What is Low Testosterone?
Low testosterone is tricky. All men are different, and testosterone levels vary greatly. The American Urology Association defines low testosterone as less than 300 nanograms (ng) of the hormone per deciliter (dl) of blood. Testosterone is responsible for all sorts of bodily functions, and when levels start to drop, men may begin to experience symptoms. On average, from around 30-35 years old, a man's testosterone levels drop between 1 and 2 percent each year.
This decline is normal, and no one knows precisely why this happens. However, some scientists and doctors believe due to advances in medicine and all aspects of healthcare; we live longer than we are 'designed' to live. A few hundred years ago, men would be lucky to reach the age of 40; however, nowadays, men can live to 80, 90, even 100 years old, we simply living longer than ever before. It was no problem for a man to peak in their 20's, reproduce, raise their kids, and die all in 40 years. Nowadays, things are very different.
In men, testosterone helps maintain and develop:
- Sexual organs
- Muscle mass
- Red blood cell levels
- Bone density
- Sexual and reproductive function
- Hair, both on the body and head
Is Decreased Testosterone Common in Men?
As previously discussed, testosterone levels start to decrease from around the age of 30 onwards, and it is perfectly normal for men by the time they reach middle age to see signs of reduced levels. Some studies suggest up to 40% of men over the age of 45 have low testosterone levels, not all of which will experience any symptoms. Levels are also affected by body mass index, general health, alcohol consumption, age illness, and smoking.
What Causes Testosterone Levels to Drop?
Testosterone levels can be affected by many factors, from getting older to diseases and hereditary conditions. Some things are within your control, while some are not. A healthy lifestyle, eating well, not drinking too much alcohol, and getting plenty of sleep and exercise will help maintain 'normal' levels in younger men. However, the natural decline is unavoidable without treatment to maintain optimum levels.
There are many potential causes for a decline in testosterone levels.
- Testicular trauma, viral or bacterial infection (orchitis)
- Chemotherapy for cancer
- Hemochromatosis (blood disorder)
- Pituitary gland tumors or disorders
- Thyroid disorders
- Certain Medications (Opioids, chemotherapy medication some antidepressants and others)
- Alcohol abuse
- Cirrhosis of the liver
- Kidney failure
- HIV / AIDS
- Type 2 diabetes
- Autoimmune disease
- Kallman syndrome
- Klinefelter syndrome
- Undescended testicles
- Lack of Sleep
- Previous anabolic steroid abuse
Primary hypogonadism is a disorder where your testicles are not producing enough testosterone. The testicles are still receiving the messages from the brain and thyroid but are incapable of producing enough or any hormone. In adults and children alike, this condition can be hereditary but also caused by illness or damage to the organs involved.
- Undescended testicles are where the testes don't descend from the abdomen before a baby is born. It is usually treatable in early childhood, which can affect testosterone levels in the future.
- Klinefelter's syndrome is a condition where men are born with an extra X chromosome. Often this can go wholly undiagnosed and only becomes apparent in later life. A girl usually has XX chromosomes and a boy XY; with Klinefelter's syndrome, a baby boy has XXY. Interestingly X is not exclusively a female chromosome and is present in both sexes. It is the Y that makes you a boy. Boys and men with this syndrome are still genetically 'male.' This condition can cause problems, particularly with testosterone production, fertility, blood disorders, weak bones, lupus, male breast cancer, an underactive thyroid, and other issues. Testosterone replacement therapy is the standard option because it can significantly reduce symptoms and the long-term effect of many of these issues.
- Hemochromatosis is a condition that causes the body to absorb too much iron from your food leading to far too high iron levels in the blood. This disorder can be hugely problematic because your body has no natural way to remove this excess. The iron then builds up in your liver, heart, pancreas, and joints. Men with this disorder often have low testosterone levels, which can be corrected by testosterone replacement treatment.
- Physical injury and damage, which affects both testicles, can affect testosterone production. Diseases such as mumps and cancer, and also cancer treatments can affect testosterone production.
- Secondary hypogonadism accounts for 75% of cases. It is most often related to neuroendocrine issues where disease disrupts the interaction between the nervous system and endocrine system or obesity, medication, and other illnesses. Secondary hypogonadism is not caused directly by damage to the testicles. It is problems in the pituitary gland or hypothalamus, which both control hormone production.The Pituitary gland and hypothalamus both send signals to the testicles triggering the production of testosterone. There are quite a few disorders and diseases that can cause secondary hypogonadism from normal aging to HIV and AIDs. Testosterone replacement therapy can help alleviate the symptoms of many of these.
- Inflammatory diseases such as tuberculosis can alter the pituitary gland and hypothalamus function.
- Pituitary issues caused by drugs, kidney failure, or small tumors
- Kallmann syndrome, present from birth, this disorder affects men and women and in men has the symptoms of hypogonadism along with a complete lack of sense of smell.
- HIV/AIDS. Men with HIV or AIDS are far more likely to suffer from hypogonadism.
- Aging: As already discussed, as you get older, you produce less testosterone and hypogonadism can develop.
- Obesity: Fat, especially visceral fat, causes testosterone levels to decline. Obesity may indicate a thyroid issue, but hypogonadism is incredibly common in obese men.
- Medications: Some medications cause testosterone levels to decline including (not exclusively), opiates, certain antidepressants, chemotherapy drugs, Spironolactone (Aldactone), and Cimetidine (Tagamet)
- Recurring illness Such as cancer, Chronic obstructive pulmonary disease, diabetes, vascular disease, and even sleep apnea can all affect testosterone levels.
What are the Optimum Testosterone Levels?
Testosterone replacement therapy could be considered essential to men over the age of 40. TRT is used to regain levels to within the top 25% of 'normal levels' we aim to get patients into the 800-1100 bracket. Most men will start to notice benefits in the 600-700 range.
It is essential to remember that every patient is different; testing your testosterone levels are only part of the story. Any doctor who understands TRT will take the blood readings as only half the picture. At Male Excel, we look at the patient's symptoms as the primary indicator of a testosterone deficiency.
- A drop in energy
- Memory Fog, Lack of Focus and Concentration
- Lack of Libido and Erection Problems
- Sleep disturbance
- Weight gain
- Inability to gain muscle
Because all men' feel' the effects of testosterone deficiency differently, it is vital to look closely at the symptoms and then the blood test. Only then can our doctors create a bespoke treatment plan for each patient. Another issue that is often confused with testosterone deficiency is low thyroid. We routinely test for thyroid problems, which is commonly confused with testosterone deficiency.
Disclaimer: The information provided on this page is not a substitute for professional medical advice, diagnosis, or treatment. If you have any questions or concerns about your health, please consult a doctor.