Men, Low T, and the Facts

What is testosterone?

Testosterone is a hormone. For men, it is primarily produced in the testicles. It is most often associated with sex drive, but also plays a role in bone and muscle mass and can affect how the body stores fat. Even a man’s mood can be impacted by testosterone levels.

What is Low T or testosterone deficiency?

It seems as if recently we have heard a lot about Low T. That is the more popular name for a condition known as testosterone deficiency, or hypogonadism. This deficiency can be seen through laboratory findings as well as through physical symptoms, which may include:

• diminished libido
• erectile dysfunction
• difficulty reaching orgasm or diminished intensity of orgasm
• diminished mood or general sadness
• fatigue
• lack of motivation

How does Low T impact a man’s health?

In addition to the typical symptoms of Low T, men who have below normal levels of this hormone may experience a sense of ill-being, foreboding, or feeling as if something is terribly wrong, but not knowing what. Men may also report fatigue, inadequate sleep, increased irritability, and poor mood. Additionally, a recently released policy brief from The Testosterone Project found that untreated testosterone deficiency can be an economic burden and increase the risk of developing diabetes and cardiovascular health concerns.  

Why has testosterone deficiency been in the news?

Secretary of Defense Pete Hegseth suggested that all male members of the armed forces be tested for low T. The FDA, which recently convened an expert panel to present the latest data on testosterone deficiency, and in which I was a participant, has changed the label and treatment indications for testosterone therapy. The FDA removed the black box label that suggested an increased cardiovascular risk with testosterone therapy, and removed the warning that testosterone therapy may cause prostate cancer. They also noted that testosterone therapy may be given to symptomatic aging men, which was previously considered an "off-label" use of the medications.

How is it diagnosed?

If a man exhibits symptoms of testosterone deficiency, the best way to confirm is with morning blood tests, drawn on two separate days, to measure the levels of testosterone. If both tests show levels below 300 ng/dl (nanograms per deciliter), the diagnosis may be confirmed.

What causes Low T?

Causes include:

• obesity, especially visceral or belly fat obesity. This particular fat drives inflammation and insulin resistance, which can lead to Type 2 diabetes.
• medical conditions, such as Type 2 diabetes, chronic obstructive pulmonary disease, heart disease, high blood pressure, depression, and chronic pain
• opiates used to manage chronic pain
• chronic stress, insomnia, or sleep disorders can also negatively impact testosterone levels

Not all testosterone deficiency is the same

There are two types of low testosterone. The first is due to reduced production of testosterone from the testes, known as classical, or primary hypogonadism. This often appears in younger men, from conditions such as testicular cancer, testicular trauma or torsion (strangulation), or a congenital condition.

The second is decreased stimulation of the testes from the pituitary gland within the brain. This is known as secondary hypogonadism and it occurs more often in middle-aged and older men. This is the kind of Low T that is usually associated with obesity and other medical conditions described above.

The basis of Low T may be inflammation due to the other diseases present with Low T, or some men may have a genetic predisposition to low testosterone levels. Not all men with low levels will show the signs and symptoms of testosterone deficiency.

Can Low T be prevented?

Like with so many other conditions, weight loss, adequate regular physical activity, a healthy diet, and reversing sleep disorders such as obstructive sleep apnea are the best ways a man can prevent Low T. Weight loss can also help men to improve other medical problems that are associated with Low T, including high blood pressure, type 2 diabetes, and elevated lipids or blood fats.

How is Low T treated?

Fortunately, there are several options for treatment of Low T. To be most effective, a healthy diet and exercise is recommended with any form of testosterone treatment.

• Testosterone therapy: This includes topical gels that are rubbed into the shoulders, underarms or thighs. Topical therapies must be applied daily. With this type of therapy, there is the risk of the medication being transferred for the first few hours after application. Affected skin areas should be covered by clothing. Other forms of testosterone therapies include new oral formulations that are absorbed by the lymphatics and need to be taken with food twice daily.
• Testosterone injections: Long used as a form of treatment, these can be administered in a doctor’s office. The patient can also be taught to do self-injections. Testosterone cypionate injections are administered weekly or every other week. 
• Enclomiphine or Clomiphine Citrate: This is the only medication or supplement known to boost testosterone levels. It is not testosterone, though it acts to increase natural production of testosterone in men through the binding of estrogen receptors in the hypothalamus of the brain. It is one of two medications known as SERMS, or selective estrogen receptor modulators.

What happens if Low T is left untreated?

It is important for a man to be checked when he is showing signs of testosterone deficiency. If Low T is left untreated, men often experience a sense of impending doom, poor health, and fear that something is terribly wrong. Men may also experience increased weight gain in the mid-section, have difficulties with focus and concentration, poor motivation, reduced memory, and perhaps difficulty engaging with others.

Testosterone deficiency is often misdiagnosed or ignored as providers are not well educated on the condition. Often, men are evaluated for many other conditions, such as Lyme disease, chronic fatigue syndrome, or low thyroid disorder when they work with a provider. 

When should men see a doctor about Low T?

Men should seek medical attention when clinical signs and symptoms are present and before illness progresses too far. Men notoriously wait until the last moment to seek medical care. It is recommended that men see a physician once every three years until age 40, every two years after age 40, and every year or two after age 50, or more often as needed for managing other medical conditions. If you are concerned about testosterone deficiency, ask your provider to request a blood draw for testosterone levels.

It is important to remember that help is available. If you are experiencing signs of Low T, our Men’s Health Center can help. Learn more about our center here.