Your doctor will also monitor you for any possible adverse side effects, such as an increased risk of blood clots and prostate cancer.
Medication and Nonsurgical Treatment Options
In the past, low T was typically treated with testosterone replacement therapy (TRT). Recently, however, thinking has changed on this. The American College of Physicians updated its clinical practice guidelines in 2020 to counsel that TRT should only be prescribed to men for sexual dysfunction.
Possible Side Effects of TRT
Possible long-term effects of TRT have not yet been established, but per the Mayo Clinic, there is scientific evidence to suggest it may cause:
- Sleep apnea
- Acne and other skin irritations
- Growth of existing prostate cancer or benign prostate growths
- Enlarged breasts
- Shrinking testicles and reduced sperm production
- Overabundance of red cell production, which can cause blood clots
- Possible cardiovascular complications, including events such as stroke or heart attack
If you do take testosterone for sexual dysfunction (and even if you’re not taking testosterone), you should seek immediate medical attention if you experience any symptoms of a heart attack or stroke, such as:
- Chest pain
- Shortness of breath or trouble breathing
- Weakness in one part or side of the body
- Slurred speech
RELATED: What Is Testosterone Replacement Therapy?
Alternative and Complementary Therapies
- Lose weight. Losing the pounds often causes testosterone levels to come up, especially if you are obese or have an underlying medical condition such as diabetes that can contribute to low T.
- Limit alcohol consumption. Consuming alcohol can convert testosterone to estrogen.
- Calm yourself. The stress hormone cortisol can compromise testosterone’s effects.
- Get a full night’s sleep. Sleep deprivation shoots up cortisol levels.
- Work out. Interval exercise can build muscle mass, which in turn releases testosterone from protein.
- Avoid BPA. Drinking out of plastic cups made with the chemical bisphenol A (BPA) can lower testosterone levels.
- Get your zinc. Found in shellfish and pork, this mineral can support testosterone levels naturally. If you take a supplement, take 12 to 15 milligrams daily.
- Eat healthy fats. Add fats to your diet such as those found in nuts, avocado, and olive oil.
- Avoid sugar. This can decrease testosterone.
Prevention of Low Testosterone
As described above, diet, stress management, and several other nonmedical approaches may be effective in staving off low testosterone issues.
Various medical conditions can cause significantly lower-than-normal testosterone levels in males. These include:
- Autoimmune diseases
- Chronic liver or kidney disease
- Chronic obstructive lung disease
- Genetic causes
- Heart failure
- HIV or AIDS
- Infections
- Injury to the testicles
- Metabolic disorders
- Obesity
- Prolactinoma (prolactin-secreting tumor) in the pituitary gland
- Testicular cancer or treatment for testicular cancer
- Type 2 diabetes
In one past study, 1 in 4 men between ages 30 and 79 had total testosterone levels less than 300 nanograms per deciliter (ng/dL), which is generally considered the low end of the normal range.
And there were no differences between men of different races or ethnic groups. Only a minority of men were feeling the sexual effects of low T. Of the men tested, 12 percent reported having low libido and 16 percent had
erectile dysfunction.
But the prevalence of symptomatic androgen deficiency — meaning low levels of testosterone that cause discernible health problems — are on the rise, according to the study authors. Other research projected that by the year 2025, as many as 6.5 million American men ages 30 to 79 will have symptomatic androgen deficiency, which is a 38 percent jump from 2000 population estimates.
As listed above (see Causes and Risk Factors of Low T), many conditions, such as obesity or heart failure, relate to or potentially contribute to low T.
Partnership for the Accurate Testing of Hormones (PATH)
PATH formed in 2010 to help the clinical, medical, and public health communities improve patient care through more accurate and reliable hormone tests. PATH supports research that improves the diagnosis and treatment of hormone disorders, including a landmark 2017 study that defines the “normal” range of testosterone in young adult men.
Dr. Turek’s Blog, The Turek Clinic
Paul Turek, MD, a urologist in San Francisco, is an international leader in male fertility research. He blogs about men’s health topics, including steroids, testosterone, and male infertility, on the Turek Clinic’s website.
Clinical Trials
If you would like to know more about testosterone clinical trials, check ClinicalTrials.gov.
