Low testosterone is also known as “low T,” hypogonadism, and hypoandrogenism. Beginning around the age of 30, testosterone levels in men often start to decline. This can result in a variety of symptoms ranging from fatigue, difficulty with exercising and gaining muscle, weight gain, decreased sex drive, and erectile problems. Testosterone, in spite of its popular image as the sex hormone, is more complicated than we think. It is essential for normal functioning and development of the male body.
What is testosterone?
Testosterone is one of the hormones naturally produced by both men and women but is more pronounced in its effects for men, where it is produced mainly in the testes. Among its vital functions are affecting appearance and sexual development, stimulating sperm production and the sex drive, as well as building bone mass and muscle.
Perhaps because testosterone levels are so intimately connected with ideas of masculinity and virility, it can be difficult for men to talk about any worries they may have about low levels of testosterone.
Our aim in this article is to dispel any myths related to testosterone and help men everywhere understand how low testosterone may be affecting their lives.
12 signs of low testosterone in men
Signs of low T in men can be quite subtle, but when you know what to look for, it may help you determine if you should be evaluated for low testosterone.
Low sex drive
Because testosterone plays a key role in a man’s sex drive, men with low T can experience a marked reduction in their libido. A decline in sex drive is part of the natural aging process.
Erection problems
Testosterone is also important in maintaining an erection. It is not what directly causes the erection, but it has a major role in stimulating brain receptors that produce nitrous oxide. This molecule helps to trigger a series of chemical reactions necessary for an erection. However, low testosterone is the cause for about half of men who experience erection difficulties. Other causes can include thyroid malfunction, diabetes, smoking and alcohol use, and psychological factors such as stress or depression.
Reduced semen volume
A low volume of semen, the milky fluid that carries the sperm in ejaculate, can be one of the signs of low T.
Balding or premature hair loss
Balding is a natural part of the aging process for a great many men. There is no sure way to tell whether this is a result of low testosterone, but when it is, men can lose facial and body hair as well as showing the classic male pattern baldness on their heads.
Low energy and fatigue
Everyone has an off day from time to time, but the extreme fatigue caused by low testosterone levels is more pronounced. This could be the cause if you are constantly tired despite getting enough sleep and following a healthy lifestyle.
Reduced muscle mass
Because of its role in building muscle, men who have low T may notice a loss of muscle mass, which can also affect strength.
Increased body fat
Along with a reduction of muscle mass, the effects of low testosterone can include more body fat, quite often accompanied by an increase in breast tissue. This is believed to be the result of an imbalance in the hormones testosterone and estrogen.
A drop in bone density
The thinning of bone density known as osteoporosis is more commonly associated with women, but it can also be an effect of low testosterone in men. As a result, low T, especially in older men, can result in an increased tendency for bone fractures.
Mood swings
Just as testosterone influences many physical bodily functions, it can also have an impact on mental capacity and mood, and consequently men with low T are at increased risk of depression, difficulty focusing, and feelings of irritability.
Impaired memory
Since both testosterone levels and memory function decline naturally with age, some doctors have speculated that low T is directly associated with the decline in memory. However, studies on whether testosterone supplements result in improved memory have proved inconclusive so far.
Smaller testicles
A smaller than usual size of penis or testicles can be caused by low testosterone, but there are several other causes as well.
Low blood counts
A research article published in the Journal of the American Medical Association studied the links between low testosterone levels and anemia. It reported that administering a testosterone gel to anemic men resulted in improved blood counts compared with men administered a placebo.
What causes low testosterone levels?
Apart from the natural decline with advancing age, there are specific conditions that can cause low testosterone in men of all ages, even in young men and children. There are two types of hypogonadism, primary and secondary.
Primary hypogonadism
This is caused by underactive testes. The problem arises because the testicles don’t produce the levels of testosterone required for optimum health and growth. This can be caused by an inherited characteristic or result from injury or illness. Inherited conditions include:
- Undescended testicles, which is when the testicles do not descend from the abdomen, which normally happens in male children before birth.
- Klinefelter syndrome, a genetic condition in which the male inherits three sex hormones, XXY, rather than the normal two, XY.
- Too much iron in the blood, known as hemochromatosis, can cause pituitary or testicular failure.
Some types of injury, as opposed to inherited conditions, that can cause primary hypogonadism include:
- Physical injury or accident can affect testosterone levels if the injury involves both testicles.
- Mumps infection, particularly in adolescent boys.
- Testicles can also be damaged by cancer treatments such as chemotherapy and radiotherapy.
Secondary hypogonadism
Secondary hypogonadism is when the cause of low T is not directly related to the testicles. It results from damage to the pituitary gland or hypothalamus in the brain, which controls hormone production by the testicles. It can be the result of either inherited conditions or acquired circumstances. Inherited causes include:
- Disorders of the pituitary gland resulting from drugs, kidney failure, or tumors.
- Kallmann syndrome, which is associated with abnormal functioning of the hypothalamus.
- Inflammatory diseases like tuberculosis, which can affect both the pituitary gland and the hypothalamus.
- HIV/AIDS can also affect these parts of the brain as well as directly affecting the testes.
Acquired conditions that can lead to secondary hypogonadism include some of the following circumstances:
- The normal aging process affects both the production and response to all hormones, including testosterone.
- Obesity has an impact on T levels because fat cells affect hormone production and how the body responds.
- Some medications such as opioids and steroids can have an adverse impact on the hypothalamus and the pituitary gland.
It is possible for men, particularly as they age, to be affected by a combination of primary and secondary hypogonadism. Before we take a look at what you can do about this and what treatments are available, let’s look at how you can get a diagnosis.
