Symptoms of Low Testosterone:
Shifting hormones can have an impact throughout your life. If
you have these symptoms, consider the possibility that you might have
Testosterone is an important hormone for men. During puberty
it helps in the development of the testes and the penis, and it also
plays a role in the growth of facial and pubic hair and the deepening of
the voice. Testosterone also continues to play an important role long
after the teenage years. It helps inform everything from a man's libido
to his mood, and when testosterone levels are low, it can have a
negative impact on a man's emotional and physical health. If you have
any of the following symptoms, talk to your doctor and be sure to ask
about your testosterone levels. Thankfully, there are many treatments
that can help improve your sexual response and get your hormone levels
back on track.
Here are signs of low testosterone in men:
A study performed at the Veterans Affairs Puget Sound Health Care System and the University of Washington in Seattle found that men
with low testosterone were four times more likely to be diagnosed with clinical depression.
Lack of Energy
testosterone is also linked to low energy. If you find that your energy
has been declining, don't just chalk it up to long hours at work: It
could be a sign of low testosterone
plays a role in bone strength, so if you feel like you are losing
height, or shrinking, it might not be all in your head: It could be low testosterone
Testosterone also plays a role in muscle mass, so if you have decreased strength or endurance but haven't changed your workout regime
, it could be a sign of decreased testosterone.
If you find that your sexual response
has been less intense and that your erections are not as strong, it could be a sign of low testosterone.
You Have Other Health Issues
Testosterone levels can be impacted by other health conditions, most notably obesity, type 2 diabetes
, and thyroid issues, so if you suffer from one or more of these, you might also have issues with low testosterone.
Decrease in Ejaculate
When your testosterone levels decrease, you might also notice that the amount of your ejaculate
decreases in volume.
Low levels of testosterone
can sometimes cause the testicles to shrink and become smaller. Some men also report a feeling of numbness in the testicles.
If you are unable to achieve or maintain an erection
, it could be because of low testosterone levels. Again, talk to your doctor and have your hormone levels tested.
Low testosterone facts
- Testosterone is produced by the testes in males and
ovaries in females. The testes are under the hormonal control of the
hypothalamus and pituitary in the brain and make testosterone in response
to stimulation by FSH and LH.
- Primary hypogonadism occurs because of the inability of
the testes to produce testosterone.
- Causes of secondary and tertiary hypogonadism are due
to a variety of illnesses or diseases that affect the
- Symptoms of low testosterone depend upon when in the
life cycle it occurs.
- and loss of muscle mass are significant complications
of low testosterone.
- In the United States, testosterone replacement therapy
is available as an FDA-approved treatment in men only. It may be
administered by injection, patch or gel, or gum and cheek putty.
What is testosterone?
Testosterone is an
anabolic-androgenic steroid hormone which is made in the testes in males and in
the ovaries in women (a minimal amount is also made in the adrenal glands).
Testosterone has two major functions in the human body.
- Testosterone is needed to form and maintain the male
sex organs and promote secondary male sex characteristics (in both men and
women) such as voice deepening and hair growth patterns. This function is
related to its androgenic properties.
- Testosterone is the facilitation of muscle growth as
well as bone development and maintenance. This is a result of its anabolic
Testosterone production is regulated
by hormones released from the brain. The hypothalamus and pituitary gland
located in the brain produce hormonal signals that ultimately result in the
production of testosterone. The hypothalamus is located just above the brain
stem, and among its many functions, it produces gonadotrophin releasing hormone
(GRH). GRH travels a short distance to the pituitary gland located in the base
of the brain stimulating the gland to release FSH (follicle stimulating
hormone) and LH (luteinizing hormone). These hormones travel through the
bloodstream to activate the sex organs in both men and women. Subsequently,
these hormones also have a role in regulating testosterone levels in the
The majority of testosterone
circulates in the blood bound to a carrier protein (a hormone is produced in
one are of the body and has its effect on another area. Often a carrier protein
that assists the hormone travel through the bloodstream). In this case the
carrier protein is called "sex hormone binding globulin," or SHBG.
When testosterone is being carried by SHBG, it is considered "bound".
Bound testosterone does not play an active role in the body; only the unbound
or "free" testosterone is able to enter the different cells of the
body and exert its androgenic and anabolic effects. Thus, anything that affects
the function or the amount of SHBG can also affect the total circulating amount
of active testosterone.
Picture of the endocrine system
including the testes and ovaries
What is low testosterone?
The human body functions within a
relatively narrow range of normal; when chemicals such as hormones fall outside
those normal levels, there can be consequences that affect the body at a
cellular, organ, or systemic (body-wide) level.
