Low Testosterone (Low T): Symptoms, Causes, and More

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Males may experience low testosterone as they get older or due to some health conditions. Symptoms can be subtle, but treatment may help if the symptoms affect your lifestyle.

Alternative names for low testosterone

People may also refer to low testosterone as:

• low T
• male menopause
• andropause
• testosterone deficiency

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Testosterone is a hormone that can affect appearance and sexual development, stimulate sperm production and sex drive, and help build muscle and bone mass. It is typically produced by the testicles in people assigned male at birth.

Who can have low testosterone?

While people assigned male at both and people assigned female at birth produce testosterone, this article focuses on symptoms of low testosterone in people who were assigned male at birth. Research suggests that some doctors may prescribe testosterone off-label to females to improve libido, but this use has not been approved by the Food and Drug Administration (FDA).

Though sex and gender exist on a spectrum, the studies and surveys below used the terms “male” and “men” and did not report data on, or include, participants who were transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.

To maintain the specificity and accuracy of the research, this article will use the terms “male” and “men” throughout.

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Testosterone production typically decreases with age. According to the American Urological Association, about 40% of males ages 45 and older have low testosterone.

If your testosterone production drastically drops, you may experience a range of symptoms. Signs of low testosterone are often subtle and can include:

Low sex drive

Testosterone plays a key role in your sex drive or libido. Some people may experience a decline in sex drive as they get older, but those with low testosterone will likely experience a more drastic drop.

Difficulty achieving and maintaining an erection

Testosterone aids in achieving and maintaining an erection. It tells brain receptors to produce nitric oxide, which is a molecule that helps trigger a series of chemical reactions to produce an erection.

With low T, you may have difficulty achieving an erection before sex or having spontaneous erections, such as during sleep.

However, research is inconclusive on whether testosterone replacement therapy can successfully treat erectile dysfunction. A 2016 review of studies looked at this therapy in males with erection difficulties and nearly half showed no improvement.

Other health conditions can cause erectile difficulties. These include:

• diabetes
• thyroid disorders
• high blood pressure
• high cholesterol
• depression
• stress
• anxiety

Smoking and alcohol use can also contribute.

Hot flashes

Hot flashes can be a sign of low testosterone. This can feel like a sudden sensation of warmth. You may also experience:

• heavy sweating
• reddening of the skin
• night sweats

Hair loss

Testosterone plays a role in hair production. Balding is a natural part of growing older for many males, and while it can be hereditary, those with low testosterone may lose body and facial hair as well.

Fatigue

Males with low testosterone may report extreme fatigue and decreased energy. You may have low T if you’re consistently tired despite getting plenty of sleep or if you find it harder to get motivated to exercise.

Decreased muscle mass

A 2016 review found that testosterone affects muscle mass but not necessarily strength or function. Males with low T may notice a decrease in muscle mass.

Increased body fat

Low testosterone levels may cause increased body fat or gynecomastia, which is enlarged breast tissue. Gynecomastia can occur when there is an imbalance of testosterone and estrogen in the body.

Decreased bone mass

Osteoporosis is a condition that affects bone density. Testosterone helps produce and strengthen bone, so males with low testosterone, especially older men, may have lower bone volume and be more susceptible to bone fractures.

Mood changes

Males with low testosterone can experience mood changes. Since testosterone influences many of the body’s physical processes, it can also influence mood and mental capacity.

Memory

Both testosterone levels and cognitive functions, particularly memory, decline with age. As a result, doctors have theorized that lower testosterone levels could contribute to affected memory.

According to a 2019 review of studies, testosterone supplementation may improve memory in older men with low testosterone though the effect may be small.

However, a 2017 study on testosterone supplementation did not find memory improvements in 493 men with low testosterone levels who took testosterone or a placebo.

Smaller testicle and penis size

The body requires testosterone to develop the penis and testicles, so low testosterone levels could contribute to a disproportionately smaller penis or testicles. Other conditions and circumstances can cause a smaller penis and testicles, as well.

Low blood counts

Low testosterone may increase your risk for anemia, according to a 2017 study. When researchers administered testosterone gel to males with low testosterone and anemia, they saw improved blood counts compared to males who used a placebo. Blood counts also improved in males with known causes of anemia, like iron deficiency.

