What are the signs of low testosterone in teenage boys. How does hypogonadism affect male development. When should parents seek medical help for suspected low testosterone in their son. What treatments are available for teenage hypogonadism.

Understanding Male Hypogonadism: A Hormonal Imbalance

Male hypogonadism is a medical condition characterized by insufficient production of testosterone, the hormone crucial for masculine growth and development. This hormonal imbalance can have significant impacts on a male’s physical, sexual, and emotional well-being, especially during the critical teenage years.

Testosterone plays a vital role in:

• Promoting muscle mass and strength
• Regulating bone density
• Influencing body hair growth
• Deepening the voice during puberty
• Supporting sexual function and libido
• Contributing to overall energy levels and mood

When testosterone levels are abnormally low, it can disrupt normal male development and cause a range of symptoms that may be particularly distressing for teenagers.

Identifying the Signs: Low Testosterone Symptoms in Teenagers

Recognizing the symptoms of low testosterone in teenagers is crucial for early intervention. Some common signs include:

• Delayed or absent puberty
• Slow growth and development of secondary sexual characteristics
• Lack of deepening of the voice
• Sparse facial and body hair growth
• Poor muscle development despite physical activity
• Disproportionate growth of arms and legs compared to the torso
• Development of breast tissue (gynecomastia)
• Low energy levels and fatigue
• Mood swings or depressive symptoms
• Difficulty concentrating

Is delayed puberty always a sign of low testosterone? While delayed puberty can be a symptom of hypogonadism, it’s important to note that puberty timing can vary naturally among individuals. However, if a boy shows no signs of puberty by age 14, it’s advisable to consult a healthcare provider for evaluation.

The Two Types of Hypogonadism: Primary and Secondary

Understanding the underlying cause of low testosterone is essential for proper treatment. Hypogonadism is classified into two main types:

Primary Hypogonadism

Also known as primary testicular failure, this type originates from problems within the testicles themselves. Common causes include:

• Klinefelter syndrome: A genetic condition where males have an extra X chromosome
• Undescended testicles: When one or both testicles fail to descend into the scrotum before birth
• Mumps orchitis: Inflammation of the testicles due to mumps infection
• Testicular injury or trauma
• Certain cancer treatments, such as radiation or chemotherapy

Secondary Hypogonadism

This type stems from issues in the hypothalamus or pituitary gland, which are responsible for signaling the testicles to produce testosterone. Causes may include:

• Pituitary disorders or tumors
• Kallmann syndrome: A genetic condition affecting hormonal regulation
• Inflammatory diseases, such as sarcoidosis or tuberculosis
• HIV/AIDS
• Certain medications, particularly opioids and steroids
• Obesity and metabolic disorders

Can hypogonadism occur from both primary and secondary causes simultaneously? Yes, in some cases, an individual may experience a combination of both primary and secondary hypogonadism, known as mixed hypogonadism.

Diagnosing Low Testosterone in Teenagers: When to Seek Help

Parents should be vigilant about their son’s development and consult a healthcare provider if they notice:

• Absence of signs of puberty by age 14
• Slow or incomplete pubertal development
• Persistent fatigue or mood changes
• Concerns about growth or physical development

Diagnosing low testosterone typically involves:

1. A thorough medical history and physical examination
2. Blood tests to measure testosterone levels and other hormones
3. Imaging studies, such as MRI, to check for pituitary abnormalities
4. Genetic testing in some cases

How accurate are testosterone blood tests in teenagers? While blood tests are a crucial diagnostic tool, it’s important to note that testosterone levels can fluctuate throughout the day and may be affected by various factors. Multiple tests and a comprehensive evaluation are often necessary for an accurate diagnosis.

Treatment Options for Teenage Hypogonadism

The treatment approach for low testosterone in teenagers depends on the underlying cause and severity of symptoms. Common treatment options include:

Testosterone Replacement Therapy (TRT)

TRT is the primary treatment for many cases of hypogonadism. It can be administered through:

• Injections
• Gels or patches applied to the skin
• Pellets inserted under the skin

Are there risks associated with testosterone therapy in teenagers? While TRT can be beneficial, it requires careful monitoring due to potential side effects such as acne, sleep apnea, or changes in mood. Long-term effects on fertility and bone density also need consideration.

Gonadotropin Therapy

For cases of secondary hypogonadism, treatment with gonadotropin hormones (FSH and LH) may stimulate natural testosterone production and sperm development.

Treatment of Underlying Conditions

Addressing the root cause, such as pituitary tumors or genetic disorders, may help resolve hormonal imbalances.

Lifestyle Modifications

In some cases, particularly where obesity is a contributing factor, lifestyle changes can help:

• Maintaining a healthy weight
• Regular exercise
• Balanced nutrition
• Stress management
• Adequate sleep

Long-Term Outlook and Management of Teenage Hypogonadism

The prognosis for teenagers with hypogonadism varies depending on the cause and treatment effectiveness. With proper management, many individuals can experience normal pubertal development and lead healthy adult lives.

Key aspects of long-term management include:

• Regular monitoring of testosterone levels
• Ongoing assessment of growth and development
• Bone density scans to monitor skeletal health
• Psychological support to address any emotional challenges
• Fertility preservation options, if necessary

How does hypogonadism affect future fertility? The impact on fertility varies. Some forms of hypogonadism may cause permanent infertility, while others can be managed to preserve or restore fertility. Early diagnosis and treatment are crucial for optimizing future reproductive potential.

Emotional and Social Impacts of Low Testosterone in Teenagers

The effects of hypogonadism extend beyond physical symptoms. Teenagers with low testosterone may experience:

• Low self-esteem due to delayed physical development
• Social anxiety or isolation
• Depression or mood disorders
• Academic challenges due to concentration difficulties
• Concerns about future relationships and sexuality

Addressing these emotional and social aspects is crucial for comprehensive care. Support strategies may include:

• Counseling or therapy
• Peer support groups
• Education for family members and teachers
• Collaboration with school personnel to address any learning or social challenges

How can parents support a teenager with hypogonadism? Open communication, empathy, and fostering a supportive environment are key. Encouraging participation in activities that boost self-confidence and providing access to appropriate medical and psychological care can make a significant difference in a teenager’s well-being.

