Low Testosterone Overview
Researchers estimated that low testosterone level in men affects from 2 to 6 million in the U.S. This statistic implies that up to 5% of all men are in danger for low testosterone levels, which may develop some men’s health issues when it comes to sexual health and function.
It’s a given that after the age of thirty, a man may drop up to 2% of testosterone level every single year. On the other hand, 20-50% of an adult healthy men between the ages of 50 and 70 have found to have lower than normal levels of testosterone in their bloodstream.
Why is Testosterone Important?
Testosterone helps keep a number of crucial bodily functions in men, such as:
- sperm production
- sex drive
- fat distribution
- muscle mass/strength
- bone density
Because testosterone affects numerous body functions, its decreasing can bring about significant physical and psychological changes. Continue reading…back to menu ↑
Testosterone and Age
Testosterone deficiency is a natural result of ageing. Production of testosterone increases during puberty and starts to slow down after age the age of 30. The level of testosterone in men starts to diminish at a rate of around 1 percent per year for each year starting at around age 30-40.
When men reach in their 60’s and 80’s, about twenty percent of men suffered from low-t and have significantly below the normal level of testosterone respectively. Furthermore, about 1:3 men with symptoms of Andropause turn out to have an abnormally low testosterone level.back to menu ↑
What is Testosterone?
Testosterone is the male sex hormone, which is secreted by the testicles. It helps boys to become men and needed for normal reproductive and sexual function.
Normal levels of testosterone can affect men’s sex drive (libido), erections, mood, muscle mass and bone density. Testosterone is also needed for men to produce sperm and fertility. It also keeps the heart, muscles and bones healthy.
Testosterone is essential throughout puberty for the physical changes such as:
- penile and testis growth
- erectile function
- prostate growth
This hormone helps to maintain features typical of adult men (secondary sexual characteristics) such as:
- muscle strength and mass
- facial and body hair
- accelerated bone maturation
- the increased oiliness of skin and hair
- the appearance of acne
- the appearance of pubic hair, axillary hair (armpit hair)
- development of “triangular” body form
- relatively higher height
- less body fat
- deeper & manly voice
If you want to increase your testosterone to an optimum level, click here.back to menu ↑
What is Low Testosterone?
Low levels of testosterone also called low-T. In medical terminology, the decrease in normal production of testosterone in the testicles is called “hypogonadism“.
As men get older, it is normal that testosterone levels to gradually decrease with age. This decrease in testosterone level production is sometimes referred to as andropause or “male menopause.”
In adult males, normal testosterone level is ranging from 300 ng/dL to 1050 ng/dL. The average concentration of total testosterone in men over forty years old is approximately 450/ng/dl. If it falls below normal, some men may feel tired, lose interest in sex, memory loss, sudden gain weight, or develop other health issues that affect the quality of life.
It is estimated that about 4 out of 10 men over the age of 45 have low-t. It is seen in about 2 out of 10 men over 60, 3 out of 10 men over 70, and 3 out of 10 men over 80 years old.back to menu ↑
Signs & Symptoms of Low Testosterone
Men with low-t do not make enough testosterone as they get older. If testosterone levels fall below the normal range some men may experience uncomfortable and sometimes distressing symptoms.
Keep an eye on the signs and symptoms that can be caused by low testosterone, or by a number of other factors.
Physical Symptoms of Low Testosterone
- Low sex drive (low libido)
- Erectile Dysfunction or the inability to achieve normal erection
- Decreased sexual function and desire
- Delayed orgasm or trouble getting an orgasm
- Reduced ejaculate volume or low sperm count
- Reduced size in testicles
- Reduced muscle mass, power, and strength
- Muscle and joint aches
- Increased body fat, especially in the abdomen
- Breast development (gynecomastia) or man’s boob
- Reduced facial, body and or pubic hair
- Decreased bone density, bone fractures or osteoporosis
- Increased risk of cardiovascular disease, heart attack and stroke
- Loss of height
- High pitch tone voice
- Night sweats or hot flushes
- Low energy
- Longer time to recover from exercise
- Reduced beard or body hair growth
- Hot flushes, sweats
Psychological Warning Signs of Low Testosterone
- Increased irritability or moodiness
- Poor concentration
- Reduced cognitive ability
- Failing memory or forgetfulness
- Trouble sleeping
- Loss of a sense of wellbeing
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What Causes of Low Testosterone?