Testosterone levels naturally decrease as males get older, but other conditions or circumstances may also cause low testosterone. These may include:

• testicle injuries
• cancer treatments, such as chemotherapy and radiation
• stress
• AIDS
• alcohol use disorder
• kidney disease
• cirrhosis of the liver
• pituitary gland conditions
• autoimmune disease
• infection
• obesity
• metabolic syndrome
• using certain medications

Testosterone levels are typically 300 to 1,000 nanograms per deciliter (ng/dL). Low testosterone is when testosterone levels fall below 300 ng/dL. A blood test called a serum testosterone test can determine your testosterone level.

Other tests may be performed to determine the cause of low testosterone.

Tests to diagnose low testosterone and its causes include:

• serum testosterone
• luteinizing hormone
• blood prolactin level

Testosterone replacement therapy is a common treatment for low testosterone.

If low testosterone symptoms are bothering you, you can talk with a doctor to determine if testosterone replacement therapy is right for you.

Testosterone replacement therapy is a lifelong treatment. If you stop treatment, your testosterone levels will drop.

Side effects can include:

• acne
• enlarged prostate
• shrinking testicles
• decreased sperm count
• high red blood cell count
• fluid retention
• swollen feet or ankles

This therapy may not be right for you if you:

• have an untreated heart condition
• have breast or prostate cancer
• have sleep apnea
• have elevated red blood cell counts
• plan to have children

Having low testosterone may increase your risk of developing other health conditions, which may require treatment.

Males experience a gradual decrease in testosterone as they get older. The older you are, the more likely that you’ll have low testosterone.

A variety of factors can cause low testosterone. A doctor can check your testosterone level with a simple blood test.

If you have low testosterone and the symptoms bother you, a doctor may recommend testosterone replacement therapy.

If you would like to know your testosterone levels, LetsGetChecked offers male hormone tests at home at various price points.

Read this article in Spanish.

Could you have low testosterone?: MedlinePlus Medical Encyclopedia

Testosterone is a hormone made by the testicles. It is important for a man’s sex drive and physical appearance.

Certain health conditions, medicines, or injury can lead to low testosterone (low-T). Testosterone level also naturally drops with age. Low testosterone can affect sex drive, mood, and changes in muscle and fat.

Treatment with testosterone therapy may help reduce symptoms.

Testosterone makes a man look and feel like a man. In a man, this hormone helps:

• Keep bones and muscles strong
• Determine hair growth and where fat is on the body
• Make sperm
• Maintain sex drive and erections
• Make red blood cells
• Boost energy and mood

Beginning around age 30 to 40, testosterone levels may start to slowly decrease. This occurs naturally.

Other causes of low testosterone include:

• Medicine side effects, such as from chemotherapy.
• Testicle injury or cancer.
• Problems with glands in the brain (hypothalamus and pituitary) that control hormone production.
• Low thyroid function.
• Too much body fat (obesity). Ask your doctor whether you need a test called free testosterone.
• Other disorders, chronic diseases, treatments, or infection.

Some men with low testosterone do not have any symptoms. Others may have:

• Low sex drive
• Problems having an erection
• Low sperm count
• Sleep problems such as insomnia
• Decrease in muscle size and strength
• Bone loss
• Increase in body fat
• Depression
• Trouble concentrating

Some symptoms may be a normal part of aging. For example, it is normal to feel less interested in sex as you get older. But, it is not usually normal to have no interest in sex.

Symptoms may also be caused by other conditions, such as high blood pressure or diabetes. If any of these symptoms are bothering you, talk with your health care provider.

Your provider will likely have you get a blood test to check your testosterone level. You will also be checked for other causes of your symptoms. These include medicine side effects, thyroid problems, or depression.

If you have low testosterone, hormone therapy may help. The medicine used is man-made testosterone. This treatment is called testosterone replacement therapy, or TRT. TRT can be given as a pill, gel, patch, injection, or implant.

TRT may relieve or improve symptoms in some men. It may help keep bones and muscles strong. TRT seems to be more effective in young men with very low testosterone levels. TRT can also be helpful for older men.

