Decreased testosterone levels in men can cause erectile dysfunction and affect sleep patterns, mood, testicular size and more. This hormonal decline affects both sexes equally, potentially leading to reduced bone density and libido.
Testosterone, a key sex hormone that is predominantly found in males, although minimal in females, has many roles. It regulates
- Skeletal and muscular development
- Voice depth modulation, hair growth and other aesthetic attributes
- Sperm production
Testosterone synthesis can slow down with age, and many older people show signs of testosterone deficiency.
The American Urological Association defines low testosterone as less than 300 nanograms (ng) of the hormone per deciliter (dl) of blood. The association's statistics suggest that around 2 in 100 men struggle with low testosterone levels.
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Symptoms Of Low Testosterone
The symptoms of low testosterone are outlined below:
Decreased Muscle Mass
Testosterone contributes to muscle development and its deficiency can cause a significant reduction in muscle mass. Notably, despite this reduction in mass, muscle function and strength remain intact, according to a 2016 review.
Decreased Bone Mass
Testosterone helps build bone tissue and maintains bone density. Insufficient levels of testosterone can lead to a decrease in bone volume, making bones more susceptible to fractures.
Decreased Libido
People with low testosterone levels often experience a decrease in sexual desire. While a decline in libido is a natural part of ageing, when it is caused by low testosterone, men may experience a marked decrease in sexual appetite.
Fatigue And Reduced Energy Levels
Low testosterone levels can cause fatigue and reduced energy levels. Even after adequate rest, individuals may feel lethargic or have reduced enthusiasm for physical activity.
Increased Obesity
A lack of testosterone can lead to an accumulation of body fat. Occasionally, people with low testosterone develop gynecomastia, a condition characterised by breast enlargement.
Hair Thinning Or Loss
Hair loss is common in ageing individuals, but it can also occur due to age-related hormonal fluctuations. A 2012 study found that testosterone implants facilitated hair regrowth in certain women undergoing treatment for symptoms associated with sex hormone deficiency.
Symptoms Of Low Testosterone In Men
There are several signs of low testosterone in men:
Erectile Dysfunction
Difficulty achieving or maintaining an erection may be due to low testosterone levels. While low testosterone isn't always the sole cause of erectile dysfunction, it plays a significant role. Testosterone stimulates the penile tissue to produce nitric oxide, which initiates the processes necessary for an erection. Insufficient levels of the hormone can interfere with this mechanism, preventing erection.
Other factors contributing to erectile dysfunction include smoking, thyroid disorders, elevated cholesterol, stress, alcohol consumption, diabetes and high blood pressure. Research highlights the effectiveness of testosterone replacement therapy in improving erectile function, particularly in cases of mild dysfunction.
Reduction In Testicular Size
Reduced testosterone levels can cause a noticeable decrease in testicular size, regardless of ambient temperature.
Decrease In Semen Volume
Testosterone stimulates sperm production and reduced levels may correlate with reduced seminal volume. Such a decrease may not only affect fertility, but also serve as an indicator of declining testosterone levels.
Sleep Disturbances
Individuals with low testosterone may have difficulty initiating or maintaining sleep. Sleep apnoea, a condition characterised by intermittent cessation of breathing, often coincides with low testosterone levels, exacerbating sleep disturbances.
Mood Swings
Evidence suggests that individuals with low testosterone levels are predisposed to mood swings, including irritability, difficulty concentrating, and depressive episodes. In particular, testosterone replacement therapy has been shown to be effective in alleviating symptoms of depression and improving overall quality of life, as supported by a 2017 review.
Symptoms Of Low Testosterone In Women
Women can also present with distinct symptoms that indicate low testosterone levels, including:
Irregular Menstrual Cycles
Low testosterone levels can cause hormonal imbalances, culminating in irregular menstrual cycles. Such menstrual irregularities can often be attributed to reduced testosterone levels.
Anaemia
Testosterone plays a crucial role in the production of healthy red blood cells (RBCs). Decreased testosterone levels can lead to anaemia, a blood disorder characterised by a lack of red blood cells. Fatigue is a primary symptom of anaemia. An earlier study in 2006 found that women over 65 with low testosterone levels had lower haemoglobin levels, which increased their susceptibility to anaemia.
Causes Of Low Testosterone Levels
Testosterone production typically starts to decline after the age of 30 and after menopause. However, people at a younger age can also have low testosterone levels.
In men, hypogonadism, a condition characterised by insufficient testosterone production by the testes, can occur at any stage of life.
Factors that contribute to hypogonadism include:
- Testicular injury, trauma or infection
- Genetic disorders such as Klinefelter's syndrome
- Chemotherapy or radiotherapy for cancer
- Pituitary disease or other hormonal disorders
- Medications such as opiate painkillers
- Substance abuse, including alcohol and drugs
In women, low testosterone levels may be caused by conditions such as:
- Adrenal insufficiency
- Surgical removal of the ovaries
- Use of oral oestrogen therapy
When To Seek Medical Advice
Although low testosterone levels do not always cause symptoms, some people may only become aware of them through routine physical examinations and blood tests.
However, anyone experiencing one or more of the above symptoms should seek medical advice immediately.
