Low testosterone is a common condition that impacts the sex life and the quality of life of millions of American men. This blog will discuss the symptoms of low T and what treatment options are available.
Testosterone is a hormone required for male development and is produced primarily in the testicles. It is responsible for building muscle and bone mass as well as sperm production and sex drive. It influences male pattern fat distribution, hair distribution such as a man’s beard, bone density, and red blood cell production.
Lack of or underproduction of testosterone either directly due to decreased production in the testes or indirectly due to lack of stimulation of the testes to produce testosterone by the pituitary gland is called hypogonadism and is a medical condition requiring treatment.
In the normal developing male, testosterone peaks during early adulthood. Once you reach age 30, testosterone levels slowly decline by approximately 1% a year. This is a normal part of aging.
The low limit of testosterone levels in men is about 300 nanograms per deciliter and the upper normal limit is approximately 1000-1200 ng/dl. A low level needs to be investigated further to distinguish it from normal aging.
Low testosterone (low-T) is underproduction or lack of production of testosterone.
Causes of low-T include chronic medical conditions such as diabetes, infections, obesity, or other hormonal conditions.
The symptoms of low-T include: erectile dysfunction (ED), decreased libido, change in sleep patterns, decreased sperm count and motility of sperm, and emotional changes such as depression and despondency.
My take home message is that low-T testing includes linking symptoms with testosterone blood levels.
Treatment options for low-T include different forms of testosterone therapy.
Some of the conditions that can lead to a low level are:
Diabetes (type 2)
Chronic medical conditions (especially liver or kidney disease)
What is the treatment for low testosterone (Low-T)?
Treatment of low testosterone is possible for most men who suffer from the symptoms of low T. There are several ways that testosterone therapy can be administered:
Transdermal (skin patch): Usually applied once a day (for example, Androderm). Tends to be clean and easy to apply. There is an available mouth patch which sticks to the upper gums and is applied twice daily.
Gels: Applied directly to the skin and then absorbed through the skin (for example, Androgel, and Axiron. Dosing is more difficult although these gels are available in single applications packages or premeasured pumps.
Injections: Testosterone can be delivered by direct injection.
Pellets: Pellets can be implanted into the soft tissue and release the testosterone.
I am often asked what treatment options are available that do not require any medications, gels, or injections. My advice is to get enough sleep, keep a healthy weight, and stay active.
Possible side effects and risks of testosterone therapy for the normal aging male include:
Stimulation of growth of the prostate (benign prostatic hypertrophy) and possible growth of existing prostate cancer. Please note that testosterone doesn’t cause prostate cancer, but if you have prostate cancer, testosterone can accelerate the growth of an existing cancer.
Limiting sperm production and shrinkage of testicles
Over-production of red blood cells (which can be a contributor to a heart attack)
Some studies have implicated testosterone in an increase in cardiovascular events although there are studies that suggest that low testosterone levels places men at risk for heart disease and stroke.
Testosterone therapy is accepted as a treatment for men with symptoms of low T, which is a clearly defined medical condition.
In older adults who have markedly decreased testosterone levels without significant symptoms or who have modestly decreased levels with significant symptoms, testosterone therapy should be considered after a discussion with your doctor about side effects and possible positive effects of therapy.
Bottom Line: Testosterone deficiency is a common problem in middle age and older men. The diagnosis is easily made with a blood test to check the level of testosterone. Treatment can be accomplished with injections, topical gels, or pellets. For more information, speak to your physician.