Advances in Research and Future Directions

The field of reproductive endocrinology continues to evolve, offering hope for improved diagnosis and treatment of hypogonadism in teenagers. Some areas of ongoing research include:

• Gene therapy for genetic causes of hypogonadism
• Development of more targeted and efficient testosterone delivery systems
• Investigation of biomarkers for early detection of hypogonadism
• Studies on long-term outcomes of various treatment approaches
• Exploration of potential regenerative therapies for testicular function

What new treatments might become available in the future? While it’s difficult to predict specific breakthroughs, researchers are exploring innovative approaches such as stem cell therapies to regenerate hormone-producing cells and novel drug delivery systems for more precise hormonal control.

As our understanding of the complexities of male hormonal health grows, so does the potential for more personalized and effective treatments for teenagers struggling with low testosterone. Continued research and awareness are crucial for improving outcomes and quality of life for these young patients.

Male hypogonadism – Symptoms & causes

Overview

Male hypogonadism is a condition in which the body doesn’t produce enough of the hormone that plays a key role in masculine growth and development during puberty (testosterone) or enough sperm or both.

You can be born with male hypogonadism, or it can develop later in life, often from injury or infection. The effects — and what you can do about them — depend on the cause and at what point in your life male hypogonadism occurs. Some types of male hypogonadism can be treated with testosterone replacement therapy.

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Symptoms

Hypogonadism can begin during fetal development, before puberty or during adulthood. Signs and symptoms depend on when the condition develops.

Male reproductive system

The male reproductive system makes, stores and moves sperm. Testicles produce sperm. Fluid from the seminal vesicles and prostate gland combine with sperm to make semen. The penis ejaculates semen during sexual intercourse.

Fetal development

If the body doesn’t produce enough testosterone during fetal development, the result may be impaired growth of the external sex organs. Depending on when hypogonadism develops and how much testosterone is present, a child who is genetically male may be born with:

• Female genitals
• Genitals that are neither clearly male nor clearly female (ambiguous genitals)
• Underdeveloped male genitals

Puberty

Male hypogonadism can delay puberty or cause incomplete or lack of normal development. It can hamper:

• Development of muscle mass
• Voice deepening
• Growth of body and facial hair
• Growth of the penis and testicles

And it can cause:

• Excessive growth of the arms and legs in relation to the trunk of the body
• Development of breast tissue (gynecomastia)

Adulthood

In adult males, hypogonadism can alter certain masculine physical characteristics and impair normal reproductive function. Early signs and symptoms might include:

• Decreased sex drive
• Decreased energy
• Depression

Over time, men with hypogonadism can develop:

• Erectile dysfunction
• Infertility
• Decrease in hair growth on the face and body
• Decrease in muscle mass
• Development of breast tissue (gynecomastia)
• Loss of bone mass (osteoporosis)

Severe hypogonadism can also cause mental and emotional changes. As testosterone decreases, some men have symptoms similar to those of menopause in women. These can include:

• Difficulty concentrating
• Hot flashes

When to seek help

See your health care provider if you have symptoms of male hypogonadism. Finding the cause of hypogonadism is an important first step to getting appropriate treatment.

Causes

Male hypogonadism means the testicles don’t produce enough of the male sex hormone testosterone. There are two basic types of hypogonadism:

• Primary. This type of hypogonadism — also known as primary testicular failure — originates from a problem in the testicles.
• Secondary. This type of hypogonadism indicates a problem in the hypothalamus or the pituitary gland — parts of the brain that signal the testicles to produce testosterone. The hypothalamus produces gonadotropin-releasing hormone, which signals the pituitary gland to make follicle-stimulating hormone (follicle-stimulating hormone (FSH)) and luteinizing hormone (luteinizing hormone (LH)). Luteinizing hormone then signals the testes to produce testosterone.

Pituitary gland and hypothalamus

The pituitary gland and the hypothalamus are located within the brain and control hormone production.

Either type of hypogonadism can be caused by an inherited (congenital) trait or something that happens later in life (acquired), such as an injury or an infection. At times, primary and secondary hypogonadism occur together.

Primary hypogonadism

Common causes of primary hypogonadism include:

• Klinefelter syndrome. This condition results from a congenital abnormality of the sex chromosomes, X and Y. A male normally has one X and one Y chromosome. In Klinefelter syndrome, two or more X chromosomes are present in addition to one Y chromosome.

  The Y chromosome contains the genetic material that determines the sex of a child and related development. The extra X chromosome that occurs in Klinefelter syndrome causes abnormal development of the testicles, which in turn results in underproduction of testosterone.

• Undescended testicles. Before birth, the testicles develop inside the abdomen and normally move down into their permanent place in the scrotum. Sometimes one or both of the testicles aren’t descended at birth.

  This condition often corrects itself within the first few years of life without treatment. If not corrected in early childhood, it can lead to malfunction of the testicles and reduced production of testosterone.

• Mumps orchitis. A mumps infection involving the testicles that occurs during adolescence or adulthood can damage the testicles, affecting the function of the testicles and testosterone production.
• Hemochromatosis. Too much iron in the blood can cause testicular failure or pituitary gland dysfunction, affecting testosterone production.
• Injury to the testicles. Because they’re outside the abdomen, the testicles are prone to injury. Damage to both testicles can cause hypogonadism. Damage to one testicle might not impair total testosterone production.

• Cancer treatment. Chemotherapy or radiation therapy for the treatment of cancer can interfere with testosterone and sperm production. The effects of both treatments often are temporary, but permanent infertility may occur.

  Although many men regain their fertility within a few months after treatment, preserving sperm before starting cancer therapy is an option for men.

Secondary hypogonadism

In secondary hypogonadism, the testicles are normal but don’t function properly due to a problem with the pituitary or hypothalamus. A number of conditions can cause secondary hypogonadism, including:

• Kallmann’s syndrome. This is an abnormal development of the area of the brain that controls the secretion of pituitary hormones (hypothalamus). This abnormality can also affect the ability to smell (anosmia) and cause red-green color blindness.

• Pituitary disorders. An abnormality in the pituitary gland can impair the release of hormones from the pituitary gland to the testicles, affecting normal testosterone production. A pituitary tumor or other type of brain tumor located near the pituitary gland may cause testosterone or other hormone deficiencies.

