Low Testosterone: Causes Symptoms And Associated Conditions
Low testosterone affects close to 5 million men in the United States. This hormone naturally decreases in men after age 30, but if it decreases substantially, replacement therapy should be considered. Heres what you need to know.
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Low testosterone levels affect close to 5 million men in the United States. This is an important hormone that naturally starts to decrease after the age of 30, but in some cases, the loss can be substantial.
While older men suffer from drops in testosterone levels more frequently, it can occur to all men at any age. Even babies and children can be affected by this, which has caused a surge in testosterone replacement therapies.
Testosterone Gels Or Patches
These are placed directly on your skin. The hormone seeps through the skin, and is slowly released into the blood. Because gels and patches are applied every day, they keep a steady level of testosterone. However, they can cause itching, irritation, and blisters at the spot where they’re applied. Women and children should not touch skin treated with a gel or patch.
What High Testosterone In Men Looks Like
Just like low testosterone, high testosterone levels can cause many different symptoms in mens bodies. These symptoms include:
- Lowered sperm count
- Increased libido
Even with these symptoms, you might think its obvious that high testosterone is to blame. But the underlying cause may still be a mystery for some.
Conditions Associated With Low Testosterone
There are several health conditions known to be associated with hypogonadism and low testosterone levels. Some can be inherited, while others are developed later in life.
Undescended testicles: When testicles do not descend properly at a young age, they will not produce sperm, and you will experience testosterone deficiency. Your risk for testosterone deficiency increases significantly with two undescended testicles.
Hemochromatosis : Hereditary hemochromatosis has been associated with low testosterone levels in men. Testosterone therapy is common in these patients to help boost libido and sexual function.
Klinefelters syndrome: This is a genetic condition where males are born with an extra X chromosome. Infertility and small testicles are common symptoms, which also mean low testosterone levels.
Pituitary disorders: The pituitary gland is responsible for regulating the production of testosterone along with other hormones, and any diseases or disorders of the gland will interfere with this.
Kallman syndrome: This disease causes disruption in the actions of the hormones that control the hypothalamus. Because the hypothalamus influences sex hormones, the result can be hypogonadism and low testosterone levels.
Inflammatory diseases: Chronic or systemic inflammatory disease interferes with testosterone activity. The excess inflammatory chemicals also create an enzyme called aromatase, which turns testosterone into estrogen, causing sexual dysfunction in men.
Mood Swings And Irritability
Being hormonal or highly emotional can be an issue for men with low testosterone levels. A healthy level of testosterone is needed to help keep your mood in check. Because mood swings can be caused by many other health issues, though, you should talk to your doctor if you have any sudden mood changes you cant explain.
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Is There Such A Thing As A ‘male Menopause’
The “male menopause” is an unhelpful term sometimes used in the media.
This label is misleading because it suggests the symptoms are the result of a sudden drop in testosterone in middle age, similar to what occurs in the female menopause. This is not true.
Although testosterone levels fall as men age, the decline is steady at less than 2% a year from around the age of 30 to 40, and this is unlikely to cause any problems in itself.
A testosterone deficiency that develops later in life, also known as late-onset hypogonadism, can sometimes be responsible for these symptoms, but in many cases the symptoms are nothing to do with hormones.
Testosterone Replacement Therapy And Prostate Cancer: Is There A Link
In past decades, many scientists believed that higher levels of total testosterone came with an increased risk of prostate cancer.
It was thought that low testosterone production actually helped protect against prostate diseases, so restoring testosterone to normal levels â through testosterone therapy â could mean a greater chance of prostate cancer.
So could prostate cancer be a potential risk of TRT?
Not likely, says todayâs researchers. While initial studies suggested a link between high T levels and prostate cancer, much more modern research â using much more rigorous methods â has convincingly shown that testosterone therapy comes with âlittle if any riskâ of prostate cancer.
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Why Is Testosterone In Men Important
Because testosterone is a sex hormone, its a common misconception that its only used by the body to aid in the development of your reproductive organs. But testosterone isnt only produced by the testes its also produced in the adrenal glands. Why? Because testosterone has a hand in A LOT more than just your reproductive health.
Testosterone plays an important role in:
- Bone density
- Increase in body fat
- Erectile dysfunction
These symptoms can impact both self-esteem and quality of life. But what is the underlying cause of low testosterone levels in men? Once these symptoms arise, there are a few things that can be causing them.
About Mens Health Center
The UPMC Mens Health Center is dedicated to male health and to the evaluation and treatment of conditions affecting mens sexual and reproductive health. With years of clinical experience in male sexual medicine and surgery, our team has treated a wide variety of conditions and performed thousands of surgeries, providing patients with the highest level of quality care. Our providers understand the intimate nature of male sexual difficulties, and we are dedicated to helping you restore your normal level of sexual function in a comfortable, educational, and discreet environment.
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When Testosterone Therapy Might Help
Men who are no longer interested in conceiving may benefit from safe, monitored testosterone replacement therapy. Some patients with genetic issues that cause subfertility, such as Klinefelter’s syndrome, may also benefit.
