Let’s Talk About Low Testosterone Levels

In a recent episode of The Dr. Jason Show, I sat down with urologist Dr. Jamin Brahmbhatt. We covered a lot of ground pertaining to men’s health, but spent a good deal of time talking about low testosterone levels.

As the male sex hormone—and as an important hormone for sex drive, muscle mass, body and facial hair, and a deep voice—testosterone is closely associated with masculinity, power, virility, and so on. I can tell you from my experience as a family physician that a lot of adult males worry about low testosterone levels and the effects it could have.

Along the same lines, men are often quick to jump to the conclusion that they have low testosterone. It’s not uncommon for them to try to pin low energy levels, diminishing sex drive, and other health concerns on low-T, as it’s sometimes called, or hypogonadism to be a little more scientific sounding.

I don’t mean to say that low testosterone doesn’t cause these symptoms, or that patients don’t ever have this problem. It’s not uncommon in middle-aged men—as many as 40 percent of men over 45 have low testosterone. But levels of this hormone naturally decline as we age; it’s not usually a disorder causing falling levels.

A Word About Testosterone Supplements

Part of the reason men are so quick to worry about and blame low-T may be exposure to marketing from the supplement industry. Testosterone supplements are aggressively promoted, all wrapped up in promises of great sexual prowess, unstoppable energy, and bulging muscles!

Before we go any further, it’s a bad idea to self-diagnose low testosterone, or to start taking an over-the-counter supplement on your own. It can have serious side effects and lead to heart problems and other serious concerns—especially if you don’t actually need it. Any type of hormone replacement therapy must be done under the close supervision of a doctor.

Symptoms of Low Testosterone Levels

Low testosterone causes a variety of symptoms. Some play to common fears in aging men, like diminishing sex drive, difficulty achieving or maintaining an erection, hair loss, loss of muscle mass, increased body fat, and low energy. Fatigue, anemia, mood swings, depression, and loss of bone density are other typical symptoms.

Of course, lots of these symptoms can have all sorts of causes. Many are often related to stress and lifestyle. These aren’t symptoms you can use to diagnose yourself, but they’re key clues that point your doctor toward testing to measure testosterone and other hormone levels.

A blood test is the only way to definitively diagnose low-T. And, as a side note, make sure to have your blood drawn between 7:00 am and 9:00 am, when testosterone levels even out on their roller coaster of daily fluctuations.

Defining Low Testosterone Levels

Again, your body starts producing less testosterone as you age—usually starting at around 30 years old. This makes it important to distinguish between low levels and levels that are too low. Naturally waning levels aren’t necessarily a problem, unless the effects are interfering with your quality of life. What constitutes low-T is different in every person.

But there are some hard numbers that provide a general guide. The lowest end of normal on the testosterone spectrum is around 300 nanograms per deciliter; 800 ng/dL is considered the high end of normal. Men who measure in at or below 300 may or may not experience symptoms. Symptoms are certainly likely when levels fall to around 200 ng/dL, though. Then again, if you’re naturally up closer to 800, a reading that’s well in the mid-range of normal may cause symptoms and be an indication that something’s going on.

Causes of Low Testosterone Levels

Along with aging, there are plenty of other causes of low testosterone. High blood pressure, high cholesterol, and being overweight or obese can suppress testosterone production. So too can a generally unhealthy lifestyle consisting of a poor diet and/or lack of physical activity.

Other possible causes include diabetes, kidney or liver dysfunction, various hormonal disorders, HIV/AIDS, infections, a testicular injury, testicular cancer, treatment for testicular cancer, and long-term opioid use.

Treating Low Testosterone Levels

In some cases, low-T can be successfully treated by addressing the underlying cause. For example, lifestyle changes like eating a nutritionally dense diet based on whole foods and regular exercise (including weight lifting or resistance training to build muscle) can boost testosterone production while helping with factors like excess weight, hypertension, and high cholesterol.

Hormone replacement therapy may be prescribed. Usually, supplemental testosterone is administered topically through a gel rubbed onto the shoulders or upper arms. Shots, patches, pills, and even timed-release pellets implanted under the skin of the buttocks are other supplement methods.

Side effects of testosterone replacement therapy can include acne, breast swelling and/or soreness, elevated red blood cell count, swollen feet and/or ankles, decreased testicle size, and infertility. Regular blood testing is needed as part of managing the course of treatment. Also, testosterone replacement therapy increases the risk of developing prostate cancer, so your doctor will talk to you about PSA screenings and prostate exams.