10 Signs Of Low Testosterone & How To Treat 2022
Testosterone is a male sex hormone most commonly attributed to men but also present in women. It’s the most important hormone in male health and well-being.
As we age, our testosterone levels drop, causing various health problems, from low sex drive to reduced cognitive function – especially in men.
Read on to learn the ten main signs of low testosterone, how to treat it, and the different types of testosterone supplements.
Signs Of Low Testosterone
- Low sex drive
- Erectile dysfunction
- Reduced cognitive function
- Low mood
- Loss of muscle mass
- Loss of body hair
- Increased risk of chronic diseases
- Increased body fat
What Does Testosterone Do?
The word ”testosterone” may bring to mind images of muscular men yelling while they lift weights, but that’s not a totally accurate representation.
Yes, testosterone is crucial for sexual desire and muscle mass, but it also plays a role in various common bodily functions, from bone to brain health.
In males, testosterone is produced by the testes. During puberty, a rise in testosterone triggers body and facial hair growth, a deepened voice, increased muscle mass, and the development of the penis and testes. It’s also linked to brain development and mood changes.
Throughout the lifespan, testosterone plays a role in many aspects of male health, from cognition to mortality risk.
In females, testosterone is produced at lower levels by the ovaries and adrenal glands. It’s mostly converted to estrogen, which leads to breast development and higher voices during puberty.
What Is Low Testosterone?
Testosterone is the main androgen hormone – the collection of male hormones, including testosterone and its derivatives.
Androgen deficiency is also called “hypogonadism,” which, if left untreated, can harm health and well-being in men. The prevalence of hypogonadism is about 39% in men aged 45 or older in the U.S.
Diagnosing low testosterone means considering both symptoms and lab values. Less than 300 ng/dl in men is an indication of hypogonadism.
Signs Of Low Testosterone
Here are the main symptoms and signs of low testosterone levels in men. Some are also signs of low testosterone in women, but not all.
Low Sex Drive
One of the first – and most obvious – signs of low testosterone in men and women is a low sex drive or libido.
Erectile dysfunction might be directly or indirectly linked to low testosterone levels.
Studies show that increasing testosterone levels via testosterone replacement therapy (TRT) can improve sexual function in older men with low levels. However, it seems that this therapy is no better than lifestyle modifications.
It turns out that erectile dysfunction – and low testosterone – is also associated with metabolic dysfunction, such as type 2 diabetes and obesity. Further studies suggest that erectile dysfunction is associated with obstructive sleep apnea, which is itself associated with obesity.
So, before starting testosterone therapy, those with mild testosterone deficiency could consider healthy diet and lifestyle changes to improve erectile dysfunction. This, of course, includes addressing your weight issues and controlling your blood sugars.
Reduced Cognitive Function
Low testosterone levels could impact cognition and memory in men.
Studies show that low testosterone levels are associated with worse cognitive performance in older men. Further studies even suggest that low testosterone levels speed up cognitive decline in Alzheimer’s disease by slowing brain glucose metabolism.
Can TRT Improve Cognition?
Most studies suggest so. A recent meta-analysis found that TRT improved basic cognitive functions such as self-control and working memory.
Further studies suggest testosterone therapy may reduce the risk of dementia and slow down the progression of Alzheimer’s disease – but only in men with low testosterone levels.
However, the results aren’t yet confirmed. TRT doesn’t seem to improve many aspects of cognition (such as attention and verbal memory), and a long-term study of men on TRT found no significant improvements in cognition or memory after one year.
There seems to be a link between irregular testosterone levels and mood in men and women.
Studies show that men aged between 60 and 65 years old with low testosterone levels are less likely to report feeling in good spirits. The study also indicated that testosterone might be useful in treating depression in older women.
However, the same study found that men with both very high and very low dihydrotestosterone levels – a more potent hormone derivative of testosterone and the hormone used in TRT – were more likely to have severe major depression. This indicates that testosterone levels should be finely balanced for mood regulation.
Loss Of Muscle Mass
We all know that bodybuilders stimulate muscle growth by taking anabolic steroids, which are mostly testosterone. That’s because testosterone has a trophic effect on skeletal muscle.
Can TRT Improve Muscle Mass?
Studies suggest that TRT increases muscle mass and physical strength as measured by stair-climbing power. Furthermore, animal studies suggest that supplementing testosterone increases oxidative muscle metabolism, leading to improved sports performance (and, hence, faster muscle growth).
Loss of Body Hair
Testosterone plays an important role in regulating hair production in both men and women.
In women, high testosterone levels relative to female sex hormones increase the risk of body and facial hair.