  Also, treatment for a brain tumor, such as surgery or radiation therapy, can affect the pituitary gland and cause hypogonadism.

• Inflammatory disease. Certain inflammatory diseases, such as sarcoidosis, histiocytosis and tuberculosis, involve the hypothalamus and pituitary gland and can affect testosterone production.
• HIV/AIDS. HIV/AIDS can cause low levels of testosterone by affecting the hypothalamus, the pituitary and the testes.
• Medications. The use of certain drugs, such as opiate pain medications and some hormones, can affect testosterone production.
• Obesity. Being significantly overweight at any age might be linked to hypogonadism.
• Aging. As men age, there’s a slow, progressive decrease in testosterone production. The rate varies greatly.

Risk factors

Risk factors for hypogonadism include:

• HIV/AIDS
• Previous chemotherapy or radiation therapy
• Aging
• Obesity
• Malnutrition

Hypogonadism can be inherited. If any of these risk factors are in your family health history, tell your doctor.

Complications

The complications of untreated hypogonadism differ depending on when it develops — during fetal development, puberty or adulthood.

Complications might include:

• Abnormal genitalia
• Enlarged male breasts (gynecomastia)
• Infertility
• Erectile dysfunction
• Osteoporosis
• Poor self-image

Low Testosterone in Teenage Males

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When you hear about low testosterone and the problems that often surround men that have low testosterone, you typically think of older men. The reason is that low testosterone is typically a problem that will affect older men, simply because it is natural for them to experience a decline in testosterone in their bodies as they age. Not many people hear about low testosterone in teenage males, but it does certainly happen.

Unlike in older males when a decline in testosterone is natural as they age, low testosterone in teenage males is not typical. For that reason, it can sometimes be cause for concern. If you are looking to learn more about low testosterone in teenage males, then you are in the right place. Our complete analysis of low testosterone in teenage males contains all of the information that you need to address, identify, and treat low testosterone when it occurs in teenage males.

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Is Low Testosterone in Teenage Males Typical?

One of the most common questions that people have about teenage males and testosterone is whether it is typical for teenage males to have low testosterone. In fact, this is not a common occurrence. In males, the amount of testosterone that they have in their body is typically higher when they are younger. As men age, the amount of testosterone should start to gradually decline, starting around age 30 by up to 1.6% a year.

So, as you can imagine, for men to experience low testosterone at such a young age is not something that is expected. In fact, it is cause for concern, since it can only be due to a number of factors, none of which are particularly easy to treat. For men that experience it later in life, it is simply a matter of administering more testosterone to make up for the missing testosterone.

However, younger males are better candidates for addressing the root of the problem so to maintain the hope of having normal testosterone production as they get older, instead of having to constantly seek out testosterone replacement therapy on a daily basis. One such way may be to assess your lifestyle choices, including diet and exercise to help boost natural testosterone levels.

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Symptoms of Low Testosterone in Teenage Males

If you are hoping to identify low testosterone in teenage males, one of the best ways to do is to watch out for the symptoms. One thing that you should know right off the bat is that identifying the cause of these symptoms can sometimes be difficult. What we mean is that sometimes, these symptoms can be caused by other things. If you are in your 20s and have low testosterone we recommend checkout this article out.

In addition, it is particularly hard to identify low testosterone in teenage males by using symptoms alone because of the fact that in their teenage years, they are typically going through a number of bodily changes that could cause atypical side effects that they wouldn’t typically have to deal with.

Loss of Muscle Mass

One of the most telltale signs of low testosterone in teenage males is the loss of muscle mass. The reason that this symptom makes it more obvious than others is that teenage males should be experiencing an expansion in muscle mass, not a decline. When teenage males experience the opposite, it becomes clear that something is not right. However, this still doesn’t mean that it is definitely low testosterone that is the cause. In fact, it could be a couple of different things.

Prolonged/Delayed Puberty

Another pretty clear sign that something is not right when it comes to the testosterone levels is prolonged or delayed puberty. In their teenage years, males should be going through puberty, which results in a number of changes in their body. This is a sign that everything is going as planned.

If puberty is not occurring or it is progressing very slowly, this could be a sign that the male’s testosterone levels are not quite in line with what they should be. This could cause a number of side effects, none of which being friendly towards the long-term development of the individual. In any case, regardless of whether it is caused by low testosterone or not, this could be a harmful sign for the future. So, it should be addressed sooner rather than later.

Thinning Hair

In a similar way to the loss of muscle mass that we touched on earlier, teenage males that experience thinning hair earlier than they should be could be experiencing low testosterone. As with muscle mass, teenage boys should in fact be gaining hair thickness and other features as they go through puberty and a rise in testosterone.

If you or your child is experiencing a decline in hair thickness instead, that could most definitely be a sign of lowered testosterone or lagging testosterone levels.

Weakened Bones

This symptom is of particular concern since it could very well cause injury to teenage boys that are going through it. Brittle bones are a common side effect of men that are experiencing lower-than-usual testosterone. If this is happening, it is a good idea to get ahead of it while you are able to. Weakened bones into the future could easily cause trouble when it comes to athletic performance and strength in other areas, as well.

Best Way to Diagnose Low Testosterone in Teenage Males

The first step to properly treating low testosterone in teenage males is to properly diagnose the condition. Without a good diagnosis, you will be flying blind when it comes to getting to the bottom of the cause and treating it in a way that is likely to have a favorable outcome. One way to diagnose the condition is to watch for the side effects and match those up to what is typical of teenage males. The problem with this is that it can lead to many false positives since teenage men are typically going through a range of changes in their teenage years.

A much more effective and accurate way to diagnose low testosterone is to get a blood test. As one of the most important hormones in the body, it is easy to determine the content of testosterone in the blood by conducting a blood test. A blood test can be conducted at a testosterone clinic or a regular doctor. A blood test can quickly tell you how much testosterone is in the bloodstream.

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Causes of Low Testosterone in Teenagers

The good thing about low testosterone in teenagers is that there are a limited number of effects that could be causing it. This allows you to narrow them down faster and determine what the cause is with enough time to repair the issue before it heavily affects the quality of life.