- Lose a few pounds: Approximately 30% of obese men have low-T. Since muscle burns more calories than fat, the more muscle you have, the less likely your body is to store excess calories as fat. However, some research suggests that low-T contributes to weight gain it’s a vicious cycle. Start by cutting belly fat, which is good for your heart health and general wellness.
- Eat a healthy diet: For full-body health and hormone balance, consider the Mediterranean diet, which focuses on lean proteins, healthy fats, and plant-based foods. Also enjoy foods that are high in vitamin D, which supports testosterone production, strong bones, and mood. Some of these include eggs, salmon, and mushrooms.
- Rethink online viewing habits: Pornography is readily available online and it can perpetuate skewed expectations for what masculinity and sexual virility should feel like. Your body was not designed to perform sexually for hours on end what you’re seeing on the screen is cinematography, not reality.
Risks Of Testosterone Therapy
Testosterone therapy has some drawbacks. Some men may develop:
- Too many red blood cells
- Sleep apnea
- An enlarged prostate
The risks and benefits of taking testosterone for many years are not known, because large studies haven’t been completed, yet. Some researchers suggest there might be a higher risk of heart disease. But the evidence is still not conclusive.
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How Is Testosterone Deficiency Treated
Early detection in boys can help prevent problems from delayed puberty. Testosterone treatment can stimulate puberty and the development of sex characteristics, such as increased muscle mass, beard and pubic hair growth, and growth of the penis.
Early diagnosis and treatment in adult men provide better protection against loss of bone density and cardiovascular disease. Treatment can also improve tiredness, general well-being, erectile dysfunction and sex drive.
The treatment for testosterone deficiency also depends on the underlying cause.
Loss Of Hair Or Less Hair Growth
Like with women, changes to your hair can indicate significant hormonal fluctuations. Do you seem to be losing a lot more hair than ever before, or perhaps you dont need a haircut so often because your hair isnt growing as much? If so, the cause may be a reduction in testosterone.
This sex hormone plays a role in many different bodily functions, including hair production on your head, face, and other parts of your body. Changes in your hair may be related to aging, your diet, stress, or even a change in seasons, though, so dont assume the worst right away. Monitor the situation and see if it continues to happen.
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Effect Of Androgen Suppression On Obesity And Diabetes
There are studies from special groups of patients where hypogonadism is a feature, either due to genetic defects or due to pharmacotherapy, which strengthens opinion that testosterone deficiency is a risk factor for the development of the metabolic syndrome and type 2 diabetes, and is an independent cardiovascular risk factor.
A longitudinal study followed a large population of 73,196 men with loco-regional prostate cancer followed for a median of 4.55 years . Those treated with androgen suppression therapy were more likely to have a higher hazard ratio of developing diabetes, ischaemic heart disease, myocardial infarction and sudden death from cardiovascular disease compared with those patients untreated or treated with other modalities. Similarly a study of 396 men with prostate cancer undergoing androgen-deprivation therapy showed worsening glycaemic control with an increase in HbA1c and an increased incidence of new onset of diabetes . A smaller study showed that initiation of GnRH agonist or anti-androgen therapy in 22 men with prostate cancer led to increases in serum insulin, arterial stiffness and fat mass over the subsequent 3-month period .
Men with Klinefelter’s syndrome, the most common classical form of hypogonadism, have an increased risk of death from diabetes, cancer, cardiovascular and respiratory diseases . This again supports an association of testosterone deficiency states with these major causes of mortality.
Symptoms Of Low Testosterone
Drops in testosterone levels that are not the result of normal aging are usually caused by hypogonadism. This occurs when the testicles do not produce enough testosterone. This can happen during fetal development, puberty, and adulthood.
The symptoms of low testosterone will depend on when the hypogonadism occurs.
When hypogonadism happens during fetal development, the growth of the external sex organs becomes impaired. Male children can develop female genitalia, ambiguous genitalia, or have underdeveloped male genitals.
If it occurs during puberty, the young man can experience problems with muscle development, underdeveloped genitals, enlarged breasts, overly long limbs, and a lack of body hair.
During adulthood, hypogonadism can cause low energy levels, infertility, low muscle mass, decreased sex drive, loss of bone mass, and erectile dysfunction.
Who Shouldn’t Take Testosterone Replacement Therapy
Testosterone replacement therapy may cause the prostate to grow. If a man has early prostate cancer, there is concern that testosterone may stimulate the cancer’s growth. Therefore, men who have prostate cancer should not take testosterone replacement therapy. It is important for all men considering testosterone replacement therapy to undergo prostate screening before starting this therapy.
