The term “Low Testosterone” has been popping up everywhere recently, from your doctor’s office to the news, and in pharmaceutical ads on television and in magazines. So what exactly is “Low T,” and why should you get checked? In this blog post, I’ll discuss the whys and hows of Low T, the symptoms to look out for, and what treatment options are available.
What is testosterone, and what constitutes Low T?
Testosterone, or “T,” is a sex hormone, which is mostly produced by the testicles, which in turn get signals from the pituitary gland in the brain. While the majority of testosterone is produced in the testicles, about 5% is made by the adrenal glands that sit on top of the kidney. Testosterone is responsible for energy levels, sex drive (libido), erectile function, muscle integrity, and mood – among many other things. T is highest between the hours of 6 and 8 am, and slowly starts to drop starting in the late afternoon. Levels are at their lowest between 6-8pm.
While different labs have variances in what they consider “normal” levels, the average range for men is between 400-600 ng/dL, which means that most men will operate within this range, and will not experience the symptoms of Low T. However each patient is different. For example, there are men with a level in the 200s who do not have any symptoms, as well as men with a level in the 400s who experience Low T symptoms. Low testosterone treatment is initiated based on lab results, as well as personal history of symptoms, and there is no hard number that we use to treat. Generally speaking, we aim for a testosterone level between 600-800, although the exact target number is individualized by patient. If a patient is at an optimum testosterone level and is continuing to experience symptoms, testosterone may not be the cause. Instead, issues such as depression, work-life issues, sleep disorders, lack of exercise, or thyroid problems – which can easily mimic the symptoms of Low Testosterone – may be to blame.
Symptoms
The most common symptom we see as providers is low energy or fatigue. Other symptoms that can occur are decreased sex drive, depression, or difficulty gaining muscle mass. Low Testosterone affects about 40% of men over the age of 45. As men age, their levels of testosterone may decrease. However, because people are mentally, physically, and sexually active much later in life than our parents or grandparents were, we don’t want our lifestyles to be impacted by these symptoms. Part of the reason that Low T has recently been getting more attention is due to the fact that as men are getting older, they want to maintain their vitality and sexual health.
Fatigue / Lack of energy: Feeling tired throughout the day, especially towards the late afternoon and evening hours, is probably the most common symptom of Low Testosterone. Since testosterone is highest in the morning, men usually have the most energy at this time.
Low libido or sex drive: Libido, or sex drive, is the desire to be physically intimate. Low libido is a symptom that both men and women struggle with, and if not treated, can cause strain in relationships. While this can be a difficult symptom to bring up with your doctor due to its personal nature, effective treatment can greatly improve your overall life satisfaction.
Erectile Dysfunction: Erections depend on blood flow to the penis, functioning anatomy, and libido. Testosterone is in part responsible for the anatomy and blood flow of the penis, and therefore Low Testosterone can be a prime contributor to erectile dysfunction. Medical conditions such as diabetes, cardiovascular disease, and high blood pressure can affect erectile function as well.
Depressed Mood and Loss of Motivation: Depression or low mood can be a frustrating symptom to deal with. Signs include no longer enjoying activities as before, lack of motivation, fatigue, and sadness. Depression can prevent us from getting proper sleep, exercising, and taking care of our health.
Loss of Muscle Mass: Exercise in general, and weight lifting in particular, should increase muscle mass in men. Testosterone promotes the growth of muscle fibers, and it is known that Low Testosterone can actually result in loss of muscle mass. Men will notice that although they exercise regularly, and some even intensely, that it is very difficult for them to put on muscle.
Metabolic Syndrome: Metabolic syndrome is a condition that causes abdominal obesity, elevated blood pressure, and heightened cholesterol levels – all risk factors that increase a patient’s chance of developing diabetes and heart disease, or having a stroke. Generally, risk factors will include high blood pressure, elevated blood sugar, elevated LDL (bad) cholesterol, decreased HDL (good) cholesterol, high body mass index (BMI), and a large waist circumference. These issues can affect testosterone production. Other symptoms include decreased strength, difficulty losing weight, and trouble concentrating.
What causes Low T?
Testosterone levels tend to decrease with age, and after the age of 30, many men begin to notice the symptoms of Low T. Since testosterone production is controlled by hormones in the pituitary gland (located in the brain), testosterone levels can be low when these hormones are abnormal. Other less common causes include increased estrogen levels, trauma to the testicles, and anabolic steroid use.
While Low T is often the primary issue causing the aforementioned symptoms, some people find that other issues – from medical conditions like depression and anxiety to non-medical issues like stress at work or home – also bear some of the blame for dips in libido and sex drive, erectile dysfunction, and depression. As always, it’s important to discuss your symptoms and treatment options with your doctor.
How do you diagnose Low T?
A thorough history and physical examination is performed, along with blood work. Since symptoms can be caused by other medical conditions, a comprehensive lab panel is conducted to account for any other reasons a patient may be experiencing low libido, fatigue, and erectile dysfunction. Sleep disorders, such as sleep apnea, should also be evaluated.
What are the treatment options?
Treatment for Low Testosterone is based on symptoms and correlating lab results.
Testosterone supplementation is often prescribed, and can be delivered through a wide range of methods, including topical gels and creams, subcutaneous pellets, injections, or orally ingested tablets. At my practice, we typically recommend starting treatment with a topical gel or cream, monitoring progress, and proceeding from there.
With most forms of treatment, testosterone levels are routinely evaluated with patient follow-up every three months. Clomid is an oral medication, typically used to treat male and female infertility. It is also a great option for patients with Low Testosterone who wish to maintain their fertility.
Can testosterone be naturally increased?
It can, to some degree. The best thing you can do to naturally increase your T level is by improving your diet and exercise habits. Central belly fat, in particular, converts testosterone into estrogen, leaving you with a lower T level. By maintaining a healthy diet and doing cardiovascular exercise, body fat decreases. Low vitamin D has also been linked to Low Testosterone. Try multivitamins, a vitamin D supplement, or thirty minutes in the sun to increase vitamin D levels. Getting proper sleep and seeing your primary care physician for yearly labs and physicals are also important.
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