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December 22, 2022

The Facts About Low Testosterone

Low Testosterone: What You Should Know

By now you probably have seen ads or TV commercials about low testosterone. That’s good because for too long the importance of maintaining healthy hormone levels in men has been ignored. This increased awareness about low testosterone has driven more men (who typically ignore their health) to finally see their doctor.

the facts about low testosterone
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Testosterone is the “male” sex hormone, but provides far greater benefits than is fully appreciated. Most symptoms of low testosterone are non-sexual in nature. That’s right, non-sexual. The reason for that is there are testosterone receptors in our cells throughout the body – not just the genitalia and muscle. Low testosterone really adversely affects the whole body.

Testosterone receptors can be found in the heart, brain, bones, fat stores, blood vessels, and elsewhere. The heart and brain have among the highest concentrations of testosterone receptors in the body.

Testosterone isn’t just for men.  Women and children also make testosterone. As in men, testosterone is also important for sex drive in women. Even women can suffer from low testosterone levels.

What Are the Symptoms of Low Testosterone?

There are sexual symptoms and non-sexual symptoms of low testosterone.

Sexual symptoms of low testosterone include:

1.  Decreased sex drive or libido.

2.  Decreased erectile function.

3.  Lack of morning erections.

4.  Diminished intensity of orgasm.

5.  Decreased sensitivity of the genitalia.

Non-sexual symptoms of low testosterone include:

1.  Low energy (perhaps even the need to nap).

2.  Gaining body fat despite maintenance of physical activity and diet.

3.  Mood swings and irritability.

4.  Loss of muscle strength and mass.

5.  Depression

6.  Lack of mental focus, concentration, or attention.

7.  Lack of self-confidence.

8.  Indecisiveness.

9.  Overall lack of well being and not feeling like one’s self.

The non-sexual symptoms of low testosterone are non-specific meaning other problems can cause these symptoms, too. That’s one reason why the possibility of having low testosterone is frequently overlooked, or never considered. These symptoms many times are attributed to something else like stress and/or depression and are frequently treated with antidepressants without addressing the root cause – low testosterone.

The sexual symptoms are many times late manifestations of declining testosterone levels. Testosterone levels begin to decline during a man’s thirties, but the symptoms may not become evident until the mid-40s and even 50s.

The Decline in Testosterone Levels

Testosterone levels begin to decline around age 30 (sooner for some). The decline in levels ranges from 0.5% per year to 2% per year. This contrasts to the more sudden decline in sex hormones experienced by women going through menopause. This slow decline in testosterone coupled with delay in symptoms also explains why the diagnosis of low testosterne frequently is not made.

Testosterone is produced in the Leydig cells of the testes. As we age Leydig cells die off and those that remain produce less testosterone. In addition, the Leydig’s cells ability to respond to luteinizing hormone (LH) to produce testosterone declines. The net effect is lower testosterone.

Typically the more health issues a man has the faster will be the decline.  Diabetics are twice as likely to suffer from low testosterone than non-diabetic men.

Eventually testosterone levels decline past a critical threshold, which varies from man to man, at which point the man begins to experience symptoms. For most men this begins around age 45 – sooner in some and later in others.

Many times reaching this critical threshold coincides with other stressors in life like worrying about paying for college education, coping with sick parents, change in job or income, or going through a divorce.  Thus, the symptoms of low testosterone are frequently dismissed or attributed to these other stressors.

What Are Normal Testosterone Levels?

The range for total testosterone levels is typically 300 ng/dl to 1,000 mg/dl. This range is misleading as it includes testosterone levels of men up to age 80 who typically have very low levels. This “drags down the curve” so to speak.  Half the men require levels in the upper half of the range.

Observational studies show that men with total testosterone levels in the upper third of the reference range to have 25% to 30% lower risk of heart disease and cancer. New evidence suggests that low testosterone is associated with more aggressive forms of prostate cancer.

What’s important is what testosterone level is normal for you. We consider that to be the lowest testosterone level where a man does not experience any of the above symptoms (or just a few).

If you are in you’re early to mid-30s and are feeling good you may wish to have your testosterone levels measured now. This provides a reference point and future target as your levels decline and you become symptomatic later in life.

How to Maintain Healthy Testosterone Levels

Nutrition and exercise go a long way in ensuring your testosterone levels remain healthy for as long as possible.

Quality protein intake is a must for healthy testosterone levels. Foods high in zinc  (protein sources) and indole-3 carbinol found in cruciferous vegetables support testosterone levels, too.

Exercise is also important, but not just any exercise. Aerobics won’t help your testosterone levels. To boost your testosterone you need to perform strength training exercises lifting until fatigue or near exhaustion. This boosts both testosterone and growth hormone levels. For best results focus on the larger muscle groups, and perform compound exercises that engage several muscle groups.

High intensity interval training or HIIT is another way to boost testosterone and growth hormone. This consists of performing aerobic exercises in short bursts at high intensity followed by periods of low intensity and repeated for several cycles. There are several ways to perform HIIT.

Ask a personal trainer to develop an exercise program designed to boost your testosterone and growth hormone.

Testosterone Therapy

Several forms of testosterone therapy now exist for low testosterone. The two most common forms of treatment include injectable testosterone (usually once or twice a week), or the application of a transdermal cream to skin daily. Each has advantages and disadvantages. Transdermal creams are convenient, but have to be applied daily and sometimes it is difficult to achieve adequate blood testosterone levels. Good blood levels of testosterone can always be achieved with injectable testosterone, but self injection is something that some men cannot or will not do.

Pellets can also be implanted into the subcutaneous fat that deliver testosterone slowly over several months (4 to 6 months). The problem is if the testosterone level is inadequate more pellets have to be implanted (which comes with a cost) or supplemented with either testosterone injections or transdermal creams. If the dose is too high or side effects occur, then pellets might need to be removed.

For younger men who still may wish to father children hCG injections (which stimulate the Leydig cells) can be a nice alternative to direct testosterone therapy which lowers sperm counts.

If you have symptoms consistent with low testosterone I recommend you see a knowledgeable physician with experience in male hormone replacement therapy.

See related articles.

15 Benefits of Testosterone

Testosterone Levels: Why They Decline

The Side Effects Of Testosterone Replacement




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Dr. Joe Jacko

Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio at Grandview Primary Care. Read more about Dr. Joe Jacko

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