Lifestyle

One of the potential causes of low testosterone in teenage males is the lifestyle that they lead. Lifestyle plays a much more important role in the health and testosterone levels of teenagers than many people realize. The lifestyle that you lead includes diet, exercise, and stress management. If a teenage male is leading an unhealthy lifestyle, they are much more prone to having lower than usual levels of testosterone.

Disorders

Another factor that could affect the level of testosterone in the body of a teenage male is any disorders that they might be experiencing. The most common of these is hypogonadism. This is the condition that directly affects the ability of the system to produce testosterone. When a male has this disorder, it will greatly impact their symptoms and cause them to have lower than usual testosterone.

Treatments

In addition to disorders affecting the amount of testosterone that is produced by the body, the treatments for those conditions can also have the same effect. A great example of this is would be chemotherapy. This is a harsh treatment that can impact the functionality of the body. This could result in the lowering of testosterone in the body, leading to various side effects.

What to do if You Have Symptoms of Low Testosterone as a Teenage Male

If you are ready to treat the symptoms and underlying cause of low testosterone in teenage males, then there are a few steps that you need to take. The first of these is to get an official diagnosis with one of our specialist testosterone doctors. This will involve contacting us for a free consultation, then booking a testosterone blood test at one of our certified centres or using the a testosterone blood kit for use at home via finger prick.

The next is to listen to the advice of the medical professional as to how to treat the underlying cause of the low testosterone. This could amount to testosterone replacement therapy or lifestyle changes that will make your body more friendly to testosterone production. Either way, this will need to be done in conjunction with a medical professional that knows what they are dealing with.

Consequences of Not Treating Low Testosterone in Teenage Males

Perhaps just as important as identifying low testosterone in teenage males is treating it. If you are unable to treat the low testosterone that is affecting the body, you will eventually find that it will continue and will rarely just go away naturally. If you hope to reverse the side effects of low testosterone,  you must take action. Without addressing the issue the side effects will undoubtedly worsen over time, making it harder to address in the future. If you are experiencing low testosterone as a teenage male, you must be sure to see a testosterone professional that can assist you in treating low testosterone.

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About the Author: Mike Kocsis

Mike Kocsis has an MBA with a focus on healthcare administration and is an entrepreneur and medical case manager for Balance My Hormones Ltd which offers medical services in the UK and Europe. Mike has over 20 years of experience in the healthcare sector, much of that working with people who have hormone imbalances. Mike has appeared on podcasts and radio and is an expert speaker on the subject of hormone imbalance. He specialises in Testosterone Replacement Therapy (TRT) and Hormone Replacement Therapy (HRT) and has helped thousands of people suffering from hormone imbalances recover and regain control of their lives. You can follow him on LinkedIn and on the Balance My Hormones YouTube Channel.

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Last update: March 8th, 2021

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testosterone after 40 and 50 years, treatment, symptoms and causes of hypogonadism

Medicine and health

05. 05.22

What is hormone replacement therapy in men and when is it needed

Ismail-Mel Redwolf

being treated with testosterone

Author profile

Five years ago I had a medical examination for health problems after surgery. As a result, the doctor ordered an analysis for testosterone levels, suspecting that there could be problems with this hormone.

Since then, I have been taking hormone replacement therapy, or HRT, to keep my testosterone normal. I will tell you why it may be needed, how it is prescribed and what you need to know about such treatment.

Go see a doctor

Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don’t write prescriptions, we give recommendations. Relying on our point of view or not is up to you.

Why testosterone levels can be reduced

A decrease in the level of sex hormones is called hypogonadism. This condition can develop in childhood or already in adulthood – for example, due to injury or infection.

Male hypogonadism – Mayo Clinic

Causes of secondary hypogonadism in men – Uptodate

In men, hypogonadism can be:

1. Primary – due to the fact that the testicles produce little hormones.
2. Secondary – associated with problems in the work of the pituitary gland or hypothalamus. These glands, located in the brain, tell the testicles and other endocrine glands how much hormone to produce. To do this, they secrete their own hormones. For example, in order to regulate the production of male sex hormones in the testicles, the pituitary gland synthesizes luteinizing and follicle-stimulating hormones at the command of the hypothalamus.

Primary hypogonadism develops due to certain genetic disorders, testicular injury, infections that cause inflammation of the testicles, such as mumps.

Secondary may occur due to damage and tumors of the pituitary gland, some inflammatory diseases, against the background of HIV infection, due to the intake of a number of drugs, obesity. Also, a decrease in testosterone production occurs with age in the aging process.

“It’s just high testosterone”: 9 myths about men’s health

It is not known exactly what led to the violations in my case. I attribute this to the fact that I underwent many operations and at one time was treated with glucocorticoid hormones, but it is impossible to say for sure.

The hypothalamus and pituitary gland produce hormones that regulate the functioning of the gonads in men and women. At the same time, the level of sex hormones in the blood also affects the functioning of the pituitary and hypothalamus: normally, if it is high, the hypothalamus and pituitary gland reduce the production of their hormones, and vice versa, the hypothalamus and pituitary gland produce hormones that regulate the work of the gonads in men and women. At the same time, the level of sex hormones in the blood also affects the functioning of the pituitary and hypothalamus: normally, if it is high, the hypothalamus and pituitary gland reduce the production of their hormones, and vice versa

How to suspect a decrease in testosterone

Testosterone is an important sex hormone. If hypogonadism occurs before birth, during childhood or adolescence, it will greatly affect growth, development and puberty. For example, a child may have underdeveloped genitals or puberty will be delayed.

Clinical Features and Diagnosis of Male Hypogonadism — Uptodate

In adult men, testosterone deficiency is manifested by low sex drive, depression, mood disorders, increased fatigue, cognitive decline.

Certain external signs are also characteristic. The most striking is problems with vegetation on the body. With testosterone deficiency, there is usually little hair on the body, stubble on the face is rare, and grows poorly.

A person’s face often looks younger than their peers. To this are added problems with muscle recruitment, muscle weakness. For example, even after long workouts, it is impossible to lift more than 5-7 kg of weight.

How much does it cost to draw up a nutrition program with a nutritionist

Often there may be excess weight, while the distribution of adipose tissue changes. It is deposited on the sides, thighs, sometimes in the chest area – this is called gynecomastia.

Erection is also disturbed, infertility may develop, osteoporosis – bone fragility, which leads to frequent fractures.

