What is low testosterone?
Testosterone is primarily a male hormone, though it is also present in women. In men, low testosterone, known medically as hypogonadism or more commonly as low T, results when the testes do not produce enough testosterone.
In men, testosterone plays an important role in male development, including sexual function, muscle development, and sperm production.
If a boy does not have enough testosterone, the expected changes at puberty will not occur. Low testosterone levels in adult men can cause loss of sex drive (libido), loss of muscle mass and body hair, hot flashes, and even an increase in breast tissue.
Women also need testosterone for their development, although in much lower levels. Testosterone helps contribute to how well the ovaries function, as well as bone strength and sexual function. Women can also be affected by low testosterone.
Low testosterone in men currently affects more than 15 million men in the United States. Most often, the cause is age, as the body naturally decreases the amount of hormones it produces. Other causes of low testosterone include certain chronic conditions, medications, and trauma to the testicles that prevents the testes from producing adequate amounts of the hormone.
While not life-threatening, chronically low testosterone levels can cause osteoporosis, which increases risk of potentially serious bone fractures. For many men, low testosterone primarily affects quality of life, including emotional health, energy levels, and sexual intimacy with partners. Treatment of low testosterone most often centers on hormone replacement therapy, along with lifestyle changes that can naturally maintain healthy testosterone levels.
What are the symptoms of low testosterone?
Low testosterone symptoms can come on very gradually, so may not be noticed at first.
Common symptoms of low testosterone in men
The most common symptoms of low testosterone are:
- Breast tissue growth
- Decrease in body hair
- Difficulty sleeping
- Fatigue
- Inability to orgasm
- Low sex drive
- Problems with memory and concentration
Low testosterone can also contribute to the development of osteoporosis and infertility, which produce their own symptoms and may be diagnosed separately through medical testing. In the process of diagnosing these conditions, your doctor may identify low testosterone as a cause.
Regular physical examinations, especially as men age, could help detect low testosterone levels before they have a significant health impact. Well child check-ups can help identify low testosterone in young boys, allowing for treatment before they enter puberty. For younger men who are experiencing symptoms or who are trying to start a family, checking testosterone levels could help detect the problem.
What causes low testosterone?
Low testosterone in men can have several causes. Doctors divide these causes into two categories, primary (when low testosterone develops independently) and secondary (when it is a complication of another condition).
Primary causes of low testosterone
Low testosterone can develop on its own due to:
- Chemotherapy or radiotherapy for cancer
- Genetic conditions, such as Klinefelter syndrome
- Infection in the testes including the infection that can result from mumps
- Injury or trauma to the testicles
Undescended testicles at birth
Secondary causes of low testosterone
Low testosterone can be a complication of underlying issues including:
- Abuse of anabolic steroids
- Age
- Alcohol abuse
- Certain medications, particularly opioids and hormones
- Head trauma
- HIV/AIDS
- Obstructive sleep apnea
- Pituitary disorders, including issues that affect the pituitary gland, such as a brain tumor
- Uncontrolled type 2 diabetes
What are the risk factors for low testosterone?
There are some risk factors that men cannot control, but there are others for which men can take steps to manage or reduce low testosterone risk.
Some non-modifiable risk factors include:
- Age
- Being born with undescended testicles
- Earlier treatment with chemotherapy or radiotherapy
- Genetic conditions
Some modifiable risk factors include:
- Avoiding excessive use of alcohol
- Following treatment recommendations for chronic conditions, such as type 2 diabetes or sleep apnea
- Losing weight if overweight or obese
- Protecting the scrotum when participating in sports or activities that could cause a trauma in the groin
- Speaking to your pharmacist about medications and how they may affect testosterone levels
Regular check-ups with your doctor or nurse practitioner could help identify issues related to low testosterone levels before the problem becomes severe. If you do have symptoms, it is important to discuss these with your healthcare provider, even if they may seem embarrassing. Doctors have experience with all manner of symptoms and care first and foremost about finding effective treatment for your condition.
How do doctors diagnose low testosterone?
In order to diagnose low testosterone levels, your doctor will ask about current and previous health issues. You will likely be asked to describe your symptoms, what you think may have caused your problem, and how long you have been experiencing the symptoms.
A physical exam may include examining your:
- Testicles
- Weight and body mass index (BMI) measurement
- Hair pattern
- Breast tissue
- Prostate
- Blood pressure
Following the physical exam, you might have blood tests, which will determine the testosterone levels in your blood. Blood tests may also look for:
- Blood sugar levels
- Hemoglobin
- Other hormones
If testosterone levels are extremely low or you have had symptoms for an extended time, you may undergo other tests, including:
- Bone density scan, to check bone strength
- Magnetic resonance imaging (MRI) of the pituitary gland
What are the treatments for low testosterone?
Treatment for low testosterone depends on the cause. If the low levels are caused by a treatable condition, like type 2 diabetes or an infection, the levels may go back up once the other condition is resolved.
However, most men who need treatment receive hormone replacement therapy (HRT).
Hormone replacement therapy for low testosterone
Hormone replacement therapy for testosterone can be administered in several ways:
- Gel: Applied to the skin, usually the upper arm or shoulder, testosterone enters the body as it is absorbed by the skin. It is essential that no one else accidentally comes into contact with the product, so the gel should be kept out of reach of children and pets.
- Patches: Similar to gel applications, patches containing testosterone are placed on the skin for the medication to be absorbed. Discard used patches carefully to prevent accidental drug exposure by others or pets.
- Injection: Testosterone can be injected either at the doctor’s office or, with training, at home every 1 to 2 weeks.
- Oral: A specially prepared substance is placed on the gum line just above the top teeth, called the buccal cavity, 3 to 4 times a day. The testosterone is absorbed through the gum. Oral testosterone can also be taken in capsule form.
- Nasal: A spray with testosterone can be pumped into the nose, three times a day in each nostril.
- Implantable pellets: The doctor inserts pellets containing testosterone under the skin every 3 to 6 months.
If the treatment works, men should feel a difference within 4 to 6 weeks of starting hormone replacement therapy.
For men who have prostate cancer, hormone replacement therapy is not an option for treating low testosterone. The hormone replacement could cause the cancer to progress. If you have prostate cancer, talk to your doctor about non-HRT options for addressing low testosterone.
How does low testosterone affect quality of life?
The effects of low testosterone on quality of life is often what prompts men to see a doctor about their symptoms. Low T affects a man’s emotional health, energy levels, and ability to have an active and satisfying sex life.
Many times, these issues resolve with effective treatment of low testosterone. When they do not, additional support is available. Your doctor can discuss alternative treatment options, and a counselor or therapist can help manage emotional issues like depression. You and your partner may benefit from seeing a sex therapist who can address how lack of sexual function is affecting your relationship and help you explore other ways to be intimate. Lifestyle habits, such as meditation or mindfulness, may help you manage fatigue and improve concentration.
What are the potential complications of low testosterone?
Complications related to low testosterone include:
- Enlarged breast tissue, called gynecomastia. This can be particularly embarrassing for teens and result in poor body image.
- Infertility
- Osteoporosis, or thinning bones that increase risk of fracture
There are also potential complications related to testosterone therapy. They include:
- Decrease in sperm count
- Enlarged breasts
- Fluid retention, particularly in the ankles
- Increase in prostate size, affecting the ability to urinate
- Increase in prostate specific antigen (PSA) levels, which can indicate prostate cancer
- Skin irritation if using a gel or patch
- Smaller testicles
- Worsening of sleep apnea