Blood tests used to measure
testosterone are usually performed in the morning. Testosterone sampling is
difficult since the levels normally tend to bounce around a fair bit during the
course of the day. The normal value for total testosterone in males is 270-1070
However, this depends to some extent on the individual laboratory being
used, and the range can vary as a result.
In women, there is debate about the
accuracy of testosterone measurements, because the circulating values are so
much lower than in males and are harder to accurately measure.
As people age, the amount of
testosterone the body produces gradually falls in both men and women. Free testosterone
levels can be measured and normal levels depend upon an individual's age.
Interestingly,menopause itself does not
seem to play a role in a reduction of testosterone levels in women beyond that
of advancing age.
are the causes of low testosterone?
Low testosterone levels may be
caused by a number of factors. For example – there may be a problem at the
level of the hypothalamus or pituitary to produce appropriate amounts of LH and
FSH to stimulate testosterone production. Another possibility is that the
organs that make testosterone do not function normally or are not able to
respond to stimulation by the brain. Also, as mentioned, changes in SHBG can
affect for the amount of testosterone that is available to exert its effects.
- When the problem is in the organs that produce
testosterone (the ovaries or testes, for the most part), it is called a
"primary" problem". In medical terminology, the
decrease in normal testosterone production is called "hypogonadism."
- When the problem is related to the pituitary and its
ability to regulate testosterone, it is called "secondary
- If the problem is thought to be at the level of the
hypothalamus, it is called "tertiary hypogonadism."
Some common causes ofprimary
hypogonadism or failure of the gonads (the medical term for the sex organs,
or testes and ovaries) may include the following:
- Undescended testicles: If the testes fail to migrate from inside the abdomen
into the scrotum during fetal development or in the first year or two of
life, the testes may become damaged and unable to produce adequate amounts
- Injury to the scrotum: If the testes are injured, they may not be able to
produce adequate testosterone. Damage to one testicle does not often to
lead to low levels if the other testis remains normal.
- Cancer therapy:Chemotherapy and radiation therapy can damage the
interstitial cells in the testes responsible for testosterone production.
This decrease in testosterone production may be temporary as the cells
recover, or it may be permanent.
Testosterone levels gradually decrease with aging. Usually, enough
testosterone is manufactured to allow for adequate bodily functions, but
there is some research that suggests that lower testosterone levels can
result in a variety of medical problems such as bone and muscle loss, and erectile dysfunction.
- Mumps orchitis:
The mumps virus can cause
inflammation of the testes in males, and if the illness occurs in puberty or adulthood, the damage to the
testes may lead to low testosterone production. Immunization against the mumps has significantly
decreased the incidence of this illness.
- Chromosomal abnormalities: A normal male has one X and one Y chromosome (a normal
female has two X chromosomes). In Klinefelter's
syndrome, in males, an extra X chromosome is present and among
other anatomic issues, there is abnormal development of the testes and
decreased ability to manufacture testosterone.
- Ovary conditions in women:Premature ovarian failure
and surgical removal of both ovaries
(bilateral oophorectomy) are conditions associated with lower circulating
Secondary and tertiary hypogonadism
may be due to damage of the hypothalamus or pituitary and/or
the failure of the production of hormones (GRH, TSH and/or LH) to stimulate the
Causes of secondary and tertiary
- Damage to the pituitary gland may occur because of tumors of the gland itself or because of
damage caused by the side effects of treatment of nearby brain tumors.
- Hypothalamus malformations can prevent normal function.
Kallman's syndrome is one example.
- Decreased blood flow to these glands from other
conditions including significant bleeding and shock.
- Inflammation caused by tuberculosis
and sarcoidosis may affect the pituitary
- may also cause inflammation of both the hypothalamus
- Illegal use of anabolic
steroids, for example in athletes and body builders, can cause
hypogonadism and low testosterone levels.
It should be noted thatobesity also can be a cause of low testosterone.
While it can be associated with other causes, obesity specifically enhances the
conversion of testosterone to estrogen. This is a naturally occurring process
in both men and women, and this conversion occurs predominantly in fat cells.
In the case of obesity, the large amount of fat cells enhances this process,
and testosterone levels may fall due to excessive conversion to estrogen.
There are rarer causes of
hypogonadism that can occur, dealing with cellular mechanisms and receptor binding.
These are beyond the scope of this discussion.
are the symptoms of low testosterone?
Low testosterone symptoms in males
In males, symptoms of decreased
testosterone depend upon when the low levels occur.
