Are you worried that you may have low testosterone levels?
It’s difficult to determine the rate of low testosterone levels in the population. Experts estimate that approximately 2 out of every 100 men have low levels. For men over the age of 80 years, the incidence is approximately 50%.
Our specialists can help you to understand whether you may be suffering from low testosterone.
Keep reading to learn about testosterone levels and hormone replacement therapy for men.
Am I suffering from the Male Menopause?
Hormone replacement therapy in women is used after they go through the menopause. But you may not have heard the term, “male menopause”.
Another term used is andropause. These labels suggest that a sudden drop in testosterone happens to middle-aged men in the same way it affects women.
This analogy stems from the oestrogen and progesterone drop that occurs during female menopause. However, this isn’t the best comparison.
Testosterone is the hormone primarily produced in the male testes. This hormone stimulates the development of secondary sex characteristics in males and ramps up at puberty.
It’s true that testosterone levels decrease as men age. Men experience a steady decline at a rate of around 1% each year. This decline begins around age 30 to 40 years.
For most men, levels aren’t low enough for noticeable symptoms to occur. But for some it can make a huge difference to their quality of life.
Hypogonadism describes a condition where the testes produce few to no hormones. This may start at birth resulting in delayed puberty and underdevelopment of male attributes such as muscle mass and bone structure.
Hypogonadism may also begin later in life. Late development often occurs in conjunction with Obesity and Diabetes. This condition isn’t related to normal ageing as with female menopause where there is a specific onset when women pass the child-bearing age.
Read more on the Male Menopause here.
Impact of Obesity and Diabetes on Testosterone Levels
One study published in the International Journal of Research in Medical Sciences in July 2018 looked at testosterone levels in those with diabetes and obesity. They concluded that men with obesity, dyslipidemia, and diabetes had lower testosterone levels.
Dyslipidemia describes a total elevated low-density lipoprotein (LDL) cholesterol or low levels of high-density lipoprotein (HDL).
Another study published in Endocrine Connections in January 2018 concluded that increasing testosterone levels may, in fact, decrease the risk of developing Type 2 Diabetes.
Other Causes of Low Testosterone
Several other factors can impact an individual’s testosterone levels.
Injury, illness, or damage from external sources including:
- An injury that interrupts the blood supply to the testes
- Head trauma
- Radiation exposure
- Brain surgery
- Cancer treatment with chemotherapy
- Orchitis, an infection of the testes
- Alcohol abuse
- Use of anabolic steroids
Abnormal hormone and chemical levels in the body such as:
- Haemochromatosis, elevated iron levels
- Pituitary gland tumours or dysfunction impacts all hormone levels
- High prolactin levels, the hormone that promotes milk production
- High estrogen levels, often caused by an environmental or external source
- Severe primary hypothyroidism, low thyroid level
Disease processes including:
- Cirrhosis of the liver
- Chronic renal, kidney, failure
- HIV and AIDS
- Sarcoidosis, which causes swelling in the lungs and other organs
- Kallman syndrome, abnormal growth of the hypothalamus which controls hormone levels
- Kleinefelter Syndrome, a birth defect associated with abnormal chromosomes
- Obstructive sleep apnea
Symptoms of Low Testosterone
Problems with low testosterone are becoming more and more widespread but may not have an obvious cause.
Many men do not understand why they are experiencing changes.
Symptoms that may suggest low testosterone include:
- Decreased libido or sex drive
- Erectile dysfunction
- Fatigue and sleep disturbance
- Loss of muscle strength or mass
- Depressed mood
- Decreased self-confidence
- Lack of motivation
- Problems with concentration
- Changes in fat placement around the hips and waist.
- Gynaecomastia (male breast enlargement)
It’s important to note that these symptoms may or may not result from low testosterone levels. An evaluation by your doctor can help to determine the cause of your symptom
Impact of Low Testosterone on Fertility
Not all men with low testosterone levels experience infertility. Many individuals can still produce healthy sperm. The follicle-stimulating hormone is the main factor in the production of sperm. Depending on the cause of low testosterone you may have reduced sperm production or complete infertility (if the testicles are damaged or removed).