TRT has risks. These may include:

• Infertility
• Enlarged prostate leading to difficulty urinating
• Blood clots
• Worsening heart failure
• Sleep problems
• Cholesterol problems

At this time, it is unclear whether TRT increases the risk of heart attack, stroke, or prostate cancer.

Talk with your provider about whether TRT is right for you. If you do not notice any change in symptoms after treatment for 3 months, it is less likely that TRT treatment will benefit you.

If you decide to start TRT, be sure to see your provider for regular checkups.

Call your provider if:

• You have symptoms of low testosterone
• You have questions or concerns about treatment

Male menopause; Andropause; Testosterone deficiency; Low-T; Androgen deficiency of the aging male; Late-onset hypogonadism

Allan CA, McLachlin RI. Androgen deficiency disorders. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 139.

Morgentaler A, Zitzmann M, Traish AM, et al. Fundamental concepts regarding testosterone deficiency and treatment: international expert consensus resolutions. Mayo Clin Proc. 2016;91(7):881-896. PMID: 27313122 pubmed. ncbi.nlm.nih.gov/27313122/.

U.S. Food and Drug Administration website. FDA drug safety communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use. www.fda.gov/drugs/drugsafety/ucm436259.htm. Updated February 26, 2018. Accessed July 6, 2021.

Updated by: Brent Wisse, MD, Board Certified in Metabolism/Endocrinology, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Low testosterone: signs and treatment

Low blood testosterone, also known as hypogonadism or andropause, affects approximately 40% of men over the age of 45. The incidence of hypogonadism increases with age. It has been scientifically proven that low testosterone is diagnosed in about 20% of men over 60, up to 30% of men over 70 and 50% of men over 80.

What are the signs of low testosterone in men?

Sexual disorders come to the fore, including decreased erectile function, low libido (sexual desire), weak and rare erections, and reduced sexual activity.

Hypogonadism is also characterized by an increase in body fat, decreased physical activity and increased fatigue, decreased muscle mass, nervousness and depression.

Approximately 40% of men with high blood pressure and 40% of men with high cholesterol levels have low blood testosterone levels. In addition, 50% of men with diabetes and 50% of obese men also have a decrease in testosterone levels. It has been proven that 30% of men with HIV and 50% of men with AIDS have low testosterone levels.

Surprisingly, nearly 75% of men with a history of chronic opioid use experience hypogonadism.

Treatment options for men with a similar situation?

There are many options and regimens for treating patients with low testosterone levels. Testosterone replacement therapy can be given as a skin gel, intramuscular injection, long-acting granules, patches, or tablets. The most common option is dermal gel therapy, which is used in approximately 70% of patients. Men simply rub the gel on their shoulders or abdomen after taking a shower. Approximately 20% of patients use testosterone injections and 10% of men use testosterone patches. a small percentage of patients (about 3%) use testosterone in the form of tablets or implantable testosterone granules.

What to expect from treatment?

Testosterone replacement therapy significantly increases physical activity, libido (sex drive), muscle mass, helps normalize sleep, erections. The level of endurance increases, irritability and depression disappear, mood and general condition of the body improve. Testosterone promotes weight loss.

There is evidence of a positive effect of testosterone in increasing bone mineral density and reducing the risk of bone fractures. It is important to understand that testosterone treatment is considered lifelong therapy, as is the case with many other chronic diseases. Stopping replacement therapy will lead to a decrease in testosterone levels in the blood.

Frequently Asked Questions:

How can I detect low testosterone?
Low testosterone is diagnosed with a blood test.
The main clinical manifestations are: decreased erection, decreased sexual desire, increased fatigue, irritability, depression, and a steady increase in body weight.
It is necessary to check the level of PSA (screening test for prostate cancer) and hematocrit (measurement of the concentration of red blood cells in the blood). The PSA is checked to make sure the patient does not have prostate cancer. A hematocrit to control a possible increase in the number of red blood cells.

What important information should you know about using testosterone?
Testosterone should not be taken with a diagnosis of breast cancer, established or suspected prostate cancer.
Men treated with testosterone may be at an increased risk of developing or exacerbating urinary (benign prostatic hyperplasia or adenoma) symptoms.
Patients with kidney, liver or heart disease are at increased risk of developing edema. Testosterone replacement therapy can lead to deterioration and sleep apnea. Finally, long-term testosterone treatment can affect a man’s fertility.