I had problems with my heart, weight, muscle gain. Also, before HRT, I had almost no hair growing on my body, including on my face. The oval of the face at the age of 20 was like that of a 13-year-old teenager.

In addition, gynecomastia appeared, which was later removed surgically. I also felt constant fatigue and apathy.

Similar symptoms in adults can occur in many other diseases more common than hypogonadism. It is best to first consult with an endocrinologist or andrologist, and only then take tests.

10 important questions for endocrinologist Yury Poteshkin

How testosterone deficiency is diagnosed

If a doctor suspects hypogonadism, he prescribes testosterone tests. He may also prescribe tests for pituitary luteinizing and follicle-stimulating hormones, LH and FSH to determine the type of hypogonadism:

1. In primary hypogonadism, testosterone levels are low and FSH and LH are high as the pituitary gland tries to get the testicles to work and produce more of the hormone.
2. In secondary hypogonadism, testosterone levels are low, FSH and LH are also low or normal. This suggests that the work of the pituitary gland is disrupted and it does not try to raise the sex hormones to the normal level.

Clinic and diagnosis of male hypogonadism – Uptodate

If the tests once showed that testosterone is low, this is not the basis for the appointment of HRT. Ideally, you need to get tested for total testosterone two or three times over two to three months to make sure there is a problem: hormone levels can fluctuate for natural reasons. But if the analysis showed that testosterone is normal, you don’t need to retake it – most likely, everything is in order.

I was found to be deficient in testosterone almost by accident. For five years, for various reasons, I have done ten operations. In the extract after one of them, I was recommended to visit a cardiologist. I didn’t feel well then, but I ascribed severe constant fatigue, insomnia, weakness and weight loss to the consequences of interventions and experienced stress.

Examination by a cardiologist did not reveal critical changes, however, my pulse sometimes suddenly accelerated, and then slowed down to 40-50 beats per minute. A couple of times I was taken away in an ambulance with a preliminary diagnosis of coronary heart disease. The reasons for this could not be found.

14 important questions for cardiologist Anton Rodionov

For seven months I went to different doctors, took tests, and as a result, they suspected a problem with the hormonal system. After that, I was referred to an endocrinologist, she ordered a blood test for the level of sex hormones, which confirmed that I had testosterone deficiency.

Before that, I had done a lot of research, which, as it turned out, was completely unnecessary, and some of it was completely useless. For example, chromato-mass spectrometry according to Osipov, which allegedly shows the microbial composition of the intestinal microflora by a blood test, or an analysis for the level of leptin – this hormone can be elevated in obesity, but its level does not affect diagnosis or treatment. I spent a little more than 48,000 rubles on examinations.

48,000 R

I spent on examinations before diagnosis

I spent 48,330 R on examinations before diagnosis

90 109 Several ultrasounds of the abdominal cavity, genitourinary system, prostate gland, thyroid gland, mammary glands

17400 R
Blood tests for vitamins, leptin, prolactin and a number of other hormones	11 540 Р
Ultrasound of vessels of the neck, lower extremities, renal arteries	9400 P
Osipov Chromatography-Mass Spectrometry	7990 P
Fat assessment, bioimpedance	2000 R

Several ultrasounds of the abdomen, genitourinary system, prostate, thyroid, mammary glands

Ultrasound of neck vessels, lower extremities, renal arteries

9400 R

Osipov Chromatography-Mass Spectrometry

7990 R

Assessment of the type of adipose tissue, bioimpedance

2000 R

Results of my analyzes 9002 0 How to test for testosterone correctly

Varvara Filatova

endocrinologist, DocMed clinic

According to the rules, a blood test to determine total testosterone is taken in the morning, from 07:00 to 11:00, because at this time the level of this hormone is highest. In the presence of non-specific complaints – fatigue, decreased sexual desire, and others – such an analysis is enough for a start.

With a more detailed clinical picture, it is worth determining the level of luteinizing hormone – LH. This is one of the pituitary hormones, the level of which can be used to assess the causes of testosterone decline.

If the total testosterone level is at the borderline of 8 to 12 mmol/L, in the so-called gray zone, the level of sex hormone-binding globulin, SHBG, should be determined in order to calculate the level of free testosterone.

When and how testosterone therapy is prescribed

In young and middle-aged adult men, testosterone hormone replacement therapy is indicated when there is a decrease in the level of one’s own testosterone and this is manifested by any symptoms. For example, a decrease in sexual desire or increased fragility of bones.

Guidelines for the Treatment of Hypogonadism in Adult Men – American Endocrinology Association

Testosterone Treatment of Male Hypogonadism – Uptodate

If there are symptoms similar to hypogonadism but male hormone levels are normal, no therapy is indicated. It has been proven that in such cases it does not improve the human condition.

HRT is used strictly according to indications, taking hormones for other purposes, for example, to gain muscle mass, is dangerous for health.

Testosterone Treatment in Adult Men with Age-Related Low Testosterone – American Academy of Family Physicians

With natural age-related decline in testosterone levels after age 60, replacement therapy may be indicated for sexual dysfunction. At the same time, it should be canceled if there is no noticeable result – taking testosterone has many side effects.

The American Academy of Family Physicians does not recommend HRT for older men solely in an attempt to increase energy, fitness, or cognitive performance.

Since I had symptoms of testosterone deficiency and a decrease in its level according to the results of the tests, I was prescribed hormone replacement therapy in the form of injections.

It should be borne in mind that there are contraindications to testosterone therapy: for example, a tendency to form blood clots, prostate cancer, obstructive sleep apnea and some other conditions. Without consulting a doctor, it will not be possible to understand whether it is worth taking HRT or the risks will outweigh the benefits.

Is HRT always necessary with reduced testosterone

Varvara Filatova

endocrinologist, DocMed clinic

Hormone replacement therapy with reduced testosterone is not always needed. It is not indicated for secondary reversible hypogonadism: for example, in young people with alimentary obesity or disorders of carbohydrate metabolism, or in patients with special pituitary tumors – prolactinomas.

In such cases, physiological recovery of testosterone levels is possible by reducing body weight and treating the underlying disease.

Which doctor to contact in case of testosterone deficiency

A doctor with experience in prescribing HRT will better cope with the selection of the dosage of the drug and control of well-being.

