Low testosterone, also known as hypogonadism, is a condition in which a man’s testosterone is below the normal reference range of the laboratory. The treatment of low testosterone is based not only upon blood work but also upon appropriate symptoms.
According to the American Urological Association, about 2 out of 5 men over age 45 and 3 out of 10 men older than 70 have low testosterone.
Low testosterone (low T) occurs when levels fall below 300 nanograms per deciliter (ng/dL). A normal range for men is typically 300–1,000 ng/dL, according to the U.S. Food and Drug Administration.
Low testosterone at a glance
- Production of testosterone, a hormone affecting emotion and appearance, ramps up during puberty and starts to gradually decline as men age.
- A lower than normal level of testosterone, however, can cause a variety of symptoms including a lower sex drive, sleep loss, hair loss, mood changes and an increase in body fat.
- A urologist can conduct a blood test to determine if/when testosterone falls below the normal levels circulating in the body.
- If low testosterone is diagnosed, a doctor may recommend testosterone replacement therapy to boost the levels of testosterone.
- Treatment may relieve symptoms and help keep bones and muscles strong; however, there is no cure for low testosterone.
- Men should not take testosterone if not recommend and directed by a physician.
Low testosterone symptoms and risk factors
Low testosterone is typically divided into two categories – primary and secondary.
- Primary refers to a problem whereby the testicle itself cannot produce enough testosterone.
- Secondary refers to a problem with the pituitary gland whereby appropriate signals are not sent to the testicle in order to produce testosterone.
Many men with low testosterone have neither a primary or secondary cause. In many of these men, low testosterone is simply related to poor overall general health. Men with obesity, high cholesterol, high blood pressure and diabetes are particularly at risk. Chronic opiate (narcotics) use may contribute to a low testosterone level. Patients who have used anabolic steroids may develop testosterone production problems.
Men may have a range of symptoms including:
- Lower sex drive
- Erectile dysfunction
- Low semen volume
- Hair loss
- Loss of muscle mass and strength
- Weight gain
- Low bone density
- Difficulty concentrating, poor memory.
- Depression and anxiety
- Decrease in bone mass
- Loss of body and beard hair
- Fatigue
While each of the symptoms above may result from lowered testosterone levels, they may also be normal side effects of aging.
To determine what’s causing these symptoms, schedule an appointment with a urologist.
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Risk factors for low T
Outside of aging, certain health issues can also contribute to the risk of low testosterone including:
- High blood pressure (about 40 percent of men also have low testosterone)
- High cholesterol (about 40 percent also have low testosterone)
- Diabetes (about 50 percent also have low testosterone)
- Obesity (about 50 percent also have low testosterone)
- HIV (about 30 percent have low testosterone)
- AIDS (about 50 percent also have low testosterone)
- Long-term opioid use (almost 75 percent also have low testosterone).
Diagnosing low testosterone
A blood test called a serum testosterone test is used to determine the level of circulating testosterone in a body.
Other tests may be required. A urologist may also conduct a PSA (prostate-specific antigen) blood test to check for signs of prostate cancer. He/she may also measure the red blood cells in the body (hematocrit) to keep a baseline record of red blood cell counts, because they can go up after taking testosterone.
These tests administered and interpreted by a urologist, can help reveal whether any underlying conditions, health issues or lifestyle choices are affecting testosterone production and whether treatment is needed.
Treating low testosterone
A thorough physical examination, including blood tests are performed to determine your hormone levels and identify potential health problems.
Other tests may be required. A urologist may also conduct a PSA (prostate-specific antigen) blood test to check for signs of prostate cancer. He/she may also measure the red blood cells in the body (hematocrit) to keep a baseline record of red blood cell counts, because they can go up after taking testosterone.
These tests administered and interpreted by a urologist, can help reveal whether any underlying conditions, health issues or lifestyle choices are affecting testosterone production and whether treatment is needed.
For example, obesity is a major cause of low testosterone. The only way to restore normal testosterone levels is with hormone replacement therapy. Testosterone is available in several forms, including:
- Injections
- Oral tablet
- Intranasal (gel placed in your nose)
- Pellet (implanted under your skin)
- Buccal (patch placed on your gums)
- Transdermal (patches, creams, and gels placed on your skin)
A urologist will talk with you about the pros and cons of each form and recommends the one that’s best for you. Your symptoms improve as your testosterone levels return to normal.
Testosterone replacement may interrupt sperm production, however. If you plan on having children soon, we may recommend adding treatment to boost sperm production.
Testosterone replacement therapy (TRT)
A variety of treatment options called “testosterone replacement therapy” are available to supplement the body’s testosterone levels. TRT may be taken as an injection, implant or via a gel or patch.
Treatment may relieve symptoms and help keep bones and muscles strong, however, there is no cure for low T.
To schedule an appointment with a urologist: Request appointment