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: Symptoms, causes, and treatment

Low testosterone levels in males can lead to erectile dysfunction. They can also affect sleep, mood, the size of the testicles, and more. In both males and females, low testosterone can lead to lower bone mass and reduced sex drive.

Testosterone is a sex hormone often associated with males, though females have small amounts.

It has many important functions, including:

• the development of the bones and muscles
• the deepening of the voice, hair growth, and other factors related to appearance
• the production of sperm

Testosterone production can slow as a person ages, and many older people experience symptoms of low testosterone.

The American Urology Association defines low testosterone as less than 300 nanograms (ng) of the hormone per deciliter (dl) of blood. The foundation also reports that about 2 in every 100 men have low testosterone.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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Below are common signs and symptoms of low testosterone.

Reduced muscle mass

Testosterone plays a role in the development of muscle mass, and reduced levels of the hormone can result in a significant loss of muscle mass.

However, as low testosterone causes a decrease in mass, the function and strength of the muscles do not diminish, according to a 2016 review.

Reduced bone mass

Testosterone helps to produce bone tissue and maintain bone volume. Low testosterone can lead to a reduction in this volume, which can make the bones more susceptible to fractures.

Reduced sex drive

People with low testosterone often experience a reduction in sex drive.

A diminishing sex drive occurs naturally with age, but when the cause is low testosterone, a male will notice a significant decrease in the desire for sex.

A decrease in energy levels

Low testosterone can lead to reduced levels of energy and fatigue.

A person may feel tired, even after adequate rest, or develop a diminished interest in exercise or movement.

An increase in body fat

A reduction in testosterone can lead to an increase in body fat.

In some cases, people with a deficiency of the hormone develop gynecomastia, which causes an enlargement of the breasts.

Hair loss

Many people experience hair loss as a natural part of aging, and age-related hair loss can also affect anyone.

Authors of an older study from 2012 found that testosterone implants supported hair regrowth in some women receiving treatment for symptoms of sex hormone deficiency.

Males may experience specific symptoms of low testosterone levels.

Problems with erections

Low testosterone can make it difficult to achieve or maintain erections. However, low testosterone itself is not always a direct cause of erectile dysfunction. People with high testosterone levels can find it difficult to achieve erections, and people with low levels the opposite.

Testosterone stimulates the penile tissues to produce nitric oxide, which starts several reactions that result in an erection. If levels of the hormone are too low, a man may not be able to get an erection.

Other factors that can cause erectile dysfunction include:

• smoking
• thyroid-related issues
• high cholesterol
• stress or anxiety
• alcohol consumption
• diabetes
• high blood pressure

Studies show that testosterone replacement therapy can improve erectile function in people with mild erectile dysfunction.

Reduction in testicle size

A male with low testosterone may notice a reduction in the size of their testicles that is not related to cold temperatures.

The scrotum may also feel softer than usual.

Reduction in the amount of semen

Semen is the fluid that makes up the majority of male ejaculate. This type of fluid helps the sperm move toward the egg.

Testosterone helps stimulate the production of semen, and reduced semen levels can indicate a reduction in testosterone. It can also lead to fertility issues.

Difficulty sleeping

People with low testosterone may find it difficult to fall or stay asleep.

Low testosterone levels are common in men who have sleep apnea. This potentially severe disorder causes a person to temporarily stop breathing, which can disrupt sleep.

Changes in mood or mood swings

Some evidence suggests that people with low testosterone levels are likely to experience a lack of focus, irritability, and depression.

One 2017 review found that testosterone replacement therapy significantly improved depression symptoms and overall quality of life in those with low testosterone.

For more research-backed information and resources for men’s health, please visit our dedicated hub.

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Females may also experience specific low testosterone symptoms, such as the following.

Hot flashes

While many people associate hot flashes with estrogen levels that fluctuate during menopause, low testosterone levels may also cause this symptom.

Irregular menstrual cycles

Low testosterone levels can cause a hormonal imbalance that results in menstrual cycles that are shorter or longer than the average of 28 days.

Vaginal dryness

Vaginal dryness is common during and after menopause, but it can occur at any age. It usually results from low estrogen, but low testosterone can also be a trigger.

