What is low testosterone (male hypogonadism)?
Low testosterone (male hypogonadism) is a condition in which your testicles don’t produce enough testosterone (the male sex hormone). Testicles are the gonads (sex organs) in men, More specifically, the Leydig cells in your testicles make testosterone.
Low testosterone causes different symptoms at different ages. Testosterone levels in adult males naturally decline as they age.
Other names for low testosterone and male hypogonadism include:
- Testosterone deficiency syndrome.
- Testosterone deficiency.
- Primary hypogonadism.
- Secondary hypogonadism.
- Hypergonadotropic hypogonadism.
- Hypogonadotropic hypogonadism.
What does testosterone do?
Testosterone is the main androgen. It stimulates the development of male characteristics and is essential for sperm production (spermatogenesis). Levels of testosterone are naturally much higher in men than women with men producing 3-10mg a day and women 0.5mg a day
In Men, testosterone helps maintain and develop:
- Sex organs and genitalia.
- Muscle mass.
- Adequate levels of red blood cells.
- Bone density.
- Sense of well-being.
- Sexual and reproductive function.
Your body usually tightly controls the levels of testosterone in your blood. Levels are typically highest in the morning and decline through the day.
Your hypothalamus and pituitary gland normally control the amount of testosterone your testicles produce and release.
Your hypothalamus releases gonadotropin-releasing hormone (GnRH), which triggers your pituitary gland to release luteinizing hormone (LH). LH then travels to your gonads (testicles or ovaries) and stimulates the production and release of testosterone. Your pituitary also releases follicle-stimulating hormone (FSH) to cause sperm production.
Any issue with your testicles, hypothalamus or pituitary gland can cause low testosterone (male hypogonadism).
What is a low testosterone level?
The American Urology Association (AUA) considers low blood testosterone to be less than 300 nanograms per deciliter (ng/dL) for adults. Normal reference range for T being 300-1000ng/dl or 10.4-34.7nmol/L. In this case one man can have three times as much testosterone as another man yet both would be considered (normal).
However, some researchers and healthcare providers (specifically in Canada) disagree with this and feel that levels below 250 ng/dL are low. (That would put someone at the similar level as the Try guys from BuzzFeed…yikes) Providers also take symptoms into consideration when diagnosing low testosterone.
Who does low testosterone (male hypogonadism) affect?
Male hypogonadism is a medical condition that can affect people with testicles at any age from birth through adulthood.
Low testosterone is more likely to affect people who:
- Are older.
- Have obesity.
- Have poorly managed Type 2 diabetes.
- Have obstructive sleep apnea.
- Have chronic medical conditions, such as kidney dysfunction or cirrhosis of the liver.
- Have HIV/AIDs.
How common is low testosterone?
It’s difficult for researchers to estimate how common low testosterone is since different studies have different definitions for low testosterone.
Most men assume that low testosterone only occurs in older individuals. It’s a sign of aging, right? A sign of a life well lived that the body is simply winding down from?
While lower testosterone is common among many older men, that doesn’t mean it can’t happen to men of all ages. In fact, nearly 1 in 4 men under 30 have low T. Low testosterone in young men can occur for a variety of reasons, many under your control. It’s important to know the warning signs so you can take proper steps.
If you happen to be under 30, this all may apply to you. This article will introduce seven common signs of low testosterone and offer a little bit of insight into potential cases and treatments.
Causes Of Low Testosterone In Young Men
Low testosterone in young men occurs for several reasons that can depend on your health and lifestyle. Many of these causes are manageable if you or a doctor can correctly identify them in order to make certain changes.
Certain physical causes of low T include high blood pressure, cholesterol, and being overweight. Other conditions such as certain diseases and tumors can also be linked to low T. Lifestyle habits like heavy drinking and doing illegal drugs can contribute to low T. In particular, the use of anabolic steroids and other prescription drugs can prevent the body from producing the typical testosterone it needs to function.
A doctor can help diagnosis and potentially identify the underlying causes of low T. First, however, you need to recognize the more common signs of low testosterone in young men.
Seven Signs
Recognizing one of these seven signs will allow you to get on track to fixing the problem. While this list isn’t exhaustive, it does present some of the more common warnings you should notice if you find yourself experiencing any of these signs.
Decreased Libido
Testosterone is one of the main ingredients involved with a healthy level of sexual activity. If you notice any sort of decrease in your sexual activity, it may be a sign of low testosterone.
