Low Testosterone

What Is Low Testosterone?

Testosterone is the male sex hormone produced in the testicles. While women also produce small amounts of testosterone, it is much more prevalent and necessary for males’ overall health and function. Testosterone is the most common androgen, or group of hormones, responsible for male physical characteristics.

Testosterone is important for the development of certain bodily functions, including:

• Bone density.
• Cognition.
• Muscle mass.
• Overall sense of well-being
• Red blood cells.
• Sex organs and the reproductive system.
• Sperm production.

Testosterone is critical for young men and boys during puberty, when:

• Acne develops.
• Body odor develops.
• Hair and skin produce more oil.
• Hair grows in the armpits, extremities, pubic region, and face.
• Libido increases.
• Quick growth spurts occur.
• Voice deepens.

In adult men, you can see testosterone in action through:

• Aggression and mood changes.
• Libido and erections.
• Mental and physical energy.

If you have low testosterone (low T), also known as hypogonadism, it means you have a reduced amount of the hormone testosterone in your body. Depending on the type of hypogonadism and symptoms, the condition may stem from the testicles or the brain.

While testosterone levels vary throughout life, low testosterone is largely regarded as anything below 300 nanograms per deciliter (ng/dL).

Among other symptoms, low testosterone can affect your desire and ability to have sex.

What are the types of low testosterone?

There are two types of hypogonadism, or low testosterone:

• Primary hypogonadism — This type, also called primary testicular failure, means the low testosterone is stemming from an issue in the testicles.
• Secondary hypogonadism — This type of low testosterone originates from the pituitary gland or hypothalamus, areas of the brain that send messages to the testicles to produce testosterone.

How common is low testosterone?

Low testosterone is common; nearly 40% of men ages 45 and older are affected.

What causes low testosterone?

Potential causes of low testosterone depend on the type and where in the body the problem originates.

If you have primary hypogonadism, it may be caused by:

• Age — As men age, their testosterone levels decrease. For some men, this can become significant enough to need treatment.
• Cancer treatment — Low testosterone is a common hormonal issue you may experience when undergoing chemotherapy or radiation therapy for cancer.
• Klinefelter’s syndrome — This condition is the result of a congenital abnormality of the sex chromosomes and can affect testicular growth, which can lead to lower production of testosterone.
• Mumps infection — Mumps that affect the testicles may create long-term testicular damage, which can affect testosterone production.
• Metabolic disorders — Such as hemochromatosis, can cause your body to absorb too much iron, which can lead to erectile dysfunction (as well as cause pituitary gland dysfunction).
• Trauma from injury — The testicles are vulnerable to injury, and traumatic force can cause hypogonadism.
• Undescended testicles — Sometimes, testicles do not descend from the abdomen to the scrotum before birth. If they have not descended by early childhood, it may lead to low testosterone production.

Secondary hypogonadism may be caused by:

• HIV/AIDS — Testosterone deficiency is sometimes seen in patients with HIV/AIDS.
• Inflammatory diseases — Such as tuberculosis and sarcoidosis, can involve the hypothalamus and pituitary gland and affect testosterone levels.
• Kallman syndrome — This condition is an abnormal development of the hypothalamus and can cause hypogonadism, as well as anosmia (the inability to smell).
• Medications — A decrease in testosterone levels can be a side effect of some prescription medications.
• Pituitary disorders — Since secondary hypogonadism is caused by issues in the pituitary gland or hypothalamus, any abnormality in these areas can cause hypogonadism. This could include a brain tumor and side effects from brain tumor treatment.
• Stress — High levels of stress or excessive physical activity have been linked to hypogonadism.

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What Are the Signs and Symptoms of Low Testosterone?

If you have low testosterone, you may experience some of the following symptoms:

• Anemia.
• Depression.
• Erectile dysfunction.
• Fatigue.
• Hair loss.
• Hot flashes.
• Issues with memory or concentration.
• Low muscle mass.
• Low sex drive.
• Low sperm count.
• Obesity.
• Shrinking testicles.

When should I see a doctor about my low testosterone symptoms?