Anemia

Testosterone helps the body produce healthy red blood cells (RBCs). Low testosterone levels could lead to anemia, a blood disorder that may occur due to the decrease of RBCs. The main symptom is fatigue.

An older 2006 study found that women over 65 with low testosterone levels tended to have lower hemoglobin levels, putting them at greater risk for anemia.

Testosterone production generally begins to decrease after the age of 30 and after menopause. However, younger people may also have low testosterone levels.

In males, hypogonadism, a condition where the testicles produce little or no testosterone, may occur at any age.

Conditions that may cause hypogonadism include:

• testicular injury or infection
• chemotherapy or radiation cancer treatments
• pituitary gland disease or other hormone disorders
• medications, such as corticosteroids and opiate pain relief
• genetic conditions, such as Klinefelter syndrome
• alcohol and drug abuse

In females, low testosterone levels may result from conditions, such as:

• adrenal gland insufficiency
• surgical removal of the ovaries
• taking oral estrogen therapy

Low testosterone does not always present symptoms, and some people only learn about it after a routine physical examination with blood work.

However, anyone who experiences one or more of the above symptoms should seek medical attention.

To diagnose low testosterone, a doctor will often perform a physical evaluation and review the person’s symptoms. The doctor may also request testing to look for additional signs.

For example, a bone density test can show diminished bone mass, one result of low testosterone.

The most common treatment is testosterone replacement therapy (TRT).

A doctor will typically only prescribe TRT if the person has several symptoms of low testosterone and blood test results that indicate a deficiency.

There are several delivery methods of TRT, including:

• skin patches
• gels
• tablets that dissolve in the mouth
• injections
• surgically implanted pellets that release the hormone

Most people will notice relief from symptoms within 4–6 weeks of starting TRT.

Weight loss and exercise can often increase testosterone levels naturally.

While changes to the lifestyle and diet alone may not raise levels sufficiently, they can often help.

It is important to remember that males typically lose testosterone as they age, and the potential benefits of lifestyle changes also decrease over time. Exercise, for example, often shows more significant results in younger people.

Diets high in saturated fats can negatively impact a person’s testosterone levels, while zinc, omega-3 fatty acids, and antioxidant vitamins can support testosterone production.

Eating a balanced diet rich in nutrient-dense whole foods and low in saturated fats may help to boost a person’s testosterone levels.

Learn more about natural ways to boost testosterone here.

Can low testosterone cause diabetes?

Studies show that low testosterone levels in men are a risk factor for type 2 diabetes, the most common form of diabetes.

Testosterone helps the body’s cells increase glucose, or blood sugar, in response to insulin, a hormone that regulates glucose. Reduced testosterone can affect insulin resistance. This can cause the body to produce more insulin to keep glucose levels normal.

When the cells are full of glucose, the body stores the excess in fat cells, which may lead to conditions such as type 2 diabetes and obesity.

Do you consult a urologist or endocrinologist for low testosterone?

A primary care physician may refer an individual to a urologist, who specializes in diseases of the male reproductive system, or to an endocrinologist who specializes in hormone-related diseases.

According to a 2018 study, urologists seemed to adhere more consistently than other specialists to established guidelines for the screening and treatment of low testosterone in males.

Does low testosterone affect fertility?

About 15% of men with fertility problems have low testosterone levels.

However, low testosterone does not cause infertility. In people with fertility problems, low testosterone may be a symptom of a testicular function issue causing infertility rather than a cause of infertility itself.

For example, testicular atrophy can cause infertility and also reduce a person’s testosterone levels. In this instance, the low testosterone levels are a symptom of an underlying condition, not a cause of infertility.

Is low testosterone genetic?

Genetic variants that affect the Y chromosome and the sex hormone-binding globulin may result in a higher risk for low testosterone. SHBG is a protein that helps deliver testosterone to the body’s tissues.

Rare genetic disorders such as Klinefelter syndrome, where males have an extra X chromosome, may also affect testosterone production.

A 2021 study identified 141 new genetic markers that may assist in determining the risk for low testosterone.