How to diagnose low testosterone
Generally, a diagnosis of low testosterone depends on two factors: a measurement of testosterone levels in the blood and the display of some of the 12 signs of low testosterone in men detailed above.
Your physician will want to discuss any of these symptoms you may be experiencing and measure your blood levels, usually with two separate blood tests taken early in the morning on non-consecutive days. This is because testosterone levels typically fluctuate throughout the day but are at their highest in the early morning.
Levels of testosterone peak around the age of 17-19 but remain fairly stable for the next 20 years or so. A gradual decline starts around the age of 30 but for the majority, the decrease is only about 1% per year. By 70, levels have dropped for most men by around 30%, although three-quarters of older men still have levels in the normal range.
We measure testosterone by nanograms per deciliter of blood (ng/dL). There is a pretty wide variation in what is considered normal for healthy adult men, ranging between 300 to 1,000 ng/dL according to the Food and Drug Administration.
What is the average testosterone by age?
Here are the figures for older age groups:
- Men in their 40s: 252–916 ng/dL
- Men in their 50s: 215–878 ng/dL
- Men in their 60s: 196–859 ng/dL
- Men in their 70s: 156–819 ng/dL
In general, you would be diagnosed with low T if you have symptoms of hypogonadism and your levels fall below 300 ng/dL. If you do receive this diagnosis, you’ll be pleased to know that there are various remedies and treatments available.
Low testosterone treatments
Treatments that you can take care of yourself include healthy eating and some food supplements to boost your overall health. We will discuss specific foods that can help boost testosterone levels in our Frequently Asked Questions below.
However, diet alone often is not a cure for hypogonadism. Following a discussion with your physician, you could be prescribed testosterone replacement therapy. This would come in the form of skin patches, topical gels/creams, injections, or implantable pellets. Testosterone replacement has risks and side effects, so make sure you meet with your Urologist first.
Finally, as promised, we’ve rounded up some of the questions we hear most frequently from men who are concerned about their testosterone levels.
Frequently asked questions about low testosterone:
Does masturbating reduce testosterone?
In a word, no. The concern is understandable, but masturbating, like any form of ejaculation, is an entirely normal and natural thing to do and it does not reduce testosterone levels. This is one of the many old-fashioned myths about masturbation that needs to be discounted once and for all!
Does low testosterone make you tired?
Yes, one of the most common symptoms of low T is that you feel tired. If you feel tired even though you are getting 7 - 8 hours of sleep, low testosterone could be the culprit.
In addition to getting enough sleep, there are other things you can do to combat this. Eat a healthy diet and drink only in moderation because over-consumption of alcohol can cause a dysfunction of the liver, which can ultimately lower testosterone levels.
Exercise is also crucial here. Breaking a sweat helps you feel more energized and can naturally increase your testosterone levels.
What food causes low testosterone?
Some foods can have a direct effect on the hormone balance, while others have a negative effect on general health. Of those with a direct effect, soy products which contain phytoestrogens can cause an imbalance in natural hormone levels. More research is needed into the connection between consumption of soy products such as edamame and tofu and testosterone levels. Dairy products can also contain synthetic or natural hormones which could have an impact on hormone levels. More surprisingly, mint and spearmint, because of their menthol content, may reduce testosterone levels.
Less surprisingly, the items that come into the “we knew it all along” category include alcohol and smoking, both of which can reduce testosterone levels in men, as well as too many cakes, pastries, and desserts.
What foods boost testosterone?
Certain foods that are rich in nutrients such as Vitamin D, zinc, and other trace minerals can help boost testosterone as well as your overall health, especially if you are overweight. These include:
- Fish which are a good source of Vitamin D, such as tuna, sardines, and salmon. Aim for 2 – 3 portions a week.
- Low-fat milk enriched with Vitamin D. This gives you all the vitamins and nutrients of whole milk without the saturated fats.
- Egg yolks are a rich source of Vitamin D and as long as you have no cholesterol issues, you can safely include one egg a day in your overall diet.
- Oysters and other shellfish such as lobster or crab may be a benefit to your testosterone levels thanks to their zinc content.
- All legumes such as baked beans, lentils, and chickpeas are not only good sources of zinc but also offer plentiful plant fiber and proteins.
Does Vitamin D boost testosterone?
We have seen that foods rich in Vitamin D can help boost testosterone levels.
A study published by the National Center for Biotechnology Information found that this is also the case when Vitamin D is taken as a food supplement. It examined the effect of Vitamin D supplements on healthy overweight men undergoing a weight reduction program compared with a group receiving a placebo. The study found that among the group receiving Vitamin D, circulating concentrations of testosterone increased significantly but remained virtually constant in the control group.
There was a significant increase in total testosterone levels, bioavailable testosterone, and free testosterone levels compared with no change in the placebo group.
Synonyms for low testosterone:
Did you know that low testosterone is also known as male menopause (sometimes referred to as MANopause)? Well, now you do!
It’s a way of relating the age-related decline in testosterone to what happens to women at menopause, but in reality, they are quite different.
In women, the decline and eventual cessation of fertility happens over a relatively short period of time, whereas for men, the process happens over many years and fertility can continue into old age.
The correct term for this decline in testosterone levels is late-onset hypogonadism or age-related low testosterone. But we have to agree that “male menopause” makes for a catchier label!
Contacting us at Peak Men’s Health
We hope that our round-up of relevant facts about low testosterone has helped you recognize the signs and symptoms to make your own judgment about whether this may be affecting you personally or someone close to you.
Now is the time to take action! Low testosterone is easily treated and our expert urologists, Dr. Philip Cheng and Dr. James Hotaling can design a personalized plan that fits your lifestyle. Don’t suffer from the side effects of low T when the solution is only a click away.