Low testosterone levels may impact the amount of sperm produced as intratesticular testosterone levels play a part in the process. Decreased sex drive and erectile dysfunction also affect fertility in a couple. You can read more on this here.
Tests for Low Testosterone
Good clinicians will order blood tests to check your testosterone level if you are showing the symptoms above.
Testosterone level. The blood sample should be taken in the morning after fasting. This helps to prevent false test results due to normal level fluctuations during the day.
These tests should be repeated on two different days to confirm the results. The practitioner should repeat the test to monitor the effectiveness of treatment.
Luteinizing hormone (LH) and follicle-stimulating hormone (FSH). The LH stimulates the production of testosterone in the testicles. FSH triggers sperm production alongside LH.
These tests are drawn at the same time to check for a testicular problem causing low testosterone. Or, if the pituitary gland or hypothalamus in your brain are not functioning properly.
Prolactin level. Prolactin comes from the pituitary gland. This test evaluates pituitary function when other tests suggest a possible problem.
High prolactin levels may signal the presence of a pituitary problem such as a tumour. The high level also interferes with normal testicular function.
Please contact us on the form below to find out which blood test is right for you.
You can read more about the required blood tests here.
Several lifestyle changes may help to balance your testosterone levels.
Smoking and drugs – Men who smoke tobacco or marijuana may have lower hormone levels including testosterone. Recreational and prescription medications can also affect hormone levels. Especially opioids and other pain killers.
Lose weight – Obesity is a well-documented cause of low testosterone levels. This is primarily the effect of the increased oestrogen production from excess body fat. This means more testosterone is converted into oestrogen and the pituitary gland is suppressed by this higher oestrogen level.
Nutritious diet and exercise – Eating a nutritious diet in conjunction with exercise helps to improve testosterone levels. Foods with zinc, magnesium and other vitamins are important for production of hormones.
Hormone Replacement Therapy (TRT) for Men
There are different opinions among experts about whether low testosterone levels need treatment or should be considered normal ageing.
The British Society for Sexual Medicine states that testosterone deficiency is problematic and common. They also state that not all men with low testosterone levels need hormone therapy. But in most cases, those with low levels and symptoms should be offered a trial of treatment.
Male hormone replacement involves taking testosterone. This is given by injections, transdermal patches, implants or gels. The goal is to raise the hormone level and decrease fluctuations throughout the day. These fluctuations are often responsible for mood and sexual changes.
Possible side effects can include an enlarged prostate, trouble sleeping and infertility. However, most side effects can be controlled with an effective protocol from a specialist. You can read more on TRT and potential side effects here.
It is important to be reviewed regularly by a specialist doctor who knows how to combat and prevent the development of these side effects. Our doctors specialise in this area
Are You Concerned About Your Testosterone Level?
If you are noticing changes that affect your daily life, contact us for more information on how to diagnose and treat this issue. Many men feel embarrassed and try to hide these problems. It’s important to find out if you have a testosterone deficiency that may be affecting you.
Treatment can help you regain your previous quality of life. If this article, Hormone Replacement Therapy for Men, provided new insight then please fill in the form below for answers to questions and to learn about testing and treatment options.
Dr Chris Airey
This article has been medically reviewed for accuracy by Dr Airey on 12th September 2020.
Dr Chris Airey is a fully registered UK doctor with the GMC (General Medical Council) Reference No: 7490533.
He trained at the University Hospital Southampton and graduated as a Doctor with a joint Bachelor of Medicine and a Bachelor of Surgery, plus a Masters in Medical Science, completing his research project in the Medical Neurosciences Department.
He is undertaking a Master of Science course in Endocrinology and is a member of the European Society for Sexual Medicine, and the Androgen Society.
He has personal experience with taking Testosterone Replacement Therapy and is a pioneer in UK treatment protocols for Testosterone Deficiency Syndrome.