A lower libido typically means you are less interested in sexual activity or are less aroused by the usual triggers. Erectile dysfunction can also be a temporary symptom of a lower libido.
Hair Loss
Hair loss can be typical for some young men depending on genes and family history, but for most people, it’s a sign that something is wrong. Lower testosterone can lead to rapid hair loss. This should be a sign you immediately act on.
Watch out for hair loss as you shower, shave, or brush your teeth. Loose hair in the sink or bath tub will be noticeable over time. This kind of hair loss will also be independent of any season changes.
Since this is a symptom of low T, treating your condition should eventually allow your body to regrow any hair lost.
Reduced Muscle Mass
Testosterone is important in the process of building and maintaining a normal, healthy level of muscle mass. If you regularly workout, you should be able to maintain your normal amount of muscle mass with the same amount of effort. If things change, it’s time to take note.
Lower testosterone in young men makes it more difficult to maintain the same level of muscle mass. You may either have to increase your workout routine or you will notice a natural decrease if your routine is unchanged.
Continuous Fatigue
Feeling tired or sleep deprivation can be normal depending on your job and lifestyle. However, chronic fatigue may be a sign that your body doesn’t have the appropriate amount of testosterone it needs to stay active. Low T will make it more difficult for your body to maintain its normal level of activity throughout the day.
Pay attention to how long and frequently you experience fatigue on a daily basis. If it lasts for several days to weeks, see a doctor to rule out low T as a cause.
Depression
Your general mood is affected by a number of internal and external factors ranging from your health to the stress in your daily life. Depression is a common emotional experience for most young men. Low T, however, can lead to more frequent or prolonged episodes. These can even cross the emotional border into chronic depression.
If you experience this, it’s important to treat the cause of the depression correctly. There are a number of drugs meant for psychological causes that may not work for you if low T is to blame.
Increased Body Fat
Similar to reduced muscle mass, low testosterone in young men can also make it more difficult for your body to process the normal amount of food you eat. This means you may notice more body fat over time despite your normal diet and exercise routine. If you change your diet or exercise routine without any noticeable effect, there is probably some underlying cause related to low T.
Sleep Disturbance
Daily fatigue may be an indirect sign of low testosterone in young men if your normal sleeping habits are being interrupted. The average adult needs anywhere from 7 to 9 hours of uninterrupted sleep each night.
Low T may interrupt this by waking you up in the middle of the night or preventing you from falling asleep at your normal time. Insomnia, or a persistent lack of sleep, should be addressed with a doctor.
Getting Better
If you notice any of these signs, it’s important to seek medical attention as soon as possible. Testosterone is involved with a number of body functions, many of which will be harmed if low testosterone lingers.
A medical professional will be able to offer you the specifics of your condition and possible treatments. Treatment usually includes testosterone replacement shots. These shots are taken regularly for a certain period of time until the symptoms of low T begin to decrease.
To learn more about low T or to explore treatment options, feel free to contact us for personal assistance. We are happy to help.
SYMPTOMS AND CAUSES
What are the symptoms of low testosterone?
Symptoms of low testosterone can vary considerably, particularly by age.
Symptoms that highly suggest low testosterone in adults males include:
- Reduced sex drive.
- Erectile dysfunction.
- Loss of armpit and pubic hair.
- Shrinking testicles.
- Hot flashes.
- Low or zero sperm count (azoospermia), which causes male infertility.
Other symptoms of low testosterone in adult males include:
- Depressed mood.
- Difficulties with concentration and memory.
- Increased body fat.
- Enlarged male breast tissue (gynecomastia).
- Decrease in muscle strength and mass.
- Decrease in endurance.
Symptoms of low testosterone in children
Low testosterone before or during puberty for children assigned male at birth can result in:
- Slowed growth in height, but their arms and legs may continue to grow out of proportion with the rest of their body.
- Reduced development of pubic hair.
- Reduced growth of their penis and testicles.
- Less voice deepening.
- Lower-than-normal strength and endurance.
What causes low testosterone?
There are several possible causes of low testosterone. The two types of male hypogonadism are:
- Primary hypogonadism (testicular disorder).
- Secondary hypogonadism (pituitary/hypothalamus dysfunction).
Causes of primary and secondary hypogonadism are also divided into either congenital (at birth) or acquired (developed later in childhood or adulthood).
