Testosterone is a steroid hormone that helps regulate sperm development, maintain muscle mass, and boost energy. Both men and women have it, but men produce about ten times more of it than women. Low testosterone is sometimes known as androgen deficiency syndrome; androgen is the term for the male sex hormone and testosterone is the main sex hormone for men.
The bottom of a man's normal total testosterone range is about 300 nanograms per deciliter (ng/dL). The upper limits are 1,000 to 1,200 ng/dL.
A decrease in a man’s testosterone level is a natural function of aging similar to the decline of the female hormone estrogen in women. For each year over age 30, the level of testosterone in men starts to slowly dip at a rate of around 1 percent annually. This decline in testosterone and the symptoms it causes have sometimes been referred to as "male menopause."
However, at any age some men have a lower than expected level of testosterone which can be due to a number of reasons:
- Hormonal disorders
- Injury to the testicles
- Testicular cancer or treatment for testicular cancer
- Chronic kidney or liver disease
- HIV / AIDS
- Type 2 Diabetes
- Some medications
- Some genetic disorders
Signs and symptoms of low testosterone include:
- Decreased sex drive
- Erectile dysfunction
- Reduced energy level
- Difficulty in concentrating
- Reduced strength and endurance levels
- Sleep problems
- Increased breast size and tenderness
- Decrease in the amount of body hair
- Decreased penis or testicle size
- Loss of muscle mass
- Emotional problems including sadness, irritability, depression
Note that some men with a low testosterone level have absolutely no symptoms at all.
A diagnosis of low testosterone includes taking a complete medical history and having a physical exam as well as blood tests to confirm the diagnosis. Your doctor will want to make sure your low testosterone is not caused by medications you are taking or by a disease or condition that needs to be treated.
Even if you have no symptoms treatment may be advised as low testosterone scores often lead to drops in bone density, meaning that bones become more fragile and increasingly prone to breaks.
If a young man's low testosterone is a problem for a couple trying to get pregnant, testosterone injections are probably the best option. Given every few weeks, the injections stimulate sperm production and motility.
When fertility is not an issue, the ideal testosterone delivery method is a daily gel or patch. Because they are applied on a regular and frequent basis, these treatments keep a man's testosterone at a steady level and keep his symptoms at bay. If you are using testosterone gel on your skin, be careful not to expose other people to the gel.
There is also a relatively new method of treatment whereby several pellets are placed under the skin of the buttocks, which release testosterone over the course of about three to four months.
Testosterone treatment is not without risk
Testosterone treatment is not without possible side effects. It may raise the red blood cell count and can enlarge breast tissue. Therefore, men with any history of breast cancer should not have testosterone treatment.
Testosterone can also accelerate prostate growth, therefore treatment is usually not advised for men with prostate cancer although medical studies are currently looking into this association.
Recent studies suggest a link between testosterone therapy and an increased risk in heart disease. A 2010 trial of testosterone in older men was stopped early because the men receiving testosterone therapy had a higher frequency of heart problems than did the men receiving the placebo. A 2013 study found a higher frequency of death and heart problems in men who had coronary artery disease and received testosterone therapy. However, two recent studies have also reported a lower risk of death in men who were receiving testosterone than in those who were not. A 2014 study reported that testosterone therapy might increase the risk of a heart attack in men age 65 and older, as well as in younger men who have a history of heart disease. Further research is needed to determine the safety of using testosterone therapy to treat older men dealing with age-related declines in testosterone. Currently, the Food and Drug Administration (FDA) is investigating the risk of stroke, heart attack and death in men taking FDA-approved testosterone products.
If you wonder whether testosterone therapy might be right for you, talk with your doctor about the risks and benefits.
Testosterone treatment should never be self prescribed (ie: to improve your sex life). If you are taking testosterone, make sure your doctor is monitoring your response to treatment with regular blood tests.
If you and your doctor decide that you should try medication to treat low testosterone, remember that a healthy lifestyle including a healthy weight, not smoking, limited alcohol, and regular exercise are also important for managing testosterone levels.