Testosterone is the male sex hormone produced in the testicles. Both males and females produce testosterone, but it is called the “male sex hormone” because it is produced in more quantity in males than females. The level of testosterone in males is very important as it determines normal male sexual development and other functions.
Testosterone is what gives men their manliness. In puberty, it helps young boys grow muscles, have deeper voices, body and facial hair. The hormone also helps produce red blood cells, strong bones, boosts mood and good thinking ability. The male body also requires testosterone to produce sperm. Generally, as men age, the level of testosterone decreases. So older men tend to have low blood testosterone levels (1).
The level of testosterone gets to its peak at adolescence and begins to decline as men grow older. From about 1% to 2% yearly beginning from age 40 or later. It is quite different for different men. Some men experience declines at 50. This decline will eventually lead to impotence or changes in sexual drive, reduced muscle mass, depression or anxiety, hot flashes, anaemia, less energy, and weight gain.
Low testosterone (or “Low T” or Testosterone Deficiency Syndrome) is a condition where the body doesn’t produce enough testosterone hormone (2).
The American Urology Association pegs low testosterone at the point where the quantity in the body is less than 300 nanograms per deciliter (ng/dL) (1).
Signs and Symptoms — How to know if you have low testosterone
Falling testosterone levels are normal in men’s ageing, but certain health conditions can cause or hasten the decline. Therefore, you must watch out for the following signs and see a doctor if you feel you have Low-T.
Feeling tired or cranky is not enough sign to look out for. You can feel tired when you subject the body to much labour. Do not diagnose low T from what TV advertisements for testosterone replacement products tell you. They just want to sell their product. This is not in any way ridiculing these advertisers or what they market. If you must diagnose low T, look out for more involved signs and symptoms, not just mere tiredness.
Regardless of the age factor, the symptoms of low T include the following.
- Inability to maintain an erection and/or erectile dysfunction
- Fewer or spontaneous erections or other changes in your erections
- Reduced libido or sexual drive
- Rapid hair loss
- Less beard growth
- Loss of muscle mass
- Experiencing fatigue all the time
- Consistent depression
- Enlarged breasts
- Brain fog
- Poor memory or memory loss
- Speech impediment or difficulty in finding words to say
- Poor or disconcerted focus
- Not doing well at work
Apart from ageing, most of these symptoms can be a result of personal lifestyle or medical conditions and other factors. If you have any of them, make an appointment with your doctor. They can help identify the underlying cause of the symptoms and recommend the best form of treatment suitable for you.
It is important to point out that having any of these symptoms may not mean you have low testosterone. Still, when you have a mix of the symptoms over a long period, which you are not familiar with, you may want to check for testosterone deficiency.
Even cases of sex drive or libido may not necessarily mean you have testosterone deficiency. But if there is a combination of reduced or low sex drive (which is not usual with you), reduced erectile function, and or feelings of extreme tiredness, then you should go see a doctor.
Causes — What causes low testosterone in men?
Low testosterone is less common in men under 30, but it can still occur (2). Some persons were born with conditions that cause low testosterone levels. Others develop the condition after birth.
Some of the causes of low testosterone that come from birth are:
- Noonan syndrome
- Klinefelter syndrome
- Ambiguous genitalia (this is when the sex organs begin to develop in ways that are different from normal)
Other environmental and self-inflicted activities can cause low testosterone in men. Some of these causes are:
- Damage to the testicles through accident
- Removal of the testicles because of cancer
- Hormone deficiency caused by pituitary gland disease
- Autoimmune disease (this occurs when the body makes antibodies that attack its cells) (2).
- Use of unsupervised drugs like antidepressants and narcotics
- High blood pressure
- Excessive alcohol intake
- Use of illegal drugs
- Use of anabolic steroids
- Taking certain prescription medications such as steroids and opiates, especially in excess (2)
- High cholesterol level
Certain health problems can also lead to low testosterone levels in men, such as:
- Men living with HIV: Studies show that 30 out of 100 men with HIV have low testosterone.
- Men living with AIDS: It has also been shown that 50 out of 100 men living with AIDS have low testosterone.
- Injuries, tumours, or other conditions that can affect the testicles
- Inherited diseases like Kallman’s syndrome, Prader-Willi syndrome, and Down syndrome
- Chemotherapy and radiation treatments for cancer
Treatment — What you should do if you think you have low testosterone
If you think you have low testosterone, you should make an appointment with your doctor. They would use your blood sample to determine low testosterone levels and further prescribe the right treatment after undergoing diagnosis.
Your doctor may decide to carry out additional tests if they diagnose a lower testosterone level than normal. The results of the diagnosis and your medical history will determine the treatment plan to adopt. Your doctor may also recommend lifestyle changes or testosterone replacement therapy (2).
