What is testosterone?
Testosterone is the main male sex hormone (androgen) in men produced by the testes. Testosterone is responsible for the muscle mass and strength, body and facial hair, density of the bone, sex drive, production of sperm in men and also improves libido (sex drive).
How do testosterone levels decline?
Testosterone levels are highest in adolescent and early phases of adulthood. As one age, the levels of testosterone slowly decline at about 1 % per year. In the scenario of lowered levels of testosterone, it is vital to establish the cause to know if it’s due to ageing or due to a medical condition like hypogonadism (condition in which there is a diminished activity of testes or ovaries). When the body doesn’t produce appropriate levels of testosterone with issues related to pituitary or with testicles, it is known as hypogonadism.
Normal physiological levels of testosterone in men range between 300 to 1,000 ng/dL. Testosterone decline rate varies from individual to individual. Chronic illnesses, stress and medicines can affect the testosterone levels. The testosterone production can be slowed down by lifestyle changes and health issues. Low testosterone levels occur when the levels of testosterone in the blood in men, fall below the normal levels and lead to problems that be can be noticed.
Low testosterone levels causes
The exact reason for the decline of testosterone levels with ageing is not yet known. The lowering of testosterone production is occasionally referred as andropause or “male menopause.”
Causes of low levels of testosterone in younger men and few older men:
- Testicular injury
- Testicular cancer and its therapy
- Chronic kidney or liver disease
- Type 2 diabetes
- Certain medications
Low testosterone levels symptoms and signs
Symptoms and signs of low testosterone include:
- Hot flashes
- Increased sweating
- Erectile dysfunction
- Decrease in sex drive
- Lowered muscle strength
- Poor memory and concentration
- Increased irritability
- Changes in patterns of sleep
Low testosterone levels diagnosis
A man may not be aware of the numerous signs and symptoms of low testosterone himself.
Medical history and physical examination
The physician may diagnose by questioning you about the medical history. Your doctor may ask you about your health and interest in sexual activity. Family history and a physical examination will be carried out. The doctor will examine the body hair distribution and amount, any enlargement of breasts, scrotum and penis size.
Blood tests to measure the levels of total and free testosterone, sex hormone-binding globulin (SHBG) and PSA (Prostate Specific Antigen) may be done.
Low testosterone levels treatment and prevention
Usually, treatment for low testosterone is initiated only after confirming the level of testosterone in the blood. Low testosterone levels are treated by testosterone therapy.
Testosterone can be given in form of:
- Gels: Topical application of testosterone gels over abdomen, shoulders and upper arms daily is done. Care is taken not to expose these areas to children and women to avoid exposure to testosterone.
- Solutions: These are testosterone based solutions which are applied in the armpits.
- Injection: Once in a week or two, testosterone is injected in the thigh or to a buttock.
- Implants: These are placed beneath the skin, that can last up to 6 months.
- Skin patches: Testosterone is released in minute amounts into the skin by the use of a testosterone patch. The patch is used once in 24 hours on the stomach, back, upper arm or the thigh. Children and women must avoid contact with the patch.
- Oral Lozenges: Testosterone-containing lozenges are kept between the upper lips and gums. Testosterone is slowly released into the blood through the skin.
Obesity, smoking, diabetes and high blood pressure can raise the risk of low testosterone levels in older men. Hence, exercising and healthy diet might lower the risk of low testosterone associated with such conditions.
Untreated medical conditions can also lead to low levels of testosterone. Certain medications also can lead to reduced levels of testosterone. Treatment of these underlying causes can help in resolving the other health issues as well.
Natural means of boosting the levels of testosterone may include weight loss and by increasing the muscle mass by resistance exercises.
Low testosterone levels: read more
There are certain side effects and risks of testosterone therapy. Risks of testosterone therapy can include:
- Sleep disorder: This will manifest as sleep apnea (pauses in breathing or shallow breaths during sleep)
- Skin irritation, rash and acne: In some men acne appear due to testosterone treatment. Use of skin patches and gels may lead to irritation and rashes in some men.
- Enlargement of breasts
- Heart disease-Recent studies have suggested that men with low testosterone levels have a high risk of developing or succumbing to heart diseases. Red blood cells production is stimulated by testosterone. Increased RBCs could result in thickening of the blood and subsequently, lead to clots that can cause a stroke or a heart attack.
- Depression- People with low testosterone levels suffer from mood changes, low sex drive, irritability, low energy levels and insomnia (similar symptoms associated with depression)
- Diabetes- Men with low levels of testosterone are predisposed to increased risk of having diabetes.
- Osteoporosis—It has been recently researched that low testosterone levels in men leads to development of osteopenia (bone condition in which the protein and mineral content of the bone is reduced) which predisposes them to increased risk for osteoporosis
- Benign prostatic hyperplasia(BPH) and Cancer — Studies have suggested that in men with low levels of testosterone noncancerous growth of prostate may be stimulated and they are at a higher risk of developing prostate cancer
- Cognitive disorders- Both cognitive function and testosterone levels decline with age. It has been seen that low testosterone levels are a risk factor for Alzheimer’s disease
- Infertility: Testicular shrinkage and sperm production may be limited though testosterone is necessary for sperm production. The rise in the levels of testosterone signals the body to stop the production of another hormone responsible for sperm production
- Fluid retention: Few men on testosterone therapy, may have signs of retention of fluid evident as swollen legs. This can be a significant problem for men with heart failure, kidney failure, or advanced liver disease.
If you are experiencing low sex drive, decreased libido, decrease and less frequent erection, loss of muscle mass, losing hair and fatigue, schedule an appointment with your doctor.
Monitoring of the treatment must be done by PSA measurement, prostate examination, blood tests to monitor levels of testosterone, RBCs, haematocrit and bone density test before and during treatment.
Rush to your doctor if:
- You are experiencing low sex drive recently
- Absent night time erections
- Sudden breast enlargement
- If you are not shaving as frequently as you were doing before
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- Andropause: Clinical implications of the decline in serum testosterone level with aging in men. J Gerontol A Biol Sci Med Sci. 2002;57:M76–99.
- AUA position statement on testosterone therapy. American Urological Association. Accessed at: https://www.auanet.org/about/testosterone-therapy.cfm
- FDA adding general warning to testosterone products about potential for venous blood clots. US FDA. http://www.fda.gov/Drugs/DrugSafety/ucm401746.htm
- Low Testosterone. Patient Education Center. Accessed at http://patienteducationcenter.org/wp-Testosterone therapy for men, US NIH-NLM. Accessed at: https://www.nlm.nih.gov/medlineplus/ency/article/007581.htm
- Testosterone therapy in men with androgen deficiency syndromes: An Endocrine Society clinical The relative contributions of aging, health, and lifestyle factors to serum testosterone decline in men. J Clin Endocrinol Metab. 2007 Feb; 92(2):549-55.