Testosterone is a male sex hormone (androgen) that is mainly produced in men’s testicles.
The testicles primarily make testosterone in men. Women’s ovaries also make testosterone, though in much smaller amounts.
Testosterone plays an essential role in men’s health. It is responsible for many bodily functions, including sperm production, sex drive, muscle mass, bone density, facial hair, fat distribution, and red blood cell count.
As men age, testosterone levels gradually decline, usually about 1 percent a year after the age of 30-40.
However, if the levels of testosterone drop below healthy levels, this can lead to conditions such as hypogonadism.
What Is Low Testosterone?
Male hypogonadism is when the body is unable to produce normal levels of testosterone. This may be due to a problem with the testicles or with the pituitary gland that controls the testicles.
There are two types of hypogonadism:
- Primary hypogonadism– refers to the injury or failure of the testes.
- Secondary hypogonadism– refers to when the brain is unable to signal the testicles correctly.
Hypogonadism can also occasionally develop later in life, particularly in older men who are obese or have type 2 diabetes.
This is known as late-onset hypogonadism and can cause the “male menopause” symptoms.
Hypogonadism affects an estimated 4 to 5 million men in the United States. While it can at any age, low testosterone levels are especially common in older males.
According to The American Urological Association, a testosterone level of at least 300 nanograms per deciliter (ng/dL) is normal for a man. A man with a testosterone level below 300 ng/dL should be diagnosed with low testosterone.
Symptoms of low testosterone
- Irritability/ mood swings.
- Hot flashes.
- Loss of muscle mass.
- Increased body fat.
- Enlarged breasts.
- Decreased bone mass.
- Hair loss.
- Erectile dysfunction.
- Low semen count /sperm production.
- Poor memory or focus.
- A low sex drive.
- Low blood count (amenia).
- Sleep apnea.
What Causes Low Testosterone Levels In Men?
There are both direct and indirect causes of low testosterone in men.
Some men are born with conditions that cause testosterone deficiency, such as:
- Klinefelter syndrome.
- Noonan syndrome.
- Prader-Willi syndrome.
- Myotonic dystrophy.
- Ambiguous genitalia (when the sex organs develop in ways that are not typically looking).
Some men may develop Low-T because of:
- Injury to the testicles.
- Infection, such as mumps.
- Removal of the testicles, because of conditions such as testicular cancer.
- Cancer treatment, such as chemotherapy or radiation therapy.
- Pituitary gland disease which can lead to hormone deficiency.
- Metabolic syndrome (high blood pressure, high blood sugar, high cholesterol levels, and belly fat).
- HIV (about 30 out of 100 also have low testosterone).
- AIDS (about 50 out of 100 also have low testosterone).
Diagnosing Low Testosterone
If you are experiencing any of the symptoms of low testosterone discussed earlier, you should make an appointment with your doctor/ urologist. They will ask you questions about your health history and family history.
To begin, your doctor will likely start with a blood test to determine whether your levels of testosterone are within the normal range for your age.
A man with a testosterone level below 300 ng/dL is usually diagnosed with low testosterone.
Testosterone levels fluctuate throughout the day and usually are highest in the morning. Therefore, your doctor will probably want to do the blood test in the morning.
They will then perform a physical exam to discern any signs and symptoms of low testosterone.
Typical diagnostic findings include obesity, loss of body hair, gynecomastia, mild anemia, and osteoporosis.
If it is confirmed that testosterone levels are low, it is recommended to categorize the hypogonadism as primary or secondary. This is achieved by checking levels of luteinizing hormone and follicle-stimulating hormone. Elevated levels of these hormones would indicate primary testicular failure.
Treating Low Testosterone
Testosterone therapy is widely used for treatment for men with low testosterone (hypogonadism). It can be administered through a range of methods, including:
Oral medications such as Methyltestosterone are a synthetic form of testosterone, which is similar to the testosterone that’s naturally in your body. It’s taken in the form of pills, which are only available when prescribed by your doctor.
Testosterone injections are a prescription medication that your doctor administers. The dose is usually an oil-based solution that contains testosterone. You would generally receive the injection in your buttocks.
A testosterone transdermal patch is a medicated patch that you apply directly onto the skin and stays in place thanks to a sticky backing.
You can apply topical creams, such as testosterone gel, to your skin, entering your system directly. It is effective in improving symptoms associated with low t, such as reduced sexual performance, reduced muscle mass, and low energy levels.
Is Testosterone Therapy an effective treatment?
Although testosterone replacement therapy is of benefit for men with low testosterone levels, it can have several side effects.
Reported side effects include acne, disturbed breathing while sleeping, breast swelling or tenderness, or swelling in the ankles. Doctors also watch out for high red blood cell counts, which could increase the risk of blood clots.
Men using testosterone therapy long term appear to have a higher risk of cardiovascular problems, like heart attacks, strokes, and deaths from heart disease.
For example, in 2010, researchers halted the Testosterone in Older Men study when early results showed that men on testosterone replacement therapy had noticeably more heart problems. “In older men, theoretical cardiac side effects become a little more immediate,” Dr. Pallais says.
