Low testosterone levels in men: Low Testosterone: Symptoms, Diagnosis & Treatment
Visual Guide to Low Testosterone
Medically Reviewed by Carol DerSarkissian, MD on November 28, 2022
Testosterone may be the most notorious of hormones. It conjures up thoughts of muscles and masculinity. In fact, testosterone does fuel sex drive and muscle mass, but it also regulates mood and bone strength. When a man’s level falls below normal, a doctor may prescribe shots, gels, or patches. But there is some debate over who needs treatment.
A slow drop in testosterone is a normal part of aging, sometimes called “andropause” or “male menopause.” For many men, this doesn’t cause any significant problems or symptoms. Others may notice a decline in muscle mass, depression, or less interest in sex.
Low testosterone can cause visible changes in some men:
- Smaller, softer testicles
- Larger breasts
- Thinner muscles (happens slowly over a period of years)
- Loss of body hair (also happens slowly, usually over a period of years)
You may think osteoporosis, or brittle bone disease, is a woman’s disease, but it can affect men as well. Low testosterone is a common cause. As testosterone levels fall, the bones may get thinner, weaker, and more likely to break.
A drop in testosterone doesn’t always interfere with sex, but it can make it more difficult for your brain and body to get aroused. Some men may notice a drop in libido, while others may lose interest in sex completely. Low testosterone can also make it tougher to get or keep an erection.
Some men have subtle problems like mood changes, poor concentration, and less energy. These symptoms can easily be caused by other health problems though, like anemia, depression, sleep troubles, or a chronic illness.
Testosterone helps a man’s body make sperm. When levels of the hormone are low, their sperm “count” can be low, too. Without enough sperm, they may not be able to father a child.
Getting older is the most common reason testosterone levels dip. Illnesses are sometimes to blame, including:
- Type 2 diabetes
- Pituitary gland problems
- Testicle injuries
Radiation therapy, chemotherapy, and steroid medicines can also affect testosterone levels.
Your doctor may suggest a testosterone test if you have:
- Erectile dysfunction
- Lower sex drive
- Low sperm count
- A loss of height, body hair, or muscle size
If you have an illness known to lower testosterone, your doctor may want to test your levels of the hormone.
Testosterone is usually measured with a blood test done early in the morning, when levels are highest. Normal levels range from 300 to 1,000 ng/DL. Your doctor may want to run this test a second time before diagnosing low testosterone.
If you have low blood levels of testosterone AND symptoms that affect your daily life, your doctor may suggest taking supplemental testosterone. Not everyone with low testosterone will need treatment. You may want to see a specialist to discuss the risks and possible benefits of treatment. Look for a urologist or an endocrinologist, a doctor who treats hormone problems.
If you need treatment, your doctor may prescribe testosterone to boost your levels. Some studies suggest this can strengthen men’s muscles, protect their bones, and improve their sex drive, improve erectile dysfunction, and contribute to improved mood. But the effects can be quite different from one man to the next.
Testosterone comes in several forms, including shots, gels, patches, and tablets you place on your gums. Injections are the least expensive option, but they can be painful. You take the shots every 2 to 4 weeks, as prescribed by your doctor. You may also be able to get the medicine without injections by using a nasal pump. Your testosterone levels can swing up and down between doses.
These are placed directly on your skin. The hormone seeps through the skin, and is slowly released into the blood. Because gels and patches are applied every day, they keep a steady level of testosterone. However, they can cause itching, irritation, and blisters at the spot where they’re applied. Women and children should not touch skin treated with a gel or patch.
Tablets are placed on the gums above your incisors every 12 hours. As the gel-like tablet dissolves it slowly releases testosterone. Gum tablets can cause a bitter taste, irritated mouth, tender gums, or headaches. These side effects may get better with time. You can eat, drink, and kiss women and children while using testosterone tablets. Testosterone pellets are placed under the skin with low continual release of T for 3-6 months which eliminates the need for a weekly or daily testosterone application.