If there is inadequate testosterone
in the fetus, genital development may be affected. There may be poor
development of the penis and scrotum, with an appearance of female genitalia or
ambiguous genitalia that are neither male nor female. Remember that the
definition of male is based upon the type of chromosomes present and not
necessarily upon the outward physical appearance.
If low testosterone occurs before or
during puberty, there may be a lack of sexual maturation. Signs may include
failure to develop muscle mass, failure of the voice to deepen, poor growth of
body hair, enlarged breasts ( gynecomastia ),
and failure of the penis and testes to enlarge.
In adulthood, low testosterone may
lead to decreased sexual function and desire,infertility ,
erectile dysfunction .
Loss of hair , decreased muscle mass, andosteoporosis or decreased bone density may occur.
Low testosterone symptoms in females
While low testosterone is usually
thought of as a male disease, low levels may occur in women and cause
significant issues. Symptoms may include
flashes , irritability, loss of sexual desire (decreased libido ), and sleep
disturbances. Loss of muscle mass, decreased bone
density (osteoporosis), and loss of body hair may also be seen.
should I contact the doctor for low testosterone?
For infants, routine screening
examination is useful in checking for normal placement of the testes within the
As puberty approaches in males, it
is important that parents and health care practitioners look for the
development of secondary sex characteristics such as lowering of voice,
development of characteristic hair growth, and increased muscle mass.
In adults, most males will seek help
with erectile dysfunction and decreased libido.
In women, a loss of sexual desire
and libido are often the presenting complaints.
is low testosterone diagnosed?
Many of the symptoms that lead to
the diagnosis of low testosterone are nonspecific, and the health care
professional may want to take a history of symptoms and perform a physical
examination prior to ordering blood tests to assess for low testosterone levels
in the body.
The diagnosis also depends upon at
what age the concern occurs. Many times the diagnosis in the pediatric age
group occurs because the parent and health care professional to observed
abnormalities or delays in physical development.
If the diagnosis of low testosterone
or hypogonadism is considered, blood tests to measure testosterone levels may
be ordered. The level of testosterone varies depending upon the time of day,
and most often, early morning testosterone levels are measured.
Based upon the clinical situation,
further tests may be considered to determine whether the low testosterone is
due to primary or secondary hypogonadism.
is the treatment for low testosterone?
The initial consideration for
treating low testosterone is to find the underlying cause and address that
While the testosterone levels fall
with aging, there is no evidence that this is an abnormal condition requiring
treatment. However, research results are inconclusive, and studies
measuring the effect of testosterone in men age 60 to 80 found no benefit in
mental or physical function.
Treatment of low testosterone in men
In men, low testosterone levels in
the body can be supplemented by hormone replacement with testosterone.
Testosterone replacement therapy can be prescribed as an intramuscular
injection usually given on a biweekly basis, as a patch or gel placed on the
skin, or as putty that is applied to the gums of the mouth. Each of the
treatments has its risks and benefits. The decision as to which form of testosterone
to use depends upon the clinical situation. Discussions between the patient and
health care practitioner often helps decide which medication to use.
Treatment of low testosterone in
In women, in the United States there
are currently no preparations that are FDA approved for testosterone
replacement.Esterified estrogens and
(Estratest), manufactured by Solvay
Pharmaceuticals, a combination of estrogen and methyl testosterone that was
formerly available, was discontinued by the manufacturer in the spring of 2009.
Some doctors will advise women to
cut the patches for men into smaller sizes, or to use the gel in smaller doses;
however, the accuracy of these methods is questionable, as is the safety.
are the complications of low testosterone?
Complications of low testosterone
levels depend upon when in life the situation occurs. Low testosterone levels
in infants can lead to poor development of sexual organs. Near puberty, it can
lead to failure of development of secondary sexual characteristics. In
adulthood, osteoporosis, loss of muscle mass, and decreased sexual function
including erectile dysfunction and decreased libido may occur.
low testosterone be prevented?
Low testosterone is due to the
failure of at least one part of the hypothalamus-pituitary- gonadal axis. Many
illnesses and diseases that affect these organs are inherited and cannot be
prevented. Other causes are unavoidable consequences such as cancer therapy and
infection. However, some causes are preventable including obesity and
is the outlook (prognosis) for a patient with low testosterone?
The ability to treat the condition
depends upon recognizing symptoms and seeking medical care. Once the cause for
the low testosterone levels is diagnosed, testosterone replacement therapy may
be helpful in reversing the symptoms related to those low levels.
Maintaining adequate testosterone
levels within the body may minimize future risk of muscle and bone loss.