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Testosterone is a hormone that plays an important role in men's overall health. As men get older, their testosterone levels naturally fall.  However, some men may experience testosterone levels that are too low, also known as testosterone deficiency.  This can lead to weaker bones, loss of muscle and changes in mood, like feeling depressed. About 30% of men between the ages of 40 and 79 are affected by low testosterone. 

 

Low testosterone, or testosterone deficiency, happens when there is a reduced production of testosterone by the testicles.  There are two different types of testosterone deficiency; one as a result of an issue with the testicles or as a result of disruption in the area of the brain responsible for the functioning of the testicles and another due to getting older, diabetes or obesity.

Cause of testosterone deficiency

Are you experiencing symptoms like low energy, reduced sex drive, or difficulty concentrating? These could be signs of testosterone deficiency (TD), a condition that affects many men. But what exactly causes it and how can it be treated? Let's break it down.

First off, there are two main types of testosterone deficiency: classical and functional.

Classical Testosterone Deficiency

Classical testosterone deficiency is categorized into primary or secondary

Primary testosterone deficiency occurs when there's an issue with the testes. This could be something you were born with, like Klinefelter syndrome, or it could develop later in life due to factors like injury or infection. In primary TD, the testes don't produce enough testosterone, which can lead to symptoms like fatigue, decreased muscle mass, and sexual dysfunction. 

Secondary testosterone deficiency, on the other hand, involves problems with the signals that tell the testes to produce testosterone. This can be caused by issues with the pituitary gland or hypothalamus in the brain. Congenital conditions like Kallmann syndrome or acquired factors like pituitary tumors can disrupt these signals, leading to low testosterone levels and related symptoms.

Functional Testosterone Deficiency

Functional hypogonadism is often a combined dysfunction of the brain and testes and is often associated with advancing age, obesity, type 2 diabetes or certain medications such as opioids.

Symptoms of testosterone deficiency

Symptoms of testosterone deficiency (TD) can vary considerably, particularly by age. Understanding the symptoms of TD is crucial for early detection and effective management.

 

It's important to note that these symptoms can be caused by various factors other than testosterone deficiency, so it's essential for individuals experiencing these symptoms to consult with a healthcare professional for an accurate diagnosis and appropriate treatment.


Fatigue: Men with low testosterone levels often report feeling tired or fatigued, even after getting adequate sleep. Persistent fatigue or lack of energy can impact daily activities and overall quality of life.
Mood Changes: Testosterone influences mood regulation, and low levels of this hormone can contribute to mood swings, irritability, or feelings of depression. Men with low testosterone may experience changes in mood or emotional well-being.
Decreased Libido: Decreased libido refers to a reduction in sexual desire or interest. When someone experiences decreased libido, they may feel less inclined or motivated to engage in sexual activities. This can manifest as a lack of interest in sex, fewer thoughts or fantasies about sex, and reduced overall sexual motivation.
Loss of Muscle Mass: Testosterone plays a crucial role in maintaining muscle mass and strength. Men with low testosterone may notice a decrease in muscle mass, as well as reduced muscle tone and strength.
Increased Body Fat: Low testosterone levels can lead to an increase in body fat, particularly around the abdomen. This can contribute to weight gain and may be accompanied by changes in body composition.

Decreased Bone Density: Testosterone helps maintain bone density and strength. Low testosterone levels can increase the risk of osteoporosis or bone fractures due to decreased bone mineral density
Cognitive Changes: Some men with low testosterone may experience cognitive changes, such as difficulty concentrating, memory problems, or decreased cognitive function. Some men refer to this as “brain fog”.
Decreased Hair Growth: Testosterone plays a role in hair growth, including facial and body hair. Men with low testosterone levels may experience a reduction in facial or body hair growth.
Hot Flashes: While commonly associated with menopause in women, hot flashes can also occur in men with low testosterone levels. These sudden feelings of warmth or flushing may be accompanied by sweating and can occur intermittently.

Low sex drive
Difficulty achieving orgasm
Difficulty maintaining an erection (weak or no morning erection)
It's important to note that these symptoms can be caused by various factors other than testosterone deficiency, so it's essential for individuals experiencing these symptoms to consult with a healthcare professional for an accurate diagnosis and appropriate treatment.

What conditions are associated 
with testosterone deficiency?

Excess fat cells in the body convert testosterone into estrogen via an enzyme called aromatase.  This can lead to men showing signs of gynaecomastia otherwise referred to as “man-boobs”. Whilst it is true than losing weight can lead to natural increase in testosterone levels, men need to lose approximately 15% of body weight to see a significant increase in testosterone levels and this can be difficult for men to achieve.