Do not renege in keeping a close rapport with your doctor before taking new medications, including testosterone replacement therapy and supplements. According to research carried out and published in PLOSOne, testosterone therapy may likely increase the risk of heart failure, especially if you initially have a heart disease condition. Your doctor is in the best position to understand the risks and benefits of different treatment plans (2).
One of the means of treatment for low testosterone is to take Testosterone Therapy (TT). It has been shown that most men between the ages of 40 and 64 have been administered the therapy, and even some men who do not have low T even want TT without being diagnosed.
This may be helpful for them and is safer than when the fall of testosterone has long begun.
The AUA, in contrast, recommends that only men who have undergone tests should take the therapy.
Below are some of the things to know about Testosterone Therapy.
Your doctor will measure your testosterone level if you have these conditions:
- Bone density loss
- Low trauma bone fracture
- Chronic use of narcotics
- Radiation to your testicles
- HIV/AIDS positive test results
Even without specific signs, you may still be tested for total testosterone level for the following conditions:
- History of chemotherapy
- Insulin resistance
- History of using corticosteroid medicines
How do you take testosterone?
There are five ways to take testosterone, which are:
- Transdermal (through the skin)
- Oral (through the mouth)
- Intranasal (through the nose)
- Pellets (under the skin)
All methods are good; no one is better than the other.
The methods are described in detail below.
These are topical gems, liquids, and cream patches. They last for up to four days and work better if covered with an air-or-water-tight dressing.
- Apply liquids and gels, creams, or patches to dry skin and does not have cuts.
- Leave the area unwashed till time for the next dose
- Always wash hands after applying gels or liquids.
- Ensure other people, especially women and children, do not touch the medicines.
A topical patch (transdermal) is like a band-aid with medicine on it. You apply it and leave it until the next dose is due. The medicine on the patch is less likely than liquids, creams, and gels to transfer to others (1).
It is divided into long and short-acting testosterone injections. The short-acting is often given under the skin or muscle, while the long-acting medication is usually administered only in the muscles. The injections are usually given weekly, every two weeks, or monthly.
3. Oral (buccal)
This medication is given by mouth. The dose comes in a patch that is placed above the incisor ( canine or “eyetooth”) (1). The oral testosterone medication looks much like a tablet, but it is not advised to chew or swallow. The drug is released after about 12 hours. This particular method has fewer side effects on the liver than if the drug is swallowed, though it may cause headaches or cause irritations where you place it.
This medication comes in the form of a gel. The dose is pumped into each nostril as directed by the doctor. This medication is usually taken three times a day.
The doctor will administer this medication who will place the testosterone pellets under the skin of your buttocks or hips. A shot of local anaesthesia to numb the skin will be given to you by the doctor, and make a little cut and place the pellets inside the fatty tissues underneath your skin. The pellets dissolve slowly and are released for 3-6 months, depending on the number of pellets.
You may want to choose how you take your testosterone based on what is best or most useful (1). In some other ways, your insurance company may be in a better position to decide the order in which testosterone therapies are provided. Make sure to talk about your several choices with your doctor.
Testosterone Therapy — Are there any side effects?
Yes, there are some side effects of testosterone therapy. Some of the effects are mild, while others are more serious.
Ask your doctor or talk to a pharmacist about the nature of these side effects and look out for them while undergoing the therapy.
Some of these side effects are:
- Gels and liquids may cause some redness at the skin site. With patches, itching and rashes may be around the area. Some of these red patches might also cause pain.
- For short-acting injections, some reactions may occur at the injection site. Some persons do have serious allergic reactions to long-acting injections. Watch closely for this when you use long-acting injections.
- Pellets may cause swelling, bruising, pain, and sometimes hematoma.
- There is also an increased risk of erythrocytosis while taking testosterone therapy.
After treatment — What next?
Do not forget that each person’s body is different and what works for one may not work in the same vein for another. While testosterone therapy may help low sex drive, erectile function, bone marrow density, lean body mass, anaemia, etc., there is no evidence enough to back the claim that it will also help energy, tiredness, memory recall, lipid profiles, or the quality of life.
You will need to go for checkups always to ensure your testosterone level stays normal. In patients who are stable on testosterone therapy, total testosterone and certain other lab tests should be checked every 6 to 12 months (1).
If you are obese, try to watch your weight based on recommended ranges. An increase in physical activity may help you lose weight and also help testosterone levels.
You do not need to panic about having low testosterone if you find signs and symptoms mentioned here. There could be others, as our list might not be exhaustive.
The first step you should take if you’re worried is to get medical help as soon as possible. Do not engage in self-medication as you cannot determine if your signs point to a deficiency in testosterone.
While taking your therapy, you need to be patient; these things may not happen overnight. In fact, most men feel improvement in symptoms within four to six weeks of taking testosterone replacement therapy, although changes like increases in muscle mass may take from three to six months (3).