Similarly, loss of body or facial hair is a common symptom of low testosterone in men. Studies suggest that testosterone therapy can increase facial hair – even one year after starting therapy.
However, hair loss is one of the signs of low testosterone but not all hair loss is a sign of low testosterone. Losing the hair on your head (i.e., male-pattern baldness) is associated with high levels of dihydrotestosterone (DHT) – a potent testosterone metabolite.
So, while testosterone therapy might help you grow a beard, it can also increase the risk of male-pattern baldness.
Anemia occurs when the number of red blood cells is below the normal range. Both men and women over the age of 50 are at higher risk of anemia, but almost a third of cases are “unexplained.” Could it have something to do with declining testosterone levels?
Well, studies show that testosterone deficiency increases the risk of anemia. It turns out that testosterone and other anabolic hormones play a role in regulating red blood cell production and iron bioavailability.
Furthermore, additional studies suggest that restoring testosterone levels via TRT can significantly reduce the prevalence of anemia in the aging population.
Testosterone helps build and strengthen bones. Both men and women with low testosterone levels are at higher risk of bone loss, osteoporosis, and fractures.
Actually, it’s the amount of testosterone relative to estradiol – a female sex hormone present in small amounts in men – that seems to matter. Studies show that serum testosterone and estradiol levels need to be above 200 nanograms/deciliter (ng/dl) and above 20 petagrams (pg)/dL, respectively, to prevent bone loss in males.
TRT can increase bone mineral density and reduce bone loss in older men with hypogonadism. However, there’s not yet enough evidence on the effect of TRT on fracture risk.
Increased Risk Of Chronic Diseases
Low testosterone levels are common in men with chronic diseases.
- Chronic kidney disease: Studies show that low endogenous testosterone may increase the risk of kidney disease and the risk of complications and death from chronic kidney disease.
- Type 2 diabetes: Studies show that men with lower testosterone levels are at higher risk of developing diabetes – independent of obesity.
- Cardiovascular disease: Studies show that low (or very high) testosterone levels are associated with adverse cardiovascular events, such as high blood pressure and heart disease.
Increased Body Fat
Testosterone plays a crucial role in regulating metabolism and body fat in men. Low testosterone levels are especially associated with increased central adiposity (i.e., belly fat).
Androgen deficiency increases adipose tissue expansion. However, obesity itself can also cause low testosterone levels.
Obesity can negatively affect testosterone production via metabolic dysfunction (i.e., insulin and leptin resistance), which interferes with hormone levels, leading to a runaway cycle of increasing body fat. Leptin is a hormone that regulates appetite, weight, and fat storage.
So, if you have low testosterone levels secondary to obesity, losing weight via lifestyle modifications might increase testosterone levels naturally. Combining lifestyle changes with TRT might further improve body composition, but more research is needed.
Causes Of Low Testosterone
The main cause of low testosterone is usually due to lower testosterone production during older age, also called late-onset hypogonadism.
Risk factors for low testosterone include
Medications that inhibit 5α-reductases for treatment of male-pattern baldness, such as finasteride and dutasteride, which block the conversion of testosterone to the more potent 5α-dihydrotestosterone. This is one of the main causes of low testosterone in males under 40.
Treatments For Low Testosterone
Low testosterone is diagnosed by a blood test measuring serum testosterone levels in the morning. The main treatment for low levels is TRT, which aims to get testosterone levels back within the normal physiologic range and improve symptoms of deficiency.
TRT can be administered differently, and clinicians prescribe the most suitable formulation for each patient. FDA-approved testosterone formulations include
- Transdermal patch
- Topical gel
- Buccal (applied to the upper gum or inner cheek)
- Intramuscular (i.e., injection)
Who Testosterone Treatment Is Not For?
In the USA, TRT is only approved by the Food and Drug Administration for men with low testosterone levels alongside other medical conditions. This treatment isn’t available for men with low testosterone levels without an associated medical condition.
Examples of applicable medical conditions are an inability to produce testosterone due to
- Genetic problems
- Brain structural problems
There’s no official testosterone therapy for women, but there are testosterone supplements for women available.
TRT may also be contraindicated for men with untreated prostate cancer. The benefits and risks of TRT will be discussed before treatment for men with a history of prostate cancer. However, more research on the safety of TRT for men with a history of prostate cancer is needed.
The Bottom Line
Testosterone is an important sex hormone for male health. Signs of low testosterone levels vary but include sexual dysfunction, depression, increased body fat, and muscle wastage.
Treatments to increase testosterone levels include testosterone replacement therapy, which isn’t available to everyone.
The best ways to boost testosterone levels naturally are through weight management, getting adequate restful sleep, maintaining normal vitamin D levels, eating healthy fats, exercising, and getting enough zinc.
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