Testosterone therapy has some drawbacks. Some men may develop:
- Too many red blood cells
- Sleep apnea
- An enlarged prostate
The risks and benefits of taking testosterone for many years are not known, because large studies haven’t been completed, yet. Some researchers suggest there might be a higher risk of heart disease. But the evidence is still not conclusive.
There’s some concern that long-term use of testosterone may cause prostate cancer in older men. Men taking testosterone will need regular checkups to look for early signs of prostate cancer. This covers: All men over 50, men over 40 with a family history of prostate cancer, and all African American men.
Men with these conditions shouldn’t take testosterone:
- Prostate or breast cancer
- Poorly controlled heart disease
- Untreated sleep apnea
- Too many red blood cells
- Clotting disorders
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The Endocrine Society: “Low Testosterone and Men’s Health.”
Patient Education Institute: “Low Testosterone.”
American Journal of Respiratory and Critical Care Medicine, November, 2005.
The Endocrine Society: “Testosterone Therapy in Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline.”
American Association for Clinical Chemistry: “Testosterone.”
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
- 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:
- thyroid disorders
- high blood pressure
- high cholesterol
Smoking and alcohol use can also contribute.
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
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.
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.
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.
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
- alcohol use disorder
- kidney disease
- cirrhosis of the liver
- pituitary gland conditions
- autoimmune disease
- 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
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.
Chief urologist of the Ministry of Health of Russia: Lack of testosterone in men
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– Testosterone is the main male sex hormone. It has a steroidal structure and is synthesized from cholesterol. It actually regulates everything in the male body, many functions, such as hematopoiesis, bone density, muscle strength, mental capacity, memory, and of course the reproductive and sexual components, and much more. Testosterone works in cells by attaching to a special receptor. Testosterone regulates many functions.
It has a predominantly greater effect on male sexual and reproductive functions, because it regulates almost everything from sexual desire to erectile function. Of course, it plays a role in spermatogenesis, that is, in the process of sperm formation for the realization of the reproductive capabilities of men.
Lack of testosterone is manifested in the violation of many functions (bone density, muscle mass and strength, mental abilities, memory and, of course, reproductive and sexual components). An increase in testosterone is a rare situation, sometimes associated with a certain type of testicular tumor. Usually, with an excess of testosterone, nothing terrible happens, the only important side effect is expressed in a too high level of hematocrit, an excess of blood cells when it becomes thick. That is why during testosterone therapy with especially high-dose drugs, it is necessary to control the composition of the blood. Lack of testosterone can be associated with either a primary lesion of the testicles, or with a lesion of the pituitary gland, which is the main hormonal gland or endocrine conductor in our body.
With age, many men develop a lack of testosterone, this is called age-related hypogonadism. Up to 5-7% of men around the world may suffer from testosterone deficiency. In athletes and especially bodybuilders, testosterone itself is rarely used, because they are interested in the anabolic effect, muscle growth. To do this, they illegally use anabolic steroids. These are substances similar to testosterone, but they are not.
From the age of 35, a man on average loses 1% of testosterone per year. And, in order to know why it falls, it is necessary to determine its content in the blood at the age of 35 and then measure it once a year and see if the level changes downwards, because a man’s health largely depends on testosterone levels. The smaller it is, the worse the prognosis. The lack of testosterone is one of the causes of early aging, shorter life expectancy, reduced reproductive and sexual potential, and decreased performance.
Categories: life expectancy; testosterone; urology.
Strong male “I”. Why is low testosterone dangerous?
Surely many have heard that hormones are responsible for our male and female selves. Women have estrogens, men have testosterone. Testosterone is called the king of hormones and the hormone of kings. That is, the higher the level of testosterone in a man, the more pronounced his authority, personal position, charisma, he usually occupies a high position in society, easily earns respect in the team and is always surrounded by beautiful women. Such men are usually called alpha males and natural born leaders. About how important testosterone is for a full life, and how dangerous age-related androgen deficiency is, tells the doctor of the Hippocrates Medical Center Tatyana Alekseevna Burmistrova.