Other men who should not take testosterone replacement therapy include those who have:
- An enlarged prostate resulting in urinary symptoms
- A lump on their prostate that has not been evaluated
- A PSA measurement above 4
Role Of The Androgen Receptor In Diabetes Obesity And Metabolic Syndrome
The biological function of testosterone is a function both of testosterone level and of the efficiency of transcriptional activity mediated by the interaction of testosterone with the androgen receptor. Serum total testosterone level is only a surrogate marker for the functions testosterone. The androgen receptor gene contains a polymorphic CAG repeat sequence in exon 1 which encodes a variable length polyglutamine stretch AR CAG. The length of this sequence correlates with the transcriptional activity of AR with longer AR CAG sequences associated with reduced transcriptional activity. Longer AR CAG was associated with increased body fat and leptin levels in a study of 106 healthy men and in a study of 233 men with type 2 diabetes . The latter study demonstrated that increased central adiposity as measured by waist circumference was greater in association with a less sensitive AR. Longer AR CAG sequences are also associated with higher serum insulin levels in healthy men but did not correlate with HbA1c in diabetic men .
Men with Kennedy’s syndrome, which is a neurological disease caused by abnormally long AR CAG , are reported to be more likely to develop diabetes. This might suggest that AR CAG may have a potential role in the pathogenesis of diabetes in this context however, the distribution of CAG repeat numbers in diabetic men is similar to a healthy population.
Physical And Emotional Side Effects Of Low Libido
A decreased sex drive can be very unsettling for men. Low libido can lead to a vicious cycle of physical and emotional side effects, including ED the inability to maintain an erection long enough to have satisfactory sex.
ED may cause a man to experience anxiety around sex. This can lead to tension and conflicts between him and his partner, which may in turn lead to fewer sexual encounters and more relationship issues.
Failure to perform due to ED can trigger feelings of depression, self-esteem issues, and poor body image.
Smaller Testicles Or Lower Semen Levels
Have you noticed that your testicle size seems to be diminishing recently, and this is unrelated to exposure to the cold or other factors that would typically have a short-term impact? If so, this is a sign of struggling testosterone levels. If youve always had testicles on the smaller size and have no other symptoms, you dont need to worry about this idea, but if yours used to be bigger and seem to have shrunk, this may be because you dont have enough testosterone in your system.
Alternatively, if your semen output when you ejaculate is lower than usual, you might also have a testosterone problem. This hormone plays a vital role in the production of semen, meaning any drop in it will lead to a decline in semen, too.
Some other top signs of lowered testosterone in men include more significant mood swings , a reduction in muscle mass, or an increase in fat gain.
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What Is The Cause Of Low Testosterone In Men
- Autoimmune disorders can be to blame. Some autoimmune disorders like rheumatoid arthritis and lupus can cause testicular failure, and are known to sometimes cause low levels of testosterone in men.
- Getting too much exercise or abusing synthetic steroids. Over-training at the gym can actually cause low testosterone levels, and synthetic steroids disrupt your bodys normal production of hormones, leading to decreased function of the testes and resulting in low testosterone levels.
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Treatment of low testosterone in hypogonadism is a fully accepted therapy. Treatment in older men is more controversial. Discuss your testosterone levels, symptoms, and side effects of treatment with your doctor to establish whether you should receive therapy and what form of therapy.
There are several ways that testosterone therapy can be administered:
- Transdermal : Usually applied once a day . Tends to be clean and easy to apply. There is an available mouth patch that sticks to the upper gums and is applied twice daily.
- Gels: Applied directly to the skin and then absorbed through the skin . Dosing is more difficult although these gels are available in single applications packages or premeasured pumps.
- Injections: Testosterone can be delivered by direct injection.
- Pellets: Pellets can be implanted into the soft tissue and release the testosterone.
Why no pills? Testosterone is available as a pill but some experts believe long-term oral delivery of testosterone can have negative effects on the liver. These other delivery methods bypass the liver and go directly into the blood stream.
What Causes Low Testosterone
There are several causes of low T, and your doctor will work with you to figure out whats causing your low levels.
“Stress can contribute to overall body dysfunction,” Dr. Eleswarapu says. “One of the things we notice in guys with poor sleep hygiene, apnea or significant stress, is that they can have a depressed level of testosterone.”
Low testosterone is broken into two main types:
Causes Of Low Testosterone Levels In Men
Testosterone deficiency in an adult man is a sign that the pituitary gland is not working properly. If someone has low T levels, it can cause health problems which include erectile dysfunction, reduced bone mass, and sex drive.
To determine if a person has low T, according to the American Urology Association, clinicians should use a total testosterone level below 300 nanograms per deciliter ng dl as a reasonable cut-off in support of the diagnosis of low testosterone.
Low levels of Testosterone, also known as hypogonadism, can begin anywhere from fetal development, before puberty or during adulthood. For example:
- Fetal development. If a child is born during the development stage, the body does not produce enough testosterone. Consequently, this can lead to impaired development of external sex organs.
- Hypogonadism can affect a childs growth before puberty by hindering the development of muscle mass, growth of body and facial hair, deepening of the voice, etc.
- For adults, low T levels affect the reproduction functions, and overtime, men can develop infertility, erectile dysfunction, loss of bone mass, etc.
To determine, the causes of low testosterone you must take into account the types of low T or hypogonadism. There are two types, primary and secondary hypogonadism. Each type is either caused by inherited traits, injury, or infection to the testicles. Lets look closer at primary and secondary hypogonadism.
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