It turned out that such an experience is more common among andrologists, despite the fact that endocrinologists usually deal with problems of the hormonal system. At the same time, all endocrinologists have the right to write prescriptions for testosterone.

Urologist-andrologists or sexologist-andrologists are more common, rarely endocrinologist-andrologists. A urologist can write a prescription for testosterone, but sometimes he will not have such a right. There is also a risk of getting to an endocrinologist who will refuse to prescribe the medicine.

13 important questions to andrologist Yuri Kastrikin about men’s health

In general, before making an appointment, you should ask the doctor:

1. Did he use HRT with testosterone.
2. Can write prescriptions for injectable testosterone.
3. Is able to adjust the dosage of the drug for HRT.

After the diagnosis was made, for a long time they could not find the working dosage of the drug, with which the testosterone level would reach the norm, and my health was normal. While I found my doctor, I spent 35,000 RUR on appointments.

What you need to know before starting testosterone therapy

Varvara Filatova

endocrinologist, DocMed clinic

Before starting testosterone therapy, it is imperative to discuss reproductive plans with the doctor and how therapy may affect them. Taking testosterone inhibits sperm production, which affects a man’s ability to conceive.

Also, before starting HRT, it is necessary to take a clinical blood test and evaluate the level of PSA, a prostate-specific antigen, especially in patients older than 40 years. This is necessary to exclude contraindications to therapy.

It is also worth asking about the various dosage forms of testosterone preparations – they are injectable and external – in order to choose those that will be most suitable for a particular patient.

What drugs are used for hormone replacement therapy with testosterone

Intramuscular injections. An injection is made into the muscle of the thigh or buttocks. You can go to the treatment room, but it’s easier to learn how to do it yourself. I give injections myself, it’s calmer and more reliable: there are no infiltrates after injections, abscesses that had to be treated after hospitals.

The choice of drugs for injections in Russia is small. Usually they use “Omnadren” or “Sustanon” – this is a mixture of testosterone esters at a dosage of 250 mg per 1 ml. On average, the price of an ampoule is 869-910 R. It takes me four or five per month, in total 3640-4550 R per month.

What it takes to maintain a sex life after 50 years

Also every month I go to the doctor’s office for a new prescription. The doctor can only prescribe five ampoules at a time. The queue to the endocrinologist in the clinic is on average a month and a half, therefore, in order not to be left without a drug, I go to private andrologists. An appointment costs 3500-7000 R, depending on which doctor you manage to make an appointment with.

There is another drug, Nebido, but it is hard to find in Russia. It can be pricked not so often, in my case – once every seven to eight weeks. There are those who need injections at all once every three months. The price of the drug is 6624 R per ampoule.

In pharmacies, one or two ampoules of Sustanon or Omnadren are usually available, while Nebido is brought only on order. The prescription is taken away after the purchase, so you have to call pharmacies, look for those where there are all five ampoules, and go there. I know that you can arrange with your andrologist to buy medicine right at the appointment, but I haven’t tried that yet.

The problem with buying a medicine is related to the legislation, which provides for a special procedure for the circulation of drugs with anabolic activity. In fact, they are equated to narcotic and psychotropic drugs.

After the imposition of sanctions, it is no longer possible to order and buy Nebido in a Russian pharmacy. There are no problems with Sustanon and Omnadren yet. In Russia, of all drugs, only Omnadren is produced.

You can buy testosterone injections in Turkey, they are sold there without any problems: I tried it once when I was in the country. With a prescription, the medicine can be imported into Russia without question.

How do I buy drugs in Turkey

Topical preparations. For those who do not like injections or are tired, there is an option for external use of testosterone – Androgel. The main problem with the gel is that a small amount of testosterone penetrates the skin. It must be applied frequently, and then for 30 minutes do not wet the skin and do not come into contact with other people, so as not to transfer testosterone to them.

I have to apply three sachets a day: morning, afternoon and evening. It is better not to apply the gel at night – testosterone will add vigor. When I don’t have time to take a prescription for ampoules, I apply the gel on my shoulders, back and stomach, and then put on a T-shirt so as not to give the drug to my wife.

The gel is available in packs of 30 sachets. I take a dosage of 5 mg. If you use the gel all month, then you need three packs of 2850 R, the consumption per month is 8550 R. If you use HRT in the form of a gel all year, you will get 105,000-110,000 R. If you use an injection form, then the gel supply is 3-5 It is better to always keep packs at home in case you fail to take a prescription on time. This is 8500-14 000 R.

It is more expensive to use the gel, but you can get it in the right amount faster than injectables.

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What prescriptions do you need for testosterone preparations

You can buy testosterone preparations only by prescription. For Androgel, you need a prescription in the form No. 107-1/y, and for testosterone esters in ampoules – in the form No. 148-1/y-88.

Order of the Ministry of Health on approval of the prescription of drugs

For injectable drugs, there are restrictions on the amount of the drug per prescription. For example, “Omnadren” and “Sustanon” write out only five ampoules at a time, “Nebido” – only one. The prescription also has an expiration date – it is valid for only 15 days, during which time you need to find and buy the drug.

The prescription for Androgel is valid for longer – 30 days, you can agree with the doctor on the release of more and order three or four packs from the pharmacist at once.

The prescription contains the patient’s data, the name and dosage of the drug, and the seal of the doctor and the clinic must be included.

How often do you need to take blood tests for testosterone therapy

Testosterone level. After the appointment of therapy, you need to take an analysis of the level of total testosterone in about two to three months. If after that the doctor reduces or increases the dose, then you need to take the tests again – until the testosterone level reaches the norm. After that, you need to retake the analysis once every six months or a year to monitor the condition.

Testosterone therapy in men with hypogonadism – recommendations of the American Endocrine Society

Avoid heavy exercise, sex, fatty, sugary, stress before testing. Pass the analysis on an empty stomach.

Sometimes your doctor may also recommend free testosterone testing. Such an analysis will cost about 2000 R if you pass both indicators at once. If you donate only the general one, you will have to spend about 700 RUR.

The level of testosterone in the blood changes gradually after the start of therapy. For example, when using Omnadren or Sustanon, the level of hormones in the blood levels off after about three months. You need to take tests in the intervals between injections.