Causes of primary male hypogonadism
Primary hypogonadism happens when something is wrong with your testicles that doesn’t allow them to make normal levels of testosterone.
Another name for primary hypogonadism is hypergonadotropic hypogonadism. In this type, your pituitary gland produces more luteinizing hormone (LH) and follicle-stimulating hormone (FSH) (known as gonadotropins) in response to low testosterone levels. The high levels of these hormones would normally tell your testicles to produce more testosterone and sperm. However, if you have damaged (most commonly related to prior chemotherapy) or missing testicles, they can’t respond to the increased levels of gonadotropins. As a result, your testicles make too little or no testosterone and sperm.
Sometimes in primary hypogonadism testosterone levels are within the normal range and gonadotropins are high. Your specialist will help you understand if you need treatment, even with normal testosterone levels.
Congenital conditions that affect your testicles and can lead to primary hypogonadism include:
- Absence of testicles at birth (anorchia).
- Undescended testicles (cryptorchidism).
- Leydig cell hypoplasia (underdevelopment of Leydig cells in your testicles).
- Klinefelter’s syndrome (a genetic condition in which people AMAB are born with an extra X chromosome: XXY instead of XY).
- Noonan syndrome (a rare genetic condition that can cause delayed puberty, undescended testicles or infertility).
- Myotonic dystrophy (part of a group of inherited disorders called muscular dystrophies).
Acquired conditions that affect your testicles and can lead to primary hypogonadism include:
- Testicle injury or removal.
- Orchitis, which is inflammation of one or both testicles. This is most often the result of a bacterial infection, such as a sexually transmitted infection, but it can be due to viral infections, such as mumps.
- Chemotherapy or radiation therapy to your testicles.
- Certain types of tumors.
- Anabolic steroid use.
Causes of secondary male hypogonadism
Conditions that affect how your hypothalamus and/or pituitary gland cause secondary hypogonadism. This is known as hypogonadotropic hypogonadism because there are low levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Those low levels cause decreased testosterone and sperm production.
Congenital conditions that can lead to secondary hypogonadism include:
- Isolated hypogonadotropic hypogonadism (a condition that causes low levels of gonadotropin-releasing hormone from birth).
- Kallmann syndrome (a rare genetic condition that causes loss of the development of nerve cells in your hypothalamus that produce gonadotrophin-releasing hormone. It can also cause a lack of smell.).
- Prader-Willi syndrome (a rare genetic multisystem disorder than can cause hypothalamus dysfunction).
Acquired conditions that can lead to secondary hypogonadism include:
- Hypopituitarism (This condition may result from an adenoma, infiltrative disease, infection, injury, radiation therapy or surgery that affects your pituitary gland.).
- Hyperprolactinemia.
- Iron overload (hemochromatosis).
- Brain or head injury.
- Cushing’s syndrome.
- Cirrhosis of the liver.
- Kidney failure.
- HIV/AIDS.
- Alcohol use disorder.
- Poorly managed diabetes.
- Obesity.
- Obstructive sleep apnea.
- Certain medications, including estrogens, psychoactive drugs, metoclopramide, opioids, leuprolide, goserelin, triptorelin and newer androgen biosynthesis inhibitors for prostate cancer.
Late-onset hypogonadism (LOH) is a type of secondary male hypogonadism that results from normal aging. As males age they have a deterioration of hypothalamic-pituitary function and Leydig cell function that decrease testosterone and/or sperm production.
LOH and low testosterone are more common in men who have Type 2 diabetes, overweight and/or obesity.
In one study, 30% of Men who were overweight had low testosterone, compared to only 6% of those with weight in the normal range. In another study, 25% of men with Type 2 diabetes had low testosterone, compared to 13% of those without diabetes.
DIAGNOSIS AND TESTS
How is low testosterone diagnosed?
If you have signs and symptoms of low testosterone, a healthcare provider will perform a physical exam. They’ll also ask questions about your medical history, medications you take or have taken, smoking history and any symptoms you currently have. Blood tests may be ordered.
To make a diagnosis, a provider will consider your specific signs, symptoms and any blood test results.
What tests will be done to diagnose low testosterone?
The following tests can help confirm low testosterone and determine the cause:
- Total testosterone level blood test: This test usually requires two sample collections between 8 a.m. and 10 a.m., when testosterone levels should be at their highest. If you’re sick or have recently been sick, it’s important to tell your provider. Acute illness may cause a falsely low result.
