Testosterone is the main male sex hormone. It is produced by the testicles and responsible for a man’s reproductive development. Testosterone is a key part of a boy’s transition from puberty to sexual reproductive maturity. During puberty, testosterone helps the penis and testicles grow; hair to begin developing on the face, pubic area, and chest; strengthen muscles and bones; deepen the voice; and promote height. After puberty, testosterone helps regulate red blood cell production, bone density, muscular strength and mass, sperm production, distribution of body fat, growth of facial and body hair, and a man’s sex drive.
What is low testosterone?
According to the National Institutes of Health, normal testosterone levels range from 300 to 1,000 nanograms per deciliter. Testosterone levels tend to decrease gradually after age 30. Hypogonadism is a condition that prevents the body from making the normal amount of testosterone. This can be caused by testicular problems (primary hypogonadism) or upstream at the hypothalamus or pituitary gland (secondary hypogonadism) responsible for controlling the testicles. Other conditions, such as type 2 diabetes and obesity, can also lead to lower levels of testosterone, as well as autoimmune diseases, alcohol, and opioids.
What are the symptoms of low testosterone?
Symptoms may include: decreased sex drive (libido), erectile dysfunction (ED) (unable to get or maintain an erection), lower sperm count and infertility, enlarged or tender breasts, less energy, inability to concentrate, irritability, low mood, changes in sleep patterns.
How does low testosterone affect a man's ability to have sex?
A man may find he has a lower sex drive (libido), suffer from erectile dysfunction (ED) that makes it difficult to get or keep an erection, and have less overall energy.
How does low testosterone affect a man's general health?
Low testosterone may lead to other health problems such as muscle weakness, bone weakness, and infertility.
Are there health risks related to low testosterone?
Men with low testosterone may be at greater risk for cardiovascular disease, type 2 diabetes, metabolic syndrome, and obesity.
How is low testosterone diagnosed?
As part of your evaluation, your healthcare provider will do a blood test to check the level of “serum testosterone” in your blood. He or she may do this blood test several times to compare levels. For your diagnosis, your provider may consider: sexual problems you may be having, current or past illnesses, your nutrition, medications that could affect your testosterone level, family health history, check if your testicles have been damaged or are shrinking, check if there are recent changes to your breasts, ask about changes in your mood, ability to concentrate, and sleep patterns. At The Billups Center, our routine is to obtain at least two separate early morning fasting blood samples for testosterone testing because there is some evidence that testosterone levels may transiently decrease after eating due to ingestion of glucose (blood sugar).
How is low testosterone treated?
Your physician will work with you to choose the right treatment plan. Your plan may include lifestyle changes for your diet and level of physical activity. It may also include a testosterone replacement in the form of a daily patch or gel on the skin, an injection that can be short-acting (every 1 to 2 weeks) or long-acting (every 10 weeks), or pellets that are placed under the skin and last for up to 4 months. Less commonly used forms of replacement therapy include a tablet that gets placed between your cheek and gum twice daily or a nasal spray used 3 times a day. Instead of testosterone replacement, your treatment plan may include taking pills that can help your body produce more testosterone.
Do nutrition and exercise have an impact on testosterone?
Yes. Obesity, especially abdominal obesity characterized by a waist circumference greater than 40 inches measured at the belly button, can contribute to lowering testosterone. A balanced diet can help reduce weight as can an appropriate amount of exercise. (Be sure to ask your physician what level of exercise is right for you first.) Exercise has also been shown to temporarily boost testosterone levels. Being fitter can also boost your confidence level.
How common is low testosterone?
Low testosterone is a common condition—it’s estimated that 39% of men age 45 or older will have low testosterone levels.
Is there a connection between low testosterone and prostate cancer?
There is no current research evidence that testosterone replacement therapy (TRT) causes prostate cancer. It is important to follow a man’s PSA blood test level both as a baseline before TRT and during TRT. If a man is noted to have a significantly elevated PSA after TRT, he usually needs a prostate biopsy to evaluate for prostate cancer. If he is found to have prostate cancer after starting TRT, he had a pre-existing undetected prostate cancer that must be evaluated and treated accordingly.
Can men with a history of prostate cancer be treated with testosterone replacement therapy?
Men with a history of prostate cancer (previously treated with surgical removal of the prostate or one of the radiation therapy techniques) can be considered for testosterone replacement therapy (TRT) after a comprehensive evaluation. This includes men with prostate cancer under an active surveillance protocol. The decision to use TRT in these populations of men is individualized and takes a number of factors into consideration. At The Billups Center, we often get referrals to see men with prostate cancer or a history of prostate cancer for possible TRT. Each patient must be fully evaluated and educated for informed consent before any individualized treatment decision is made.
Is there a connection between low testosterone and cardiovascular risk?
In November 2013 and January 2014, two studies were published reporting increased cardiovascular risks in men on testosterone replacement therapy (TRT). These studies triggered a flurry of concern in the general public and medical profession, including the FDA. When investigated by multiple sexual medicine societies, both studies were found to have significant flaws in methodology that challenged their conclusions. In addition, there is a body of scientific literature supporting that low testosterone may increase cardiovascular risk and be associated with increased risk of other comorbidities, including obesity and type 2 diabetes. There is also preliminary evidence that, in some hypogonadal men, TRT can improve glucose metabolism and lower overall risk of cardiovascular events. In order to resolve the situation, there needs to be a long-term, randomized, placebo-controlled clinical trial to better assess cardiovascular risk in hypogonadal men undergoing TRT. At The Billups Center, we take the time to educate men about the potential risks and benefits of low testosterone and TRT. While there is no final consensus on cardiovascular risk associated with TRT, we feel that with proper education, evaluation, monitoring and follow up, TRT is an appropriate treatment for many men. Each man is assessed on an individual basis and followed with a treatment plan that is personalized for his medical status.