The American Urology Association reports that low testosterone affects around 2 in every 100 men. The risk increases with age, though most people naturally lose testosterone as they get older.

Most cases of low testosterone are treatable, and being aware of the symptoms can help a person receive an early diagnosis and treatment.

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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.

How to determine low testosterone levels, which is affected by a deficiency of the male hormone – December 18, 2022

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An andrologist told how testosterone deficiency can worsen a man’s life in all matters all organs. For male health, the concentration of the hormone testosterone is extremely important. With its lack, a man will not have strength, he will not be able to fully relax, even if he gets enough sleep, and still does not want sex. That is, not enough testosterone – there is no full life.

Andrologist told how to determine the lack of “male power” and how to regain it.

Roman Viktorovich Rozhivanov — andrologist, urologist, Doctor of Medical Sciences, Chief Researcher, Professor of the Department of Endocrinology of the National Medical Research Center for Endocrinology of the Ministry of Health of Russia.

Andrology is a narrower specialization of the urologist, requiring a much deeper and more comprehensive knowledge of the male reproductive system, its diseases and possible treatments.

– First of all, it is a hormone of sexual activity: it affects the production of sperm, the ability to fertilize and sexual function, the differentiation of the genital organs (their formation in the unborn fetus. – Note ed. ). This is his classic role, but not the only one, since testosterone is also a very important anabolic hormone. That is, under its action, the development of muscles, bones, strengthening of the body, the development of endurance and strength occur.

The metabolic function is also important: regulation of the interaction of cells with other hormones and other factors of the biochemistry of our body. Here we are talking about normal carbohydrate metabolism, which does not allow obesity. A classic example of metabolic dysfunction is a neutered cat. During castration, sexual function is lost so that the cat does not have the motivation to run after the cat, while the animal becomes lethargic and inactive, and obesity develops. That is, testosterone was removed, and metabolic disorders began in the body.

The work of almost all organs and systems, even the central nervous system, depends on this hormone. It has also been found that the concentration of testosterone affects many psychological factors.

The work of almost all organs and systems depends on testosterone. With a low level of the hormone, a man can feel tired all the time

Illustration: Philip Sapegin / E1.RU

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— Speaking of hormones, you can’t argue: the more, the better. A person in the body should have a normal level of any hormone.

Low testosterone levels clearly negatively affect health: obesity can develop, sexual dysfunction, depression, fatigue and weakness will appear, bone mineral density will decrease, and carbohydrate metabolism will worsen.

High testosterone levels, although it carries fewer health risks for men, but also has its effect. The risk of developing skin acne (acne. – Note ed. ), baldness, “thickening” of the blood, that is, an increase in hemoglobin and hematocrit levels, increases.

— Directly, because it is a hormone of sexual activity. There is a center in the brain that is responsible for sexual desire (libido). If there is little testosterone, then the release of nitric oxide, a neurotransmitter that is produced in neurons and due to which they interact, decreases in the neurons of this center. And when the synthesis of this substance decreases, the impulses are transmitted worse. As a result, the patient’s sexual desire decreases.

– There are no exact symptoms of testosterone deficiency. Even general weakness or deterioration in mood can signal about it. Most often, there is a decrease in sexual activity and desire, but it cannot be said for sure that the problem is always in the lack of testosterone. Any trouble in the body of a man can be associated with a deficiency of this hormone.

The man comes to the appointment, we do a screening and determine if the complaints are related to low testosterone or something else.

– Deficiency may be caused by congenital diseases, the boy may be born with underdeveloped testicles or with no testicles. If we are talking about an acquired deficiency, then diseases of the testicles or the pituitary gland lead to it. Also, testosterone levels can decrease with age, that is, after 30 years, its production in men decreases. But this is a gradual process, and its duration depends on many factors.

For example, if obesity develops with testosterone deficiency, then hormone production will decrease faster. If the patient has chronic diseases, such as diabetes, then this is also a catalyst for the process of lowering the hormone level.

– There are two main factors that lead to acquired testosterone deficiency – obesity and stress. Also, a negative impact is exerted, albeit to a lesser extent, by hypodynamia (inactivity. – Note ed. ), smoking, taking certain medications.