This genetic disorder, characterized by the presence of an extra X chromosome (XXY), interferes with the normal development of the testicles. As a result, individuals with Klinefelter syndrome typically exhibit reduced testosterone production due to impaired testicular function.

Opioids, commonly prescribed for pain management, disrupt the normal functioning of the hypothalamus and pituitary gland. These brain structures play a crucial role in regulating testosterone production. Consequently, prolonged opioid use can lead to a rapid decline in testosterone levels, often noticeable within just a week of starting treatment.

While the precise relationship between low testosterone and erectile dysfunction remains incompletely understood, it's important to note that erectile issues can arise from various underlying health conditions besides testosterone deficiency. Nonetheless, low testosterone is often associated with chronic conditions such as type 2 diabetes and obesity, both of which contribute to erectile dysfunction through different mechanisms.

The connection between type 2 diabetes and TD is firmly established, with roughly half of men diagnosed with type 2 diabetes experiencing low testosterone levels. Notably, this association persists even in individuals without obesity. Studies have shown that a significant proportion of men with diabetes exhibit low testosterone alongside abnormalities in pituitary hormone levels, highlighting the complex interplay between metabolic health and testosterone regulation.

Testosterone levels naturally decline with age, dropping by approximately 1% per year after the age of 40. This age-related decline in testosterone production is compounded by the increasing prevalence of medical conditions such as obesity and type 2 diabetes as individuals grow older. Consequently, advancing age poses a dual risk factor for developing low testosterone levels.

Contracting the mumps virus during childhood can result in inflammation and damage to the testicles, leading to decreased testosterone production later in life. This highlights the importance of timely vaccination against infectious diseases to prevent potential long-term health consequences.

Both chemotherapy and radiation therapy, while effective in treating cancer, can inadvertently damage the testicles and disrupt testosterone production. While these effects are often temporary and reversible, some individuals may experience long-term or even permanent infertility as a consequence of cancer treatment. Notably, survivors of testicular cancer are particularly vulnerable to long-term testosterone deficiencies.

In cases where one or both testicles fail to descend properly during fetal development, there is an increased risk of impaired testicular function and reduced testosterone production. Although many cases of undescended testicles resolve spontaneously during early childhood, persistent undescended testicles may require medical intervention to prevent long-term complications.

What can be done naturally to increase testosterone levels?

Adequate sleep is essential for maintaining healthy testosterone levels. During sleep, the body produces testosterone and other hormones necessary for overall well-being and bodily functions. Aim for 7-9 hours of quality sleep per night to support optimal testosterone production.

Chronic stress can elevate cortisol levels in the body, which can suppress testosterone production. Engage in stress-reducing activities such as mindfulness meditation, deep breathing exercises, yoga, or hobbies that you enjoy. Managing stress effectively can help maintain hormonal balance and support healthy testosterone levels.

Nutrition plays a crucial role in testosterone production. Include a variety of nutrient-rich foods in your diet, such as lean proteins, healthy fats, fruits, vegetables, and whole grains. Certain nutrients like zinc, vitamin D, and omega-3 fatty acids are particularly important for testosterone synthesis. Incorporating foods rich in these nutrients, such as seafood, nuts, seeds, leafy greens, and fortified dairy products, can help support optimal testosterone levels.

Regular exercise is essential for maintaining testosterone levels and overall health. Both resistance training and cardiovascular exercise have been shown to boost testosterone production. Aim for a combination of strength training exercises, such as weightlifting or bodyweight exercises, and aerobic activities like running, cycling, or swimming. Consistent physical activity can help increase testosterone levels, improve muscle mass, and promote overall well-being.

Consulting with a fitness professional or personal trainer can help you develop a tailored exercise program to optimize testosterone production. They can provide guidance on effective workouts, proper form, and progression strategies based on your individual goals and fitness level. Working with a professional can help ensure that your exercise routine is safe, effective, and conducive to supporting healthy testosterone levels.

Talking to your healthcare professional about low testosterone

It can be difficult to talk about low testosterone but the sooner you start the conversation, the closer you will be to getting your life back in balance.

 

It might be useful to have a list of questions with you at your next appointment, such as:

 

  • I don’t feel ill; I just don’t feel like myself anymore. Could I have low testosterone?
  • Could the symptoms I’m experiencing be related to low testosterone? Considering my symptoms, could I be tested for low testosterone?
  • How do my diet, fitness and lifestyle affect my testosterone level?
  • If I need any, what medical treatment options are available for low testosterone?

     

Keeping track of your symptoms is important as it will help your healthcare team in deciding whether you should be tested for low testosterone.