Low Testosterone (Low T) in Men
Low testosterone at a glance
- Low testosterone is a condition in which a man does not produce enough of the testosterone hormone that affects sexual function, helps build muscles and plays a role in other aspects of male development.
- Low testosterone, known popularly as low T, can affect a man’s sexual drive, erection, muscle mass, bone density and mood.
- Low testosterone affects around 40 percent of men age 45 and older, and it is natural for testosterone levels to decrease with age.
- Not all men with this condition need treatment, but when treatment is needed it usually involves testosterone replacement therapy.
- There are also some risks associated with testosterone replacement, which men should discuss with their provider.
What is low testosterone?
Testosterone is produced in the testes and adrenal glands. It is the hormone in men that fuels sex drive, muscle mass, regulates mood, adds facial and body hair, deepens the voice and controls bone strength.
Women also produce small amounts of testosterone in their ovaries that helps build bone and lean muscle mass, and also affects their sex drive. They can also experience low testosterone levels requiring treatment.
Testosterone levels tend to peak in men around the age of 19. After age 30, it is normal for a man’s testosterone levels to slowly drop.
If a man’s testosterone dips past the average numbers, he may be diagnosed with “low testosterone,” often referred to as low t or male hypogonadism. According to one study, low levels of testosterone is very common and affects around 40 percent of men 45 and older.
For most men, low t does not cause major problems or symptoms. For those who do experience changes due, common symptoms include:
- Decreased interest in sex.
- Decline in muscle mass.
- Depression/mood changes.
- Low energy.
- Smaller, softer testicles.
- Loss of body hair.
- Anemia (low iron).
- Larger breasts.
- Increased body fat.
- Osteoporosis or brittle bone disease.
Causes of low T
While aging is the most common reason for a male’s testosterone levels to dip, other causes include:
- Type 2 diabetes.
- Pituitary gland problems.
- Testicle injuries.
- Testicular cancer or treatment by radiation or chemotherapy.
- Steroid medicines.
- Chronic liver or kidney disease.
- Alcohol abuse.
- Long-term opioid use.
Testing for & treating low t
If a male is experiencing low sex drive, loss of sperm count, erectile dysfunction, or loss of muscles, height or body hair, the doctor might suggest a testosterone test. This involves a blood test that is usually done early in the morning when levels are the highest. Normal levels range from 300 to 1,000 ng/DL (nanograms per deciliter).
Our urologists are skilled in diagnosing and effectively treating low T.
Not everyone who has insufficient testosterone will need treatment. In fact, there is some risk associated with testosterone replacement. On top of the blood test showing low levels of testosterone, the patient must have symptoms that affect his daily life before the doctor will discuss benefits and risks of treatment.
Lifestyle changes affecting testosterone
For some patients, lifestyle changes will be enough to increase testosterone levels. Exercise, both lifting weights and cardiovascular exercises, have been found to increase testosterone levels. However, those increases are generally higher in younger men.
Working out is beneficial on its own, but it can also help with weight loss and that can improve obesity and type 2 diabetes, both of which can cause low T. Men may also need to change their intake habits of alcohol, steroids and opioids to increase their testosterone levels.
Increasing zinc and vitamin D in the diet could also cause an increase in testosterone levels. One study on mice found that garlic supplements increased testosterone. More research will need to be done before confirming a diet high in garlic could increase testosterone levels.
Medical treatments for low T
If treatment is needed, the urologist will discuss the different options of testosterone replacement therapy. This could be done in the form of shots, long-acting pellets, gels or patches placed under or on a man’s skin.
The shot will be given every 2 to 4 weeks in a doctor’s office. With proper training some patients may be able to give themselves shots at home. Between injections, the testosterone level can go up and down.
The long-acting pellet is a small pellet implanted under the skin, usually near the hip, to slowly release testosterone over the course of 3 or 6 months. This is inserted in an office visit.
Gels or patches provide a steady level of testosterone because they are changed daily, and the hormone seeps topically through the skin. Some patients report irritation, blisters and itching at the spot where applied. It is important to keep the patch or gel away from children and women. If a child comes in contact with the patch or gel, he or she could develop signs of early puberty. A woman could see changes in her body hair or develop acne by touching the testosterone replacement therapy products.
Testosterone replacement therapy is a life-long therapy, as the male is not going to start producing more testosterone on his own. Stopping replacement therapy will result in testosterone levels decreasing.
Each method of administration has its pros and cons. Cost may be a big factor helping to determine the formulation best suited for the individual. A urologist may be able to offer a more affordable formulation, such as topical testosterone through a compounding pharmacy that is equally effective and chemically identical to brand name options, for a fraction of the cost.
Risks of testosterone therapy
Testosterone replacement therapy does have some drawbacks, including:
- Sleep apnea.
- Enlarged prostate.
- Smaller testicles.
- Too many red blood cells, which may increase the risk of blood clotting, raising the chances of cardiovascular problems or a stroke.
Some doctors are also concerned that long-term use of testosterone supplements may cause prostate cancer and heart disease. Additional studies are needed to confirm if there is a link between the treatment and either of those diseases. While taking testosterone replacement therapy, men will need regular doctor’s appointments that include a prostate-specific antigen (PSA) test to look for early signs of prostate cancer.
Men should visit with a specialist to determine if their testosterone levels are high and if the benefits of hormone replacement therapy outweigh the potential risks in their particular situation.
Men should not take testosterone supplements if they have:
- Prostate cancer.
- Breast cancer.
- Poorly controlled heart disease.
- Untreated sleep apnea.
- Clotting disorders.
- Too many red blood cells.