With advancing age, the amount of testosterone the body produces gradually declines. In younger men—and some older men—a low testosterone level can be caused by an injury to the testes.
Other factors include infection, testicular cancer, and conditions that cause abnormal levels of two other hormones: LH and prolactin.
There are numerous causes of low testosterone. These causes are divided into two main groups: primary causes – where the problem originates in the testicles and secondary causes – where the problem originates in the brain.
Primary causes of low testosterone:
- Klinefelters syndrome. In Klinefelter’s syndrome, in males, an extra X chromosome is present and among other anatomic issues, there is abnormal development of the testes and decreased the ability to manufacture testosterone.
- Undescended Testes. If the testes are unsuccessful to migrate from inside the abdomen into the scrotum during fetal growth or in the first year or two of life, the testes may become damaged and unable to make sufficient amounts of testosterone.
- Injury to one or both testicles. If the testes are injured, they may not be able to make enough testosterone. Injury to one testicle does not typically to lead to low levels of testosterone if the other testis continues to be normal.
- Cancer therapies. Cancer therapies such as chemotherapy and radiation can harm the interstitial cells in the testes responsible for testosterone production. This causes the decrease in testosterone production but may be short-term as the cells recover, or it may be permanent.
- Aging. Testosterone levels lessen with ageing. Generally, adequate testosterone is produced to allow for adequate bodily functions.
- Mumps or orchitis. The mumps virus can cause swelling of the testes in males, especially if mumps occurs in puberty or adulthood, the damage to the testes may lead to low testosterone production.
Secondary Causes of Low Testosterone:
- Disorder or tutors of the pituitary gland
- Radiation or surgery to the pituitary gland
- Hypothalamus malformations can stop normal function. Kallman’s syndrome is one example.
- HIV and AIDS may also cause inflammation of both the hypothalamus and pituitary.
- Compromised blood flow to these glands from other conditions such as excessive systemic blood loss.
- Inflammation caused by tuberculosis and sarcoidosis may affect the pituitary gland.
- Illegal use of anabolic steroids, for example in bodybuilding, can cause hypogonadism and low testosterone levels.
- Use of certain prescription drugs such narcotic & opioid use.
- Snoring or Obstructive Sleep Apnea (OSA).
- Certain chronic diseases also tend to have low testosterone such as high blood pressure, high cholesterol, and diabetes.
What are the Risk Factors for Low Testosterone?
So who is at risk? Men over 65 are more than twice as likely to have suffered from testosterone deficiency as compared to men under 65. The use of certain prescription drugs also increases the risks of low-t.
Men with certain health problems also have a high risk of low testosterone level. Some of these are:
- High blood pressure or hypertension (about 40 out of 100 also have low testosterone)
- High cholesterol or hypercholesterolemia (about 40 out of 100 also have low testosterone)
- Type 2 diabetes (about 50 out of 100 also have low testosterone)
- Overweight or obesity (about 50 out of 100 also have low testosterone)
- HIV (about 30 out of 100 also have low testosterone)
- AIDS (about 50 out of 100 also have low testosterone)
- Long-term opioid use (almost 75 out of 100 also have low testosterone)
- Sleep apnea
- Renal failure
How Does Low Testosterone Diagnose?
How To Get Screened?
If you experience symptoms of low testosterone, make sure to get screened and it’s important to find out why.Testosterone is measured with a simple blood test and treat you if you have low testosterone. So make sure to ask your healthcare provider about getting testosterone levels checked.