If you are experiencing any of the above symptoms or have low testosterone levels from a blood test, it is important to talk with your primary care doctor to discuss treatment options.

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How Do You Diagnose Low Testosterone?

To diagnose low testosterone, your doctor will consider your medical history and symptoms, conduct a physical examination, and order a blood test to measure your testosterone levels. A blood test is one of the most definitive ways to diagnose the condition.

Medical history

Your doctor may ask you questions regarding:

• Current or past illnesses.
• Current symptoms.
• Genetic conditions in the family (diseases linked to low testosterone).
• Headaches.
• History of chemotherapy.
• History of head trauma.
• Injury to the testicles.
• Loss of smell.
• Sex drive.
• Use of tobacco, alcohol, and opiates.
• Use of glucocorticoids (steroid hormones).

Physical examination

A physical exam for low testosterone levels is essential. Your doctor will look at:

• BMI.
• Body hair (pattern, amount, and location).
• Presence and size of testicles.
• Size and consistency of the prostate.
• Size of breasts.

Tests to diagnose low testosterone

In addition to a physical exam, your doctor may order the following tests:

• Blood test — Typically done in the morning when testosterone levels are highest.
• Blood hemoglobin (Hgb) — While hypogonadism cannot be determined from this test alone, it is often a part of a broader evaluation for diagnosis.
• Blood prolactin level — High levels of prolactin are associated with issues in the pituitary gland.
• Luteinizing hormone (LH) — This test can help determine if there is a link to the pituitary gland.
• Semen analysis — Determining the quantity and health of sperm can help understand where low testosterone is affecting.
• Total testosterone level — This test involves two samples collected in the morning.

Androgen deficiency in aging males (ADAM) questionnaire

The Androgen Deficiency in Aging Males (ADAM) questionnaire is an online module men can use to determine if their symptoms may be stemming from low testosterone. This tool is not to be used as a diagnosis or in place of medical attention, but can help men determine if they may have the condition.

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How Do You Treat Low Testosterone?

Once a formal diagnosis of hypogonadism has been established, men can start considering their treatment options. All treatment options involve testosterone replacement therapy (TRT) — or an artificial way to receive the correct amount of testosterone for the body to function.

The most common testosterone replacement therapies are:

• Gels and creams — These are applied topically on the skin every day at the same time.
• Injection — These are weekly or bi-weekly injections of testosterone into your muscle tissue, either administered by a provider or self-administered. Long-acting testosterone injections may be an option, as well.
• Nasal gel — This method is applied three times a day into each nostril.
• Oral tablet — These slow-release oral tablets are placed in your mouth to dissolve and be absorbed into your bloodstream through the gums.
• Oral pill — This type of oral treatment is typically reserved for men with certain medical conditions.
• Pellets — Your doctor will place slow-release pellets under your skin.
• Skin patches — Similar to a Band-Aid, medication on these patches is absorbed into the skin, and the patch is replaced daily.

While receiving TRT, it is important to have regular appointments with your doctor so they can check your testosterone levels and help manage any negative side effects.

Potential side effects of testosterone therapy may include:

• Acne.
• Ankle swelling.
• Breast tenderness.
• Difficulty urinating.
• Polycythemia (high red blood cell count).
• Skin irritation.

You may not be eligible for testosterone replacement therapy if you have:

• Breast cancer.
• Heart failure.
• Obstructive sleep apnea.
• Prostate cancer or a lump in the prostate.

Is low testosterone treatment right for me?

If you are experiencing the symptoms of low testosterone, TRT may be right for you to return to your normal, functioning self. Some medical conditions may not mesh with TRT well, so it’s important to talk with your doctor and create a personalized treatment plan.

How long does it take for testosterone levels to return to normal?

For many men, testosterone replacement therapy is an ongoing need to keep normal testosterone levels. However, the benefits of TRT are usually seen or felt within a few weeks. After a few months of taking TRT daily, most people see significant improvements in their physical and mental symptoms, as well as their testosterone levels on blood tests. Symptoms may return if TRT is stopped.

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