Why testosterone is low: Low Testosterone: Symptoms, Diagnosis & Treatment
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.
Was this helpful?
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.
Was this helpful?
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.
Read the article in Spanish.
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.
Was this helpful?
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.
Was this helpful?
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.
Read the article in Spanish.
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.
Chief urologist of the Russian Ministry of Health: Lack of testosterone in men
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Chief Urologist of the Ministry of Health of Russia: Lack of testosterone in men is one of the causes of early aging, shorter life expectancy, and decreased performance.
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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.