Your endocrinologist, who specializes in treating conditions such as low testosterone, will ask you a series of questions about past or present illnesses, your family’s medical history, your use of prescription drugs, and if you are having any sexual problems.
If your testosterone level result is below 300 ng/dL, your specialist may recommend other tests, such as PSA (prostate-specific antigen) blood test to check for signs of prostate cancer. Your endocrinologist may also do a test to measure the red blood cells in your body (hematocrit level). A hematocrit is checked to keep a file of your red blood cell count because it can increase if you take testosterone therapy.back to menu ↑
What Blood Tests Should I Take?
There are a various blood test to determine if you have low testosterone. However, your specialist may require to take some of these tests to role out the cause of your low-T.
Total Testosterone: Total testosterone test is the most obvious test required in measuring of testosterone level in your blood. The test for total testosterone has been widely available for many years. At present, it also remains the standard for indicating a need for replacement therapy.
SHBG: The sex hormone binding globulin (SHBG) test may be used to help evaluate men for low testosterone. It may be ordered in conjunction with other tests such as total testosterone to evaluate the status of a person’s sex hormones.
Free Testosterone: Free testosterone levels can be measured and normal levels rely on a person’s age and it is the best indicator of a man’s testosterone status. However, there has been so much controversy over the quality and interpretation of these numerous tests that many experts have given up on the free testosterone and rely primarily on the total testosterone.
LH: A luteinizing hormone test measures the volume of luteinizing hormone (LH) in a sample of blood or urine. LH test will determine whether your pituitary gland is working properly to regulate and stimulate the production of testosterone.
LH low levels raise the possibility of a problem with the pituitary gland or hypothalamus. High levels indicate that the problem has arisen because the testicles are unable to produce testosterone sufficiently despite a strong stimulus to do so.
Prolactin: Very high levels of prolactin may indicate the presence of a tumour of the pituitary gland which in turn can lead to low testosterone.
HCT or HGB: The hematocrit and hemoglobin tests reveal whether there are normal numbers of red blood cells in the bloodstream. A side effect of testosterone replacement is a rise in red blood cells, thus blood donation may be recommended.
PSA: This test measures the amount of prostate-specific antigen (PSA) in your blood and should be obtained to have a baseline value prior to beginning testosterone treatment and to make sure it is within normal limits.
The PSA test is a blood test used primarily to screen for prostate cancer because one of the long-term side effects of testosterone therapy can develop a cancerous cell in the prostate gland.
Misc: When to take the blood sample for these tests is important because the level of testosterone normally varies from a high point in the morning to lower points throughout the day – most significantly in men 45 and younger. The blood sample should be drawn between 8:00 and 9:00 AM to be sure it will provide the highest level of testosterone during the cycle
Other Tests: Other tests may be ordered by your physician like bone density screening if bone loss is suspected, or genetic testing may be useful to verify an inherited condition.
If tests indicate that there might be health issues with the pituitary gland, the physician may want to examine the gland itself through a computed tomography (CT) scan or magnetic resonance imaging (MRI.)back to menu ↑
Treatments of Low Testosterone in Men
If you have symptoms of low-T, there’s nothing to be worried about because low testosterone can be treated by adding more testosterone to the body. There are several treatments, remedies, and natural ways to bring testosterone levels back into a normal range.
The most common treatment is testosterone replacement therapy (TRT), which is administered in various ways, including injections, patches, gels, pills, and even implanted pellets. A doctor can determine which treatment option may be best for you.
Nowadays, there have been a much wider variety of treatment options that lead to the question “Which treatment is best for me?”
Generally, gel absorption rate is quicker than patches, however, there is great variability in absorption from one person to another and early blood test are needed to assess and adjust dosage to attain a great testosterone concentration.
Gel should be applied the prescribed amount daily and rubbed into the skin of the upper arms and shoulders. It’s highly recommended to wash your hands thoroughly after applying a gel and to cover the treated area with clothing or cotton to prevent exposing others to testosterone. This treatment is quite expensive considering the high cost per gel. Possible side effects: skin irritation.