- Luteinizing hormone (LH) blood test: This test can help determine if the cause of low testosterone is an issue with your pituitary gland.
- Prolactin blood test: High prolactin levels may be a sign of pituitary gland issues or tumors.
MANAGEMENT AND TREATMENT
How is low testosterone treated?
Healthcare providers treat low testosterone (male hypogonadism) with testosterone replacement therapy. Testosterone replacement therapy has several different forms, including:
- Testosterone skin gels: You apply the gel every day to clean, dry skin as directed. It’s important that you don’t transfer the gel to another person through skin-to-skin contact. Testosterone skin gels are one of the most common forms of treatment in the U.S. due to its ease of use but can get very expensive vs injectable and also low bioavalibility.
- Intramuscular testosterone injections: You or a provider can administer the injections into a muscle every 1 to 2 weeks. Providers can administer long-acting testosterone by injection every 10 weeks. There are also subcutaneous injection options. (this is the most efficient and cost effect form of replacement therapy)
-we do not recommend spacing out shots that long due to an unstable blood level. Every 5 days would be ideal for trt.
- Testosterone patches: You apply these patches every day to your skin as directed. You usually have to rotate their location to avoid skin reactions.
- Testosterone pellets: A specialist implants these pellets under your skin every three to six months. The pellets provide consistent and long-term testosterone dosages.
- Buccal testosterone tablets: These are sticky pills that you apply to your gums twice a day. The testosterone absorbs quickly into your bloodstream through your gums.
- Testosterone nasal gel: You apply a testosterone gel by applying it into each nostril three times a day.
- Oral testosterone: A pill form of testosterone undecanoate is available for people with low testosterone due to specific medical conditions, such as Klinefelter syndrome or tumors that have damaged their pituitary gland.
You may not be able to receive testosterone replacement therapy if you have a history of the following:
- Prostate cancer.
- An unevaluated lump on your prostate. Everyone considering testosterone replacement therapy must undergo prostate screening before starting this therapy.
- Breast cancer.
- Uncontrolled heart failure.
- Untreated obstructive sleep apnea.
What are the side effects of testosterone replacement therapy?
The side effects of testosterone replacement therapy include:
- Acne or oily skin.
- Swelling in your ankles caused by mild fluid retention.
- Stimulation of the prostate, which can cause urinary symptoms such as difficulty peeing.
- Breast enlargement or tenderness.
- Worsening of sleep apnea.
- Smaller testicles.
- Skin irritation (if you use topical testosterone replacement).
Laboratory abnormalities that can occur with testosterone replacement therapy include:
- Increase in prostate-specific antigen (PSA).
- Increase in red blood cell count.
- Decrease in sperm count, producing infertility (inability to have children), which is especially important in younger people who want to have biological children.
PREVENTION
Can low testosterone be prevented?
Healthcare providers and medical researchers don’t know how to prevent low testosterone from genetic conditions or damage to your testicles, hypothalamus or pituitary gland.
Lifestyle habits that may help keep testosterone levels normal include:
- Eating a healthy diet.
- Exercise.
- Weight management.
- Avoiding excessive use of alcohol and drugs.
OUTLOOK / PROGNOSIS
What can I expect if I have low testosterone (male hypogonadism)?
There’s no one-time fix for low testosterone. However, consistent hormone replacement therapy helps improve sex drive, ease symptoms of depression and increase energy levels for many men experiencing low testosterone. Treatment may also boost muscle mass and bone density.
The mortality of men with testosterone deficiency is significantly higher than among men with normal testosterone levels
For congenital hypogonadism in children assigned male at birth, testosterone replacement therapy often helps prevent problems related to delayed puberty.
LIVING WITH
When should I see a professional about low testosterone?
If you’re taking hormone replacement therapy, regular follow-up appointments with a healthcare provider are important.
If you’re experiencing symptoms of low testosterone, such as a decrease in sex drive and hot flashes, talk to a healthcare provider. They will evaluate you and may order blood tests.
If your son isn’t showing signs of puberty by the age of 14, talk to their pediatrician.
Conclusion.
Many people shrug off the symptoms associated with low testosterone as an unpleasant part of getting older. But you should address symptoms that interfere with your quality of life. If you’re noticing bothersome signs of low testosterone, see a provider and discuss your options for treatment.