The gel works faster, the testosterone from this preparation immediately enters the blood, however, in order to maintain an optimal level, you need to constantly use it. Pass the analysis when using the gel 2-8 hours after application.

The doctor usually focuses on tests and well-being, he can increase the amount of the drug, or, conversely, increase the time between injections if the testosterone level is high.

Blood tests. Testosterone therapy can affect health: for example, change important blood parameters, increase the tendency to blood clots. Because of this, you need to regularly – once every six months or a year – take a clinical blood test. Also, the doctor may advise taking a biochemical blood test to assess the state of the cardiovascular system. These studies will cost approximately 4500 R.

What does a biochemical blood test show?

I also take tests for other hormones to monitor the state of the hormonal system: luteinizing hormone, prolactin, estrogen, thyroid-stimulating hormone, thyroid hormones. It costs me about 4000 R.

You can take the necessary tests for free if you get a referral from the clinic. The problem is that where I live, to get tested for hormones, you have to drive across the city in the morning, on an empty stomach and without energy. After sitting in line for the treatment room a couple of times, I gave up on this idea. On average, once every six months I spend 7,500 rubles on tests.

The result of a blood test when choosing a dosage The results of tests for hormones now

What tests and examinations are needed during HRT with testosterone

Varvara Filatova

endocrinologist, DocMed clinic

After starting hormone replacement therapy with testosterone drugs, it is necessary to monitor the following indicators: 900 03

1. The level of total testosterone.
2. Clinical blood test.
3. Blood test for prostate-specific antigen.

Usually, these tests are ordered 3-6 months after the start of therapy and every six months to a year thereafter. With the same regularity, it is worth conducting a digital rectal examination or an ultrasound examination of the prostate so as not to miss its changes. All other examinations are prescribed by doctors according to indications.

How testosterone replacement therapy has affected my health

I have now been on testosterone HRT for five years. Problems with the pulse disappeared, my health improved, my sleep improved, my mood improved. I exercise, maintain a healthy lifestyle, I can say that I live happily.

I track some body parameters using smart scales. According to their measurements, during the treatment, the bone weight changed from 5 to 11 kg, the amount of muscles increased by 6%, and the amount of fat, on the contrary, decreased by 6%. This is with a sedentary lifestyle and three to five strength training per week. I used to train five or six times a week, plus every day I spent an hour on cardio training – and the result was worse.

My appearance now corresponds to my age, the beard is thicker than before HRT. All my blood tests are normal, that is, controlled therapy in my case does not bring side effects, if the dosage is not exceeded.

Demonstrable effect of therapy on beard growth

According to some data, in general, hormone replacement therapy for testosterone deficiency does not increase the risk of cardiovascular disease. However, further research is required.

Side effects of testosterone therapy in adult men – Journal of Clinical Endocrinology

A potential risk may be due to the fact that testosterone slightly increases the risk of blood clots. That is why in the process of therapy you need to take blood tests.

Data on the effect of HRT on prostate cancer suggests that men with testosterone deficiency do not have an increased risk. However, since this disease is to some extent dependent on testosterone, men on therapy, especially the elderly, should be screened for prostate cancer, in particular, take a blood test for PSA. My prostate has been removed, so this risk is not relevant in my case.

The health consequences of low testosterone may be greater than the negative effects of HRT. Before its appointment, it is worth consulting with a competent endocrinologist or andrologist so that he evaluates the need for therapy and weighs all the risks, pros and cons.

The duration of testosterone intake depends on the disease, course and reaction of the organism. In my case, HRT is lifelong.

I spend an average of 125,000 R per year on testosterone hormone replacement therapy

Testosterone injections	48 000 R
Visits to the doctor once a month	48 000 R
Wellness tests	15 000 R
Testosterone gel stock	14 000 R

Injectable testosterone preparations

R48,000

Monthly visits to the doctor

R48,000

Well-being tests 900 03

15,000 R

Stock of testosterone gel

14,000 R

Why you should not use testosterone without indications

Varvara Filatova

endocrinologist, DocMed clinic

There is no clinical sense in taking testosterone without indications. HRT in men without hypogonadism will not improve well-being, on the contrary. With an increase in testosterone levels above physiological values, complications may develop: the appearance of acne, hair loss in some areas of the head, in some cases, an increase in blood pressure.

Also, testosterone preparations suppress spermatogenesis, therefore, with prolonged and uncontrolled use, this can lead to great difficulties in conceiving a child.

Remember

1. Testosterone replacement therapy is prescribed if there is a deficiency of the hormone according to the test results and symptoms that indicate its decrease below normal.
2. Testosterone deficiency can be suspected by a general deterioration in well-being, a decrease in mood, problems with sleep, a set of muscle mass and libido.
3. An endocrinologist can prescribe and monitor therapy, but it is better to contact an andrologist who has experience in managing such patients.
4. After starting therapy, regular blood tests should be taken to assess testosterone levels and other health indicators.
5. If HRT with testosterone is prescribed according to indications and takes place under the supervision of a doctor, then side effects can be avoided.

Did you also have an illness that affected your lifestyle or attitude? Share your story.

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How to determine your testosterone level and correct it

Health

March 26, 2018

Why it’s so important to know your testosterone level, when it’s time to get tested and how to do it.

Iya Zorina

Author of Lifehacker, athlete, CCM

Why know your testosterone level

Testosterone is involved in many body processes: it regulates sexual behavior in both sexes, stimulates muscle growth, maintains bone density, affects fat metabolism.

Hormonal imbalances can cause many problems, including being overweight, losing sex drive, and even memory loss. By recognizing the signs of low testosterone in yourself, you can take steps to normalize it and solve your health problems.

How to determine the level of testosterone by indirect signs

There are several indirect signs by which you can determine that your testosterone level has dropped or, on the contrary, has risen too much.

Signs of low testosterone

Decreased libido

Low testosterone is often the cause of decreased libido in men.

Men with low testosterone have less desire for sex, which can cause erection problems, masturbate less and have no erotic fantasies.

For women, the decrease in sexual desire, together with the decrease in testosterone levels, is especially noticeable after menopause, but testosterone therapy rarely gives positive results. The best results have been obtained with the combined use of testosterone and estrogen.

Overweight

Testosterone is associated with increased body fat in men.

