Testosterone is a male sex hormone that is present in the bodies of both people assigned male at birth and assigned female at birth along with female sex hormone (estrogen) in different ratios. It is produced by testicles in males and ovaries in women. It gives men their male characteristics such as muscular build, deep manly voice, and facial hair including beard and mustache. Testosterone plays an important role in fertility, puberty, and sexual desire. Moreover, it fosters red blood cell production, keeps the bone strong, boosts mood, and supports thinking ability.
The level of testosterone made by the body constantly changes in response to the needs of the body. Throughout one’s life, the overall testosterone levels keep on changing. Typically, the testosterone levels are at their peak by early adulthood after the hit of puberty and decline with age, particularly in people assigned to masculinity at birth. It’s hard to define normal testosterone levels because they vary throughout the day and get affected by one’s nutrition, Body Mass Index (BMI), age, illnesses, intake of certain medications, and alcohol consumption. However, some people have low testosterone levels resulting in undesirable effects on the body. Hence, they start looking for ways to get back to normal hormone balance. [1, 3, 4]
What Is Low Testosterone?
Low testosterone, medically termed male hypogonadism, is a condition wherein an insufficient amount of testosterone is produced by the testicles, the male reproductive glands in men. It can be broken into two main types: Primary hypogonadism (a testicular failure due to injury, genetic disease, or undescended testicles) and Secondary hypogonadism (problem of the hypothalamus or pituitary glands that signals testosterone production) [2, 4]
How Common Is Low Testosterone?
Statistical studies may vary but experts have estimated that low testosterone can be found in about 2 men in every 100 males. Low testosterone can affect almost 40% of men who are aged 45 or above. Experts have even found that men who are engaged in daily exercises are less likely to have low testosterone as compared to others with a sedentary lifestyle. Furthermore, as per research on dietary habits of men, those who have more dairy products, bread, desserts, and other junk or processed food or have done intermittent fasting have more chances of suffering from low testosterone condition than men who eat an organic diet. [2, 4]
Causes and Risk Factors of Low Testosterone
Naturally, testosterone levels lower with age starting at the age of 30 or above and continuing throughout life at the rate of about 1-2% per year. For some individuals, testosterone levels may decline and reach abnormal values. The potential causes of low testosterone levels and risk factors of it could be:
- Chemotherapy for cancer
- Delayed puberty
- Alcohol abuse causing testicular damage
- Liver cirrhosis
- Testicular injury/trauma of testes resulting in interrupted blood supply to the testes, or orchitis (infection of the testes like mumps)
- Pituitary gland dystrophy or non-cancerous pituitary tumors
- Hypothalamic disease
- Some genetic diseases like Kallmann Syndrome (abnormal development of the hypothalamus gland present in the brain), Klinefelter Syndrome (where males are born with an extra X chromosome), and Myotonic Dystrophy (characterized by prolonged muscle weakness and wasting).
- Extreme weight loss or obesity
- Metabolic disorders such as hemochromatosis (excess iron production)
- Certain medications like steroid prednisone, opioids, and hormones used to treat prostate cancer.
- Uncontrolled Type 2 diabetes mellitus
- Head injury, prior brain surgery, or radiation exposure to the brain
- Excess to estrogen and prolactin hormones
- Congenital defect
- Obstructive Sleep Apnea. [1, 4]
What are the Signs or Symptoms Of Low Testosterone?
Following are the low testosterone symptoms discussed:
- Enlarged male breasts (gynecomastia)
- Libido- a reduced sex drive
- Erectile dysfunction or impotence
- Weight gain
- Sleep disturbances
- Low sperm count- infertility
- Mild anemia (reduced hemoglobin in blood).
In serious cases, the symptoms include:
- Loss of muscle mass and strength
- Loss of the body or facial hair
- Osteoporosis (weaker bones)
- Hot flashes
- Mood swings or irritability, trouble concentrating, and memory issues. [2, 4]
Diagnosis Of Low Testosterone
To evaluate whether the patient has low testosterone, the concerned doctor will go through the patient’s medical records, perform a physical examination or some medical tests, and review the symptoms the patient is experiencing.
Low testosterone can be diagnosed by a blood test to measure the amount of testosterone present in the blood which must come out to be less than 300 ng/dL. Several measurements may be taken to conclude as the testosterone levels keep fluctuating during the day. It’s generally high in the morning, which is why the blood test is done during early morning hours.
Some other tests may even be performed to assess the cause of low testosterone including a check of prolactin level, blood hemoglobin, and luteinizing hormone, or others like bone density test, test for diabetes, etc., and see for the need for treatments of underlying causes. [2, 3, 4]
Treatment of Low Testosterone:
For men who have low levels of testosterone in their blood and key symptoms of male hypogonadism, the doctors first look for the source of the decline in their testosterone levels. For instance, if low testosterone is caused by particular medicine, weight gain, or a problem with the hypothalamus or pituitary gland, then the doctor first addresses that concern. If the patient’s condition is not becoming better, then Testosterone replacement therapy is the prescribed course of action for low testosterone treatment.
Testosterone replacement therapy can be delivered by various methods:
- Oral therapy- Testosterone-containing tablets are attached to the inner cheek or gums or capsules are swallowed twice a day to absorb testosterone into the bloodstream.
- Testosterone patch- Once daily, testosterone patches are applied on different body parts like arms, abdomen, back, and buttocks to release small amounts of hormone into the skin.
- Intramuscular injections- After every one to two weeks, various formulations of testosterone injections are administered into the muscles of the patient.
- Testosterone gels- Daily testosterone gels are spread onto the clean, dry skin over both shoulders, thighs, or upper arms and covered by clothing. After applying, the hands must be washed properly. The gel must be applied with care to not accidentally transfer it to others.
- Pellets- These are implanted under the skin after every 2-6 months to slowly release testosterone. Usually, they are placed around the buttocks or hips. [3, 4]