Testosterone Therapy and Prostate Cancer
Evidence it can increase risk
In past decades, many scientists believed that higher levels of total testosterone came with an increased risk of prostate cancer.
Total testosterone is a measure of the total amount of testosterone circulating in your bloodstream. This includes testosterone that’s bound to other compounds as well as free testosterone.
According to the CMAJ guidelines referenced above, there is “robust evidence” to support the long-held view that testosterone replacement therapy is unsafe for men with prostate cancer (Hackett, 2015).
The guidelines also acknowledge that there is a lot of concern that testosterone replacement therapy could increase your risk of prostate cancer, or cause prostate enlargement.
However, they state that this is based more on “extrapolation” rather than actual evidence.
Evidence that it does not increase risk
The CMAJ report briefly refers to a 2008 study, which indicates that there’s no link between serum concentrations of testosterone and the risk of prostate cancer.
Meanwhile, we have a 2017 study from the University of Oxford, which concludes that men with low levels of testosterone are less likely to develop prostate cancer than men with high levels of testosterone.
However, that doesn’t mean high testosterone means more chance of prostate cancer.
Both studies support the same theory, known as the “saturation model.” According to this theory, the body has a limited number of androgen receptors, which means that the prostate is sensitive to androgens like testosterone, but only up to a point.
When all the body’s androgen receptors are ‘full’ with testosterone, then it doesn’t matter how much more testosterone you have in your body, because it can’t be activated and so it makes no difference. That explains why low testosterone levels reduce your risk, but high testosterone levels don’t increase it.
The only way to know for sure whether testosterone replacement therapy is safe for you is to discuss it with your doctor. Your doctor might need to perform special immunohistochemistry tests to determine whether or not your prostate cancer is sensitive to testosterone concentrations and if you’re a fitting candidate for testosterone replacement therapy
Tell your GP about all your pre-existing conditions, your risk factors, your lifestyle, and your medications. They can then provide the solution that’s best for your unique needs.
How To Naturally Raise Testosterone Levels
Most of us don’t get the recommended 7-8 hours of sleep per night. This may mostly be because we tend to believe that we can sacrifice a couple of hours of nighttime rest for other activities like work, socializing, or even exercise.
But to benefit from all the hard work you’ve put in during the day, you need to have an adequate amount of sleep. That means allowing enough time to have full cycles of deep sleep and light sleep.
Why? Testosterone levels rise and peak during sleep (Luboshitzky et al., 1999), which may explain why you wake up with an erection.
It’s not just the quantity of sleep that’s important. Studies have shown that men who suffer from sleep apnea also have lower low testosterone than men who don’t (Romero-Corral et al., 2010).
Studies have shown that testosterone levels rise after exercise, but only briefly. This suggests that exercise doesn’t affect your hormones directly.
However, it is still beneficial for men who have levels bordering the average and low ranges of testosterone (and anything smaller than that).
There are a lot of other variables that come into play when using exercise for a natural boost of testosterone. For example, the type of activity you do can affect your testosterone levels.
What’s the connection between being overweight and having low testosterone? Well, it may have to do with the fat cells themselves.
These fat cells produce an enzyme called aromatase, which speeds up the reaction that converts testosterone into estradiol, a form of estrogen.
More estrogen in the bloodstream results in less testosterone being produced, and so more female physical traits start showing up. So losing muscle and developing those man-boobs is a result of that extra fat you’re storing in your body.
Certain foods, including oysters, leafy greens, fatty fish, and olive oil, may encourage the body to produce more testosterone. Foods that contain zinc, vitamin D, and magnesium may be vital. Therefore a balanced diet is important.
Results of a study published in the Journal Nutrients suggested that individuals who prefer Western-style food (bread and pastries, dairy products, and desserts), eat out, and eat fewer homemade foods, noodles, and dark green vegetables are more likely to have an unhealthy body composition (e.g., increased visceral fat and decreased skeletal muscle mass) and low serum total T levels, and are likely to develop hypogonadism.
Maca root– Maca is native to Peru and grows at high altitudes in the Andes. It has been proven to increase libido and sexual function in men with mild ED.
In fact, a study in 2002 proved that maca has an independent effect on sexual desire in healthy men aged between 21-56 years over a 12 week period. (Gonzales et al., 2002).
Tongkat Ali– Tongkat Ali root has been used for centuries to treat hypertension, fevers, malaria, erectile dysfunction, and low libido. The root specifically is full of natural compounds called Quassinoids.
These are particularly potent compounds that multiple studies have shown to reduce cortisol levels as well as increase the amount of bioavailable testosterone in your blood.
Ashwagandha– Ashwagandha is a herbal remedy used as part of Ayurvedic medicine for thousands of years to relieve stress, improve concentration and energy levels.
It’s also been proven to elevate testosterone levels. Participants of a study saw an 18.7% increase in testosterone after a twice-daily dosage of ashwagandha root after 8 weeks, compared to those who took a placebo.
Low testosterone levels can have a significant impact on men’s health and well-being, both physically and mentally.
The American Urology Association report that low testosterone affects around 2 out of every 100 men.
Although most men naturally lose testosterone as they grow older, the risk increase with age. Take note of the signs and symptoms of low testosterone, and if you believe you are experiencing them, consult with your doctor.