A decrease in testosterone increases the activity of the enzyme lipoprotein lipase, which determines the concentration of lipids in the blood and their transportation to visceral fat – reserves around the internal organs.

In women, both high and low testosterone levels with low estradiol (female sex hormone) can cause obesity.

Depression

If you are in a bad mood all the time, have no strength and energy, it may be due to low testosterone levels.

Scientists have found that depressed men have lower testosterone levels. While it is still unknown what the underlying cause is, hormone therapy is quite effective in treating depression, especially in older adults.

In women, a decrease in testosterone also leads to a lack of energy, depression, constant fatigue and a bad mood.

Muscle loss

If you’re not able to lift weights in the gym that you were able to lift easily some time ago, while still exercising and eating well, it could be testosterone levels.

Loss of muscle mass is directly related to reduced testosterone levels.

Increasing the amount of testosterone leads to increased synthesis of muscle cells. For example, an additional injection of 3 mg of testosterone per 1 kg of body weight once a week for 12 weeks increases muscle mass synthesis by 27%.

Unwillingness to achieve your goal after failure

If you lose heart after failure, it may not be a matter of character at all.

The level of testosterone determines the desire of a man to compete after a loss and achieve his goals after a setback. Since it is so important for success in any endeavor, testosterone levels can be a critical factor in achieving success.

Memory impairment

Lack of testosterone can negatively affect memory in both men and women.

In a large scientific review in 2015, scientists concluded that testosterone definitely affects memory, but the specific effect depends on gender, age, the presence of diseases and hormonal levels.

For example, testosterone injections help improve spatial memory in healthy young women, but when combined with estrogen impair verbal memory in menopausal women.

At the same time, testosterone improves spatial and verbal memory in patients with Alzheimer’s disease.

If you have trouble remembering words or can’t find a place even though you’ve been there a few times, it might be because of your hormones.

Signs of high testosterone

Although everyone strives to increase testosterone levels, too high levels of this hormone also negatively affect the body. Especially strongly increased production of testosterone hits women’s health.

Skin problems

Increased levels of male sex hormones in women increase sebum production and cause acne.

In addition, elevated testosterone can cause follicular hyperkeratosis, or goosebumps. This is a disease in which the exfoliation of the skin is disturbed, its upper layer coarsens and reddens.

At the same time, acne is associated with a high level of androgens not only in women, but also in men.

Aggressiveness and recklessness

Testosterone provides confidence and motivation, but when it is too much, the positive qualities are replaced by negative ones.

Testosterone activates the subcortical areas of the brain responsible for aggressive behavior, while cortisol and serotonin act as antagonists and reduce the effect of testosterone. Prisoners and violent offenders tend to have higher testosterone levels, so they tend to be aggressive.

But even if it concerns a completely civilized and adequate person, increased testosterone makes you take risks and make decisions rashly, relying on the first thing that comes to mind.

Menstrual irregularities

In women, high testosterone levels often manifest as menstrual irregularities. This dependence is observed regardless of the presence or absence of diseases.

So, indirect signs may indicate an increased or decreased level of testosterone, but you can find out for sure by doing an analysis.

Which testosterone test to take

There are two types of testosterone test. This is due to the fact that testosterone in the human body can be in a free or bound state. Free testosterone is bioactive and acts on receptors, while globulin or albumin associated with special proteins remains in reserve.

The bond between testosterone and globulin is very strong. Globulin is produced in the liver and binds most of the testosterone in our body. But albumin does not hold testosterone so tightly, this bond is also called conditionally free.

When laboratory tests are carried out, the total amount of testosterone in the body (free and bound) is determined.

There are also tests for free testosterone levels, but since it is very small (about 1-2%), it is rather difficult to accurately calculate its amount. Therefore, to begin with, take an analysis of the total level of testosterone. If it is indeed low or high, your doctor may order a free level test.

How to get a testosterone level test

You can go to a public or private clinic and get a testosterone blood test from a vein. For your results to be accurate, follow a few rules:

• If you are taking hormonal drugs, consult your doctor about the possibility of temporarily canceling them in 48 hours to take the test.
• 12 hours before the test, it is recommended to refrain from smoking, alcohol, fatty foods and physical activity.
• If you cannot stop smoking by 12 hours, do not smoke for at least 30 minutes before donating blood.
• Women donate blood for testosterone on the 2nd-5th day of menstruation.
• Get tested in the morning on an empty stomach, before 11 am.

What level is considered normal

To interpret the results, the indicators are compared with the standard. We will give standards for different ages from the Mayo Clinic. Rates are in nanograms per deciliter. If your test form shows a different value, such as milligrams per deciliter, you can convert the values ​​​​here.

Total testosterone in men

9010 9 300-1 200

Age, years	Testosterone level, ng/dL
10–11	7– 130
12-13	7-800
14	7–1 200
15–16	100–1 200
17–18
19+	240-950

In more than 3,000 men aged 40 to 79 years, changes in testosterone levels become noticeable when the testosterone level drops below 320 ng/dl, according to a study.

Total testosterone in women

Age, years	Testosterone, ng/dL
10–11	7 -44
12–16	7–75
17–18	20–75
More than 19	8–60

Free testosterone in men

901 08

Age, years	Number testosterone, ng/dL
10–15	0.04–17, 7
15–20	1.62–21.2
20–25	5.25–20.7
25–30	5.05–19.8
30–35	4.85–19.0 ​​
35-40	4.65-18.1
40-45	4.46-17.1
45–50	4.26–16.4
50–55	4.06–15.6
55–60	3.87–14.7
60–65	3.67–13.9
65 –70	3. 47–13.0
70–75	3.28–12.2

Free testosterone in women

9011 3

90 113

Age, years	Amount of testosterone ng/dL
10–15	0.04–1.09
15–20 (19)	0.04–1, 09 (0.04–1.08)
20–25	0.06–1.08
25–30	0.06–1.06 901 10
30–35	0.06–1.03
35–40	0.06–1.00
40–45	0.06–0.98
45–50	0.06–0.95
50–55	0.06–0.92 90 110
55–60	0 ,06–0.90
60–65	0.06–0.87
65–70	0.06–0.84
70–75	0.06 -0.82

What to do with test results

If your testosterone is below the normal range for your age group, you should see a doctor.