Testosterone is injected via intramuscular or into a buttock or thigh once every 7 to 14 days, either at home or in your doctor’s office. Usual dosage is 50-400 mg of testosterone cypionate or testosterone enanthate.
You place oral lozenge testosterone supplement between your gums and upper lips for at least twice a day. The amount of testosterone in the lozenge is gradually absorbed through the skin and into the bloodstream.
A patch that contains testosterone releases small quantities of the hormone into the skin. Testosterone patch is applied to the back, stomach, thigh, or upper arm once every 24 hours. Women and children should avoid coming into contact with the patch as it may cause hair growth and other male characteristics. A major disadvantage is that patches can cause skin irritation and sometimes may fall off.
Pellets are the most appealing treatment options for men who are suffering from low testosterone level. These pellets are each about the size of a grain of rice and six to eight of them usually are implanted at a time under the skin, usually around the hips or buttocks. Extended-release pellets containing testosterone are good for three to six months.
HCG (Human Chorionic Gonadotropin) or Clomid
This testosterone treatment can be used to stimulate a person’s own testosterone production level and at the same time preserving normal sperm production.
- prostate cancer or a nodule on the prostate that can be felt during a digital rectal exam (DRE)
- a PSA greater than 3 ng/ml without further evaluation
- untreated obstructive sleep apnea
- class III or IV heart failure
- a hematocrit greater than 50% or thick, viscous blood
- severe lower urinary tract symptoms
Risks & Side Effects of Testosterone Treatment
It is highly advisable to weigh first the pros and cons of testosterone treatment before you take any testosterone supplementation because some of the side effects and long-term usage are highly dangerous.
Testosterone therapy has potential risks and side effects, they are:
According to endocrinology society, men should not take testosterone treatment especially for men who already have prostate cancer because it may encourage cancer to spread.
Excess of Red Blood Cells
One of the main function of testosterone is to help stimulate the body’s production of red blood cells. However, too many red blood cells in the bloodstream can make blood thicker. And this may lead to forming blood clots and such clots can cause stroker and heart attack.
Without a doubt, testosterone is essential for producing healthy sperm cells. However, increasing testosterone level with injections, gels, patches, or other modalities of therapies signals the body to switch off production of another hormone, which is necessary for sperm production. If you plan to expand your family in the near future, you may postpone testosterone therapy.
Some men who have undergone testosterone therapy may experience swollen legs or other signs of fluid retention as a side effect of the testosterone. In the long run, this can create a big problem for men with kidney failure, heart failure, or advanced liver disease.
Other side effects of testosterone therapy are the appearance of acne not only on the face but also on the back.
An uncommon side effect of testosterone therapy is the development of the breasts or man’s boob. This may happen because the body converts some testosterone into estrogen, which may stimulate the growth of breast cells.
Skin irritation or rash is a common side effect of a testosterone therapy patch or topical gel.
If you decide to try testosterone treatment replacement, your doctor should perform the following tests:
- Prostate and PSA test prior to testosterone therapy
- Bone density test before and after testosterone therapy
- Blood tests such as testosterone level and red blood cells in circulation
The benefits of taking testosterone vary from man to man. Most men experience a stronger sex drive and improvements in erectile function. Some (but not all) have more energy and improved mood. Work with your doctor to be sure that the benefits outweigh the risks of testosterone therapy for you. If you try it and don’t feel better in 3 to 6 months, talk to your doctor about discontinuing the treatment.
- Guideline on Male Hypogonadism
- Low Testosterone: How Do You Know When Levels Are Too Low?
- Low Testosterone Consultation Information
- What men should know about low testosterone
- The Laboratory Diagnosis of Testosterone Deficiency
- A Harvard expert shares his thoughts on testosterone-replacement therapy
- Testosterone and prostate cancer: an evidence-based review of pathogenesis and oncologic risk