With low testosterone, a man may not want sex, even if everything is in order with his beloved

org/Person”> Illustration: Philip Sapegin / E1.RU

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this process becomes noticeable after 30 years. But if there are concomitant diseases, such as visceral obesity, then testosterone deficiency can be diagnosed even at 20 years old.

– Globally, there are two modern diagnostic methods. The most common and affordable is enzyme immunoassay (ELISA), it has a high accuracy (about 90%). There is also a method of mass spectrometric analysis, in which chromatography is first performed: the separation of steroid hormones occurs. This is more expensive, but if the doctor has doubts or borderline testosterone levels are observed, then it is worth resorting to this option.

– Yes, in most regions a man can have his testosterone levels checked by the CHI by order of a doctor. Globally, any doctor can refer to this analysis, but it is urologists-andrologists and endocrinologists who mainly deal with the problem of testosterone deficiency.

— A man is naturally given everything to maintain normal testosterone levels. Therefore, the main task is to maintain. To do this, you need to try not to be exposed to chronic stress, observe sleep patterns, monitor nutrition and exercise. In other words, all these recommendations are related to a healthy lifestyle.

– Such products do not exist, this is a myth. It is important to monitor your diet in general, it must be balanced. People often turn to unreliable sources and begin to self-medicate. Therefore, recommendations on the Internet should be considered only in terms of obtaining information.

In this regard, I like the social project “Wild Male Nature”, which draws attention to the problem of testosterone deficiency through non-standard comparison of the symptoms of this condition with the characteristics of wild animals. In this case, a man can take a test and get a recommendation to contact an andrologist or endocrinologist. But seeing a doctor will not replace anything for you.

Reduced testosterone levels are affected by chronic stress, obesity, diabetes and other diseases. But often this process is reversible

Illustration: Philip Sapegin / E1.RU

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— Yes, but the methods differ depending on the situation. Irreversibility is associated with complications. For example, if a patient has not treated testosterone deficiency for a long time and he has already experienced atrophy of certain tissues of the penis, erectile dysfunction has occurred, then the doctor can raise the hormone level, but the consequences must be addressed separately.

– Obesity, diabetes mellitus, erectile dysfunction (a man’s inability to maintain a sufficient level of erection for a full-fledged sexual intercourse. – Note ed. ), low libido and chronic diseases of the genitourinary system (prostatitis, prostatic hyperplasia).

— If we talk about diabetes mellitus, then in medicine there is such a thing as a pathological vicious circle. This happens when one indicator worsens the other, and that, in turn, affects the first one negatively. The links of the system in a cycle begin to negatively influence each other, worsening the problem more and more. Therefore, testosterone deficiency and carbohydrate metabolism disorders form a pathological vicious circle.

If a man is deficient in testosterone, this will lead to a deterioration in tissue sensitivity to insulin. The body will try to produce more insulin, which in turn will lead to an increase in adipose tissue cells, which have an enzyme that converts testosterone into other hormones that suppress the activity of the pituitary gland (for example, female hormones). The pituitary gland reduces the amount of production of testosterone stimulants, then the body’s sensitivity to insulin decreases – and so on in a circle.

The opposite happens when a man has normal testosterone levels but has developed visceral obesity or diabetes. Here the main point is insulin resistance, that is, the sensitivity of tissues to insulin, in which there is a violation of the production of hormones responsible for stimulating the production of testosterone. Low testosterone leads to decreased insulin sensitivity. The circle is closed.

– This decision requires an additional examination, which can only be ordered by a doctor. If he decides that the deficiency is potentially reversible, then a change in the factors affecting the patient’s life is in play. A person must lose weight, we must compensate for his carbohydrate metabolism. After that, in some patients, testosterone levels normalize.

If the situation is irreversible, then prescribe drugs that promote own production of testosterone, or, if this is not possible, substitution therapy.

– There are no statistical studies on this topic, so I would not say that testosterone deficiency among men has increased in recent years.

However, we can say that over the past few years the problem of sexual dysfunction in men has worsened, which is logical: the environment is deteriorating, more and more stress factors are appearing. All this does not contribute to normal male sexual function.