Everyone knows that women have menopause at a certain age, and men are glad that they do not have it, and they can be active (in every sense) until the end of their days. In fact, everything is different. Nature has determined that a woman should give birth to a child, raise him and “bring him out to the people”, and a man should conceive a baby and, roughly speaking, his role on this Earth will be over. Therefore, in men, the decrease in the level of the male sex hormone – testosterone begins earlier than in women, from about 30 years. With age, the reproductive system of a man undergoes certain changes, which, despite the analogies with menopause, are significantly different from the changes that occur in women. In men, the drop in hormone levels does not occur so sharply, and the reproductive function, at times, persists until old age.
According to global statistics, testosterone decreases by 1% per year. When the level approaches the lower limit of the norm (and the norm is from 15 to 35 nmol / l), then various age-related changes begin to occur in the male body. A man after 30 years old may notice that he becomes irritable both at home and at work, which was not the case at 25 years old. In addition, he begins to be lazy more often, his libido, mental and physical performance decrease, he lies more on the couch and watches TV. Many men after 30 years have a so-called “beer tummy”, which is often called a “ball of nerves” or “labor callus” among friends, and its appearance is explained by the fact that, they say, “the wife feeds well. ” Some people, of course, are afraid of it. And many rush to the gym, but in training men pump up anything – biceps, triceps, hips – but the stomach does not go anywhere. Why? Because he did not grow up from beer, as is commonly believed, but from a low level of testosterone. Extra pounds on the anterior abdominal wall is not just excess fat, it is hormonal tissue and, unfortunately, it produces female sex hormones – estrogens, which further reduce testosterone levels. So the emerging tummy is the first diagnostic sign of age-related androgen deficiency.
In addition to the natural decrease in testosterone in the body, men accelerate the process by smoking, drinking alcohol, violating the work regime and other urban negative factors. Stress, chronic fatigue, short daylight hours, radiation, etc. also negatively affect testosterone levels. What are pigs and chickens fed now? Female hormones to accelerate their growth. Meat, getting into the body of a man along with artificial chemical estrogens, which are testosterone antagonists, reduces its level. Testosterone-lowering foods include beer, which contains plant estrogens. Further more. In men, muscle strength and muscle mass decrease with age. At the age of 40–45, diabetes mellitus and hypercholesterolemia (increased blood cholesterol) await him. Hence all these “youthful” heart attacks and strokes, provoked by blockage of cerebral vessels by cholesterol plaques, or blood vessels supplying the myocardium. Moreover, the diameter of the above vessels is 5-6 mm, and the diameter of the vessels supplying the penis is only 1-2 mm, so their blockage occurs much faster, resulting in erectile dysfunction. A decrease in erection is not just a social factor, but the first bell that if you do not pay attention to this problem, then in 5-6 years there will be problems with the heart or brain. At an older age, due to low testosterone levels, calcium is washed out of the bones, they become brittle. Therefore, already at the age of 60–65, many lie bedridden, because somewhere they accidentally fell and broke, for example, the neck of the hip. Restoration of bones in such cases is very slow.
Androgen deficiency is included in the concept of “metabolic syndrome”, which includes high blood pressure (above 140 mmHg), waist circumference over 94 cm, high blood sugar (over 6.4 mmol/l), low testosterone levels. The presence of at least three of the above signs indicates the presence of a metabolic syndrome that needs treatment. This is so serious that the drugs prescribed for its correction are included in the list of vital drugs approved by the President of the Russian Federation. In 2012, testosterone-boosting drugs also made the list.
All over the world, testosterone levels are prescribed by neurologists for strokes, cardiologists for heart attacks, traumatologists for bone fractures, endocrinologists for the treatment of obesity, and urologists to correct erectile dysfunction. None of the above diseases can be cured. If you do not raise testosterone to the proper level. Otherwise, the patient will be prescribed high doses of drugs that lower cholesterol and blood pressure, which will negatively affect other organs.