Is there a relationship between testosterone and prostate cancer?
It is the most common question among patients.
Studies conducted so far have not found evidence of a greater risk of prostate cancer among men who receive testosterone compared to men who receive placebo or no treatment at all. However, this remains an issue that requires further research.

Testosterone deficiency – diagnosis and treatment at the MedEx clinic in Moscow

Testosterone is the main male hormone (androgen), which affects the appearance, sexual activity and well-being of the stronger sex from a young age. The substance is produced by the testes, or rather, the Leydig cells. Testosterone deficiency in a man’s body can lead to serious complications, so the problem must be addressed in a timely manner.

The MedEx Personal Medicine Clinic invites you to undergo an examination and determine your hormonal status. We will identify the causes of testosterone deficiency, prescribe treatment, and talk about relapse prevention. Reception is conducted by experienced therapists and urologists.

Functions of testosterone in the body

The word “testosterone” refers to a whole group of steroid hormones of different forms, which are strong anabolics. Substances stimulate the synthesis of a huge amount of proteins in the cells of the human body. Testosterone activates the processes of regeneration, tissue growth, penetrates the nuclei and starts more than 146 genes. It is safe to say that a group of steroid hormones affects not only men’s health, but also the state of the whole organism as a whole.

Causes of testosterone deficiency

The vast majority of clinical cases are age-related changes. Androgen deficiency is observed in men after 30 years, when the production of active substances slows down by about 1% annually. Over the age of 40, the level of hormone synthesis drops by 1.5% per year, which is associated with a decrease in reproductive function.

Other possible causes of testosterone deficiency:

• surgical removal of testicles for medical reasons;
• bad habits: smoking, drinking alcohol, psychotropic substances;
• sedentary lifestyle, sedentary work;
• unfavorable ecological situation in the area of ​​residence;
• work with dangerous and harmful production factors, toxic substances;
• hypertension, cardiovascular diseases;
• taking medications (opioids, corticosteroids, ketoconazole, hormones) without medical prescription;
• high levels of bilirubin, which destroys testosterone;
• renal insufficiency;
• endocrine diseases, pathologies associated with hormonal shifts;
• obesity, diabetes mellitus;
• past inflammatory diseases, infections;
• elevated levels of lipoproteins in the blood;
• genetic pathologies, for example, Down syndrome, Kalman, Klinefelter.

In addition to physical factors, testosterone deficiency can also be provoked by psychological reasons. If a man constantly experiences stress, depression, adrenaline actively enters his blood. This hormone is able to block testosterone, even if the androgen is produced in sufficient quantities.

Symptoms of lack of testosterone in men

Signs of lack of hormones depend on the cause. If the synthesis of testosterone slows down due to genetic abnormalities, then the man shows pronounced external symptoms of deficiency:

• formation of female genital organs, accumulation of adipose tissue in the waist area;
• underdevelopment of the penis and testicles;
• true or false hermaphroditism (the patient has both female and male external genitalia).

The characteristic signs of a hormone deficiency in adolescence are a slowdown in the growth of the genital organs, a slender physique. The figure of a boy develops according to the female type. His hips become wide, his legs are full, there are no secondary male sexual characteristics. One of the symptoms of testosterone deficiency is the absence of voice breakage.

A hormonal imbalance also affects the character of an adult man. Behavioral features become a symptom of testosterone deficiency:

• increased emotionality, sentimentality, mood swings;
• sleep disorders;
• depression, tearfulness, moodiness, suicidal mood;
• scattered attention, inability to concentrate on one thing.

The symptoms of lack of testosterone in a man in adulthood are added by the lack of growth of muscle mass, hair loss on the chest, head, arms and legs, enlargement of the mammary glands (gynecomastia), increased sweating, metabolic disorders. From the side of the heart, a low level of hormones is manifested by arrhythmia, tachycardia, hot flushes, and cardialgia.

As the deficiency progresses, the patient begins to experience difficulties in intimate life. A symptom of a lack of testosterone in a man can be a decrease in potency, impotence, premature ejaculation, infertility.

