Testosterone is the primary sex hormone for males. It is involved in developing many physical traits typically considered masculine, such as deep voice, hair growth, and increased bone density.
Part of the class of hormones known as androgens, testosterone is produced by the testicles following stimulation by the pituitary gland. This gland is located near the base of the brain and sends signals to the testicles in men that trigger feelings of sexual desire.
Although testosterone can be used to treat women, low testosterone (aka low testosterone or hypogonadism) is considered a male problem.
Low testosterone symptoms
Symptoms vary depending on the cause and the age at which low T first appears. Young men should be aware of the following:
- underdeveloped genitals
- Delayed onset of puberty
- Absence of secondary sexual characteristics such as deep voice or facial hair
Middle-aged and older men should be aware of the following:
- Malaise
- depression
- Sleeping disorder
- low libido
- inability to get or maintain an erection
- low sperm count
- breast enlargement or tenderness
- muscle and bone loss
- infertility problems
- loss of body hair
Causes and risk factors of low testosterone
Men’s testosterone levels begin to decline naturally by the age of 30 and then decline by about 1% per year for the rest of their lives. Various other medical conditions can cause testosterone levels to drop significantly below average in boys and men. These include:
- autoimmune disease
- chronic liver or kidney disease
- chronic obstructive pulmonary disease
- genetic cause
- heart failure
- Infectious diseases (such as mumps)
- testicle damage
- metabolic disorders
- obesity
- Prolactinomas (prolactin-secreting tumors) or other tumors of the pituitary gland
Some drugs associated with low testosterone levels are:
- alcohol
- chemotherapy drugs used to treat cancer
- opioid
What is low testosterone?
The American Urological Association (AUA) estimates that low blood testosterone levels are less than 300 nanograms per deciliter (ng/dl) in adults.
However, some researchers and healthcare providers disagree, believing that levels below 250 ng/dL are low. Providers also consider symptoms when diagnosing low testosterone.
How common is low testosterone in men?
We don’t know how many men have testosterone deficiency (TD), but data suggest that about 2.1% (about two men in 100) may be testosterone deficient. Only 1% of young men can get a TD, but up to 50% of men over 80 can get a TD. It is more common in diabetic or overweight men.
DIAGNOSIS AND TESTS
How is low testosterone diagnosed?
If you have signs or symptoms of low testosterone, the doctor will do a physical examination. They will also ask about your medical history, medications you are taking or have taken, smoking history, and current symptoms.
Your provider will consider your specific signs, symptoms, and blood test results to diagnose.
The following tests can help confirm low testosterone levels:
- Blood tests for total testosterone levels: The test usually requires him to take two samples between 8 am and 10 am, when testosterone levels are at their highest. You must tell your healthcare provider if you are ill or have recently become sick. Acute diseases may result in falsely low results.
- Luteinizing hormone blood test: This test can help determine if a problem with the pituitary gland is the cause of low testosterone.
- Prolactin blood test: High prolactin levels can signify pituitary problems.
PREVENTION
Can testosterone deficiency be prevented?
Healthcare providers and medical researchers do not know how to prevent low testosterone levels due to genetic disorders or damage to the testicles, hypothalamus, or pituitary gland.
Some lifestyle habits that help keep testosterone levels standard include:
- Eat healthy
- exercise
- Weight management
- Avoid overdosing on alcohol and drugs.
MANAGEMENT AND TREATMENT
How is testosterone deficiency treated or how to increase testosterone
Healthcare providers treat low testosterone (male hypogonadism) with replacement therapy. Various testosterone replacement therapy includes:
- Testosterone Skin Gel: Apply the gel daily to clean dry skin as directed. It is important not to transfer the gel to others by touching the skin. Testosterone skin gel is one of the most popular treatments in the United States.
- Intramuscular testosterone injection: You or your healthcare provider can inject your muscles every 1–2 weeks. A healthcare provider can inject long-acting testosterone every ten weeks. A subcutaneous injection option is also available.
- Testosterone patch: Apply these patches to your skin daily as directed. The position usually needs to be rotated to avoid skin reactions.
- Testosterone pellets are implanted under the skin every three to six months. Pellets provide a consistent long-term testosterone dosage.
- Buccal Testosterone Tablets: These are sticky tablets you apply to your gums twice daily. Testosterone is quickly absorbed from the gums into the bloodstream.
- Testosterone Nasal Gel: Apply testosterone gel to each nostril daily.
Testosterone replacement therapy Side effects?
Side effects of testosterone replacement therapy include:
- Acne and oily skin.
- Ankle swelling due to mild fluid retention. It can irritate the prostate and cause urinary problems such as difficulty urinating.
- Breast enlargement or tenderness
- Small testicles.
- Skin irritation (if using topical testosterone replacement).
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