Testosterone is a hormone produced primarily in the testicles in males, with smaller amounts also made by the adrenal glands and ovaries in females. This hormone plays a broad role in the body, influencing various functions beyond just reproductive health. It helps regulate sex drive, supports bone mass, affects fat distribution, contributes to muscle mass and strength, and is involved in the production of red blood cells and sperm. When the body does not produce enough of this hormone, it results in a medical condition known as testosterone deficiency, or male hypogonadism.
Causes of Low Testosterone
Low testosterone can arise from issues in different parts of the body, categorized into two main types. Primary hypogonadism stems from a problem directly within the testicles. Conditions affecting the testicles, such as an injury, infection like mumps orchitis, or genetic disorders like Klinefelter syndrome, can lead to this deficiency. Cancer treatments involving chemotherapy or radiation to the testicles can also impair their function.
Secondary hypogonadism occurs when the brain’s signaling glands, the hypothalamus or pituitary gland, do not properly stimulate testosterone production. These glands regulate hormones that tell the testicles to produce testosterone. Conditions such as pituitary disorders, inflammatory diseases, or chronic illnesses like HIV/AIDS, can disrupt this signaling pathway.
Obesity and poorly managed type 2 diabetes are often linked to secondary hypogonadism, as excess body fat can convert testosterone into estrogen. Testosterone levels also naturally decline with age, typically beginning around age 30. Certain medications, including opiate pain relievers, may also affect testosterone production.
Signs and Symptoms of Deficiency
Testosterone deficiency manifests through a range of changes affecting sexual function, physical characteristics, and emotional well-being. Individuals may experience a reduction in sex drive. Erectile dysfunction is a frequent symptom, alongside a decrease in spontaneous morning erections. Reduced sperm production can also occur.
Physical changes associated with low testosterone include an increase in body fat, particularly around the abdomen, and a decrease in muscle mass and strength. Persistent fatigue is common. Bone density may also diminish, increasing osteoporosis and fracture risk. Other physical signs can include a reduction in facial and body hair, and some men may experience hot flashes or the development of breast tissue.
Beyond physical manifestations, low testosterone can impact emotional and cognitive states. Mood swings, irritability, and depression are common. Difficulty concentrating, memory problems, or “brain fog” may also occur. Sleep issues, such as difficulty falling or staying asleep, can also be present.
The Diagnostic Process
Confirming testosterone deficiency involves a structured approach, as symptoms alone are often insufficient for a diagnosis. The process begins with a discussion of the individual’s symptoms and a medical history review, including current medications or chronic conditions. A physical examination follows, where the provider assesses general physical development, including body hair distribution, muscle mass, and the size of the testes.
The definitive step in diagnosis is a blood test to measure total testosterone levels. This test is usually performed in the morning, typically between 7:00 a.m. and 10:00 a.m., because testosterone levels are generally at their highest during these hours. To ensure accuracy, especially if the initial result is low, a healthcare provider often requires two separate blood samples on different mornings. A diagnosis is typically considered when total testosterone levels fall below 300 nanograms per deciliter (ng/dL), though specific thresholds can vary slightly among medical guidelines. Further blood tests, such as luteinizing hormone (LH) or prolactin, may be conducted to help determine if the cause originates in the testicles or the brain’s signaling glands.
Management and Treatment Options
Addressing testosterone deficiency often involves a combination of lifestyle adjustments and, when appropriate, medical interventions. Lifestyle strategies can support hormone health. Regular physical activity, particularly resistance training and high-intensity interval training, can improve testosterone levels. Maintaining a healthy body weight through a balanced diet is also beneficial, as obesity can negatively impact testosterone.
Ensuring sufficient sleep, ideally 7 to 9 hours per night, contributes to testosterone production. Managing stress through techniques such as meditation or yoga can also help, as high stress levels can interfere with hormone balance. Limiting alcohol consumption is another lifestyle consideration that can support healthier testosterone levels.
Beyond lifestyle changes, medical interventions often involve Testosterone Replacement Therapy (TRT), which aims to restore testosterone levels to a healthy range. TRT is available in several forms, chosen in consultation with a doctor based on individual needs and preferences.
- Topical gels or creams applied daily to the skin.
- Injections administered every one to two weeks.
- Patches applied to the skin daily.
- Small pellets inserted surgically under the skin, which release testosterone gradually over three to six months.
- Buccal tablets that adhere to the gumline and deliver testosterone three times a day.
Oral testosterone formulations are generally not recommended due to potential liver concerns and inconsistent hormone levels.