Diagnosis of pathologies

As soon as the first signs of testosterone deficiency appear, a man needs to undergo a comprehensive examination. Diagnosis of deficiency begins with laboratory blood tests to determine the concentration of hormone forms in nmol / ml.

Biomaterial is examined by enzyme immunoassay. An enzyme-based substance is added to the blood, which stains testosterone in a bright color. According to the intensity of the shade, the level of various forms of androgen in the blood is calculated. The enzyme immunoassay method is accurate, fast, and it is impossible to get a false result.

Three types of testosterone are determined in the blood:

1. Free is the active form of the hormone responsible for the manifestation of male sexual characteristics. In the total volume of androgens, the share of such testosterone is not more than 2%.

2. Bound – a form combined with globulin (SHBG) and albumin.

3. Total – total value of free and bound hormone.

If, in the presence of obvious signs of testosterone deficiency, the analysis shows the norm, the man is prescribed additional blood tests:

1. Determination of the level of globulin. This protein binds and blocks androgens. The higher the amount of globulin, the lower the concentration of testosterone in a man. Androgen deficiency in the analysis develops with endocrine diseases, diabetes mellitus, severe disorders of the liver.

2. Determination of LH and FSH – gonadotropic hormones. Substances are synthesized by the pituitary gland and affect the production of androgens in the male body. When the level of testosterone decreases and at the same time there is a decrease in the concentration of LH and FSH according to the results of the analysis, the cause of the deficiency must be sought in the work of the pituitary gland or hypothalamus. Proper treatment will help restore the balance of male hormones.

3. Determination of dihydrotestosterone content. The active substance is a form of free testosterone. A decrease in the concentration of dihydrotestosterone indicates a deficiency of 5-alpha reductase. The cause of the disease should be sought in metabolic processes. If the normal level of 5-alpha-reductase is restored, then androgens will begin to be produced in sufficient quantities.

4. Determination of the amount of estradiol. This hormone is an antagonist of male testosterone. The more estradiol in the blood, the more pronounced will be the lack of androgens.

If the imbalance of hormones is accompanied by characteristic signs of testosterone deficiency, men are diagnosed with hypogonadism. The task of the doctor is to determine the cause of this condition. This may be a violation of the functionality of the nervous system or diseases of the reproductive organs. To select an effective treatment for testosterone deficiency, ultrasound of the pelvic organs, prostate gland, CT scan or radiography according to indications, other laboratory and instrumental methods for diagnosing the causes of hypogonadism may be required.

Treatment of testosterone deficiency

Low androgen levels affect a man’s quality of life. Therefore, the treatment of testosterone deficiency must be started as early as possible. Hormonal imbalance can lead to complications such as diabetes, heart disease and blood vessels. In the absence of treatment, testosterone deficiency pulls a whole chain of metabolic disorders. Over time, jumps in blood pressure increase, up to a stroke. Without treatment, pathologies of the musculoskeletal system develop: in a man, muscles weaken, bone density decreases. Patients complain of pain in the joints and limbs. The lack of hormones disrupts the trophism of tissues and cells. The patient’s skin dries, the hair becomes brittle, early wrinkles appear on the face.

An interesting fact: low testosterone is treated in most cases with non-hormonal remedies. For many men, it is enough to observe a sleep schedule, walk more, lead a healthy lifestyle, and adhere to proper nutrition. Gradually, the level of hormones returns to normal without medical treatment, sexual activity is restored. Regular sex life helps to increase testosterone levels. Intimacy must be with a permanent partner.

Drug treatment of testosterone deficiency includes the following drugs:

1. Hormonal agents. To increase the level of androgen, a man is treated with pills or injections in a strictly calculated dose. The drugs have many side effects, so their use requires regular medical supervision.

2. Transdermal patches. The drugs also contain hormones, but at a lower dose. The patch is applied to the inside of the thigh or to the scrotum and is worn for several hours a day. Transdermal preparations have fewer side effects than tablets, but local irritation is noted in some cases.

Men are advised to maintain a healthy lifestyle to prevent testosterone decline. Refusal of bad habits and promiscuity will help to maintain strength and attractiveness for the opposite sex for a long time.