Diagnosing Low Testosterone
When assessing low testosterone levels, healthcare professionals will usually carry out a full physical examination and carefully analyse the symptoms reported by the individual. They may also order a battery of tests to look for other clues.
For example, the inclusion of a bone density scan can provide insight into possible reductions in bone mass, which may indicate low testosterone levels.
Treatment Options For Low Testosterone
The main treatment for low testosterone is testosterone replacement therapy (TRT).
Doctors generally reserve the prescription of TRT for people who have multiple symptoms of low testosterone and whose blood test results confirm a deficiency. According to a report by ndtv, TRT includes several delivery methods, such as:
- Transdermal skin patches
- Topical gels
- Sublingual tablets
- Intramuscular injections
- Surgically implanted pellets designed to release the hormone over time
After starting TRT, most people experience relief of symptoms within 3 to 60 weeks. However, the timeline for symptom relief may vary depending on the specific symptoms observed. For more information on various online TRT clinics, visit onlymyhealth.
How To Get Testosterone Replacement Therapy (TRT)
TRT, a medical treatment for low testosterone levels, requires a formal prescription to access. Individuals seeking TRT must undergo a comprehensive medical assessment by a qualified doctor. This evaluation typically includes a detailed review of medical history, along with thorough physical examinations and laboratory tests.
Given the variability of hormone levels, which are influenced by factors such as physical activity, dietary habits and circadian rhythms, doctors often choose to take two blood samples before midday to accurately assess testosterone levels.
In some cases, additional diagnostic procedures such as imaging studies and specialised hormone tests (including luteinising hormone and follicle-stimulating hormone tests) may be needed to determine the underlying cause of the testosterone deficiency.
Natural Ways To Boost Testosterone Levels
In many cases, men can increase their testosterone levels naturally through weight loss and regular exercise.
While lifestyle and dietary changes alone may not always result in a significant increase in testosterone levels, they can be beneficial.
It's important to recognise that testosterone levels typically decline with age in men, and that lifestyle changes become less effective over time.
Diets high in trans fats have been linked to adverse effects on testosterone levels, whereas the inclusion of zinc, omega-3 fatty acids and antioxidant vitamins in the diet can promote testosterone production.
Eating a balanced diet of nutrient-rich whole foods and minimising the intake of trans fats can help boost testosterone levels.
Frequently Asked Questions
Here are some frequently asked questions about low testosterone.
What are the effects of low testosterone in men?
Low testosterone levels in men can result in a variety of symptoms, including reduced libido, erectile dysfunction, depression, irritability and reduced lean muscle mass. In addition, individuals may experience a reduction in testicle size and semen volume, and may experience difficulties with sleep patterns.
Should a person experiencing these symptoms see a doctor?
Yes, anyone experiencing these symptoms should see a doctor immediately. A healthcare professional can assess their condition and develop an appropriate treatment plan to address low testosterone levels. Treatment often includes testosterone therapy.
Can low testosterone levels contribute to the development of diabetes?
Studies suggest a link between low testosterone levels in men and type 2 diabetes, the most common form of diabetes. Testosterone plays a role in increasing the body's cellular response to insulin, which regulates blood sugar levels. Reduced testosterone levels can lead to insulin resistance, resulting in increased insulin production to maintain blood glucose levels within the normal range. This metabolic imbalance can contribute to the development of conditions such as type 2 diabetes and obesity.
Which specialist should I see for low testosterone?
People with concerns about low testosterone may be referred by their GP to either a urologist, who specialises in disorders of the male reproductive system, or an endocrinologist, who specialises in hormone-related conditions.
Does low testosterone affect fertility?
About 15% of men with fertility problems have been found to have low testosterone levels. However, it's important to note that low testosterone itself does not cause infertility. Instead, in cases of fertility problems, low testosterone can be an indication of an underlying testicular dysfunction that is contributing to infertility. For example, conditions such as testicular atrophy can lead to both infertility and low testosterone levels. In such cases, low testosterone is a symptom rather than a direct cause of infertility.
Is low testosterone affected by genetics?
Genetic factors, including variants affecting the Y chromosome and sex hormone-binding globulin (SHBG), can increase the risk of low testosterone. SHBG is a protein that is crucial for the delivery of testosterone to the body's tissues. In addition, rare genetic disorders such as Klinefelter's syndrome, which is characterised by an extra X chromosome in men, can affect testosterone production. Recent research has identified a number of genetic markers that may help assess predisposition to low testosterone.
Conclusion
According to the American Urology Association, low testosterone affects about 2 out of every 100 men. This risk tends to increase with age, as testosterone levels naturally decline with age.
Fortunately, most cases of low testosterone are manageable, and early recognition of symptoms can facilitate prompt diagnosis and treatment.
Sources
- ScienceDirect. “Testosterone Deficiency and Sleep Apnea.” Link.
- PubMed. “[Testosterone replacement therapy and its relationship with hyperestrogenism and obesity. Problems of laboratory diagnostics of hyperestrogenism].” Link.
- ScienceDirect. “Testosterone, Diabetes Risk, and Diabetes Prevention in Men.” Link.
- PubMed. “Testosterone deficiency in women: etiologies, diagnosis, and emerging treatments.” Link.
