Low testosterone (testosterone deficit) in males occurs when the body is unable to create adequate testosterone. It is sometimes termed hypogonadism. Low testosterone may drastically damage a man’s health and enjoyment of life.
Testosterone is the most essential sex hormone in males. Its synthesis is regulated by both the brain and the testicles (testes). The body begins to manufacture testosterone throughout puberty. From the age of roughly 30 years, testosterone levels normally start to fall.
Testosterone is vital for developing and retaining masculine traits. Testosterone also has affects on sexual function. Low testosterone levels raise a man’s chance of developing illness of the heart and blood arteries (cardiovascular disease), and increase the risk of early mortality.
What causes low testosterone?
Low testosterone may be caused by natural aging. However, there are other probable reasons of low testosterone. Some reasons may be inherited. Low testosterone may be present at birth or it may develop later in life.
Being considerably overweight or obese at any age is associated to low testosterone.
Testosterone levels may fall owing to a physical illness, surgery or mental stress, but in these instances the testosterone level will go back to normal after the underlying cause has been addressed.
Primary testosterone deficiency
Low testosterone may be caused by a failure of the testicles (testes) to create adequate testosterone. This is frequently termed primary testosterone insufficiency. Common causes of primary testosterone insufficiency include:
Klinefelter’s syndrome. A guy generally has one X and one Y chromosome. In Klinefelter’s syndrome, two or more X chromosomes are present in addition to one Y chromosome.
Undescended testicles. This is when a newborn is born missing one or both of his testicles in the scrotum. They are normally in the lower region of the pelvis but have failed to move into the scrotum. If they have not descended by 6 months of age then surgery is required to put them into the scrotum. Testicles need to be somewhat lower than normal body temperature in order to operate correctly. If the testicles stay within the body rather than the scrotum they will be overly heated and this decreases their capacity to create testosterone.
Mumps orchitis. This is when there is an inflammation of the testes owing to the mumps infection (which may mostly be avoided by immunization with the MMR vaccine).
Haemochromatosis. This is a hereditary disorder causing elevated iron levels to build up.
Injury to the testicles.
Cancer therapy. Both chemotherapy or radiation may interfere with testosterone and sperm production.
Secondary testosterone deficiency
Low testosterone may also be caused by a problem with sections of the brain (hypothalamus and pituitary gland) which create the hormones that trigger the testicles to make testosterone. This is frequently termed secondary testosterone deficiency. See the companion leaflet called Pituitary Gland Disorders for additional information.
In secondary testosterone shortage, the testicles are normal but don’t function correctly because of an issue with the pituitary gland or brain. A variety of disorders may produce secondary testosterone insufficiency, including:
Pituitary gland diseases such as a benign growth termed a prolactinoma.
HIV/AIDS: may produce reduced levels of testosterone by damaging the hypothalamus, the pituitary gland and the testicles.
several drugs (such as opiate painkillers and several hormones): may alter testosterone production.
How prevalent is low testosterone?
Men are more prone to acquire low testosterone as they become older. It is also more likely among men who are overweight and men who are in poor overall health with long-term health issues.
One big research in Europe indicated that testosterone insufficiency affected roughly 2 in 100 males aged 40 to 79 years. Testosterone insufficiency impacted roughly 5 in 100 males aged 70 to 79 years.
Low testosterone symptoms
The symptoms will vary on when the illness begins.
If an expectant male infant does not create enough testosterone throughout the pregnancy then the testicles won’t grow correctly and the baby may be born with either:
Female genitals.
Genitals that are neither plainly masculine nor definitely female (ambiguous genitals); or
Underdeveloped male genitals.
In adult men, low testosterone may cause:
Erectile dysfunction.
Infertility.
Decrease in beard and body hair growth.
Decrease in muscular mass.
Development of breast tissue (gynaecomastia).
Loss of bone density (osteoporosis).
If testosterone insufficiency occurs before puberty then it may also cause:
Delayed puberty.
Lack of depth of the voice.
Impaired development of the penis and testicles.
Excessive development of the arms and legs compared with the trunk of the body.
As testosterone levels decline in elderly men, some males suffer symptoms comparable to those of the menopause in women, such as:
Excessive tiredness (fatigue).
Decreased sex desire (reduced libido).
Difficulty focusing.
Hot flushes.
How to test for low testosterone
Many elderly men with low testosterone are never diagnosed. Problems like as weariness, poor sex desire and erectile dysfunction might be assumed to be attributable to the natural aging process hence medical aid is frequently not sought.
Testosterone shortage may be discovered by blood testing which could be indicated when explaining lower sex desire (reduced libido) or erectile dysfunction.
Men who don’t react to the drugs that are used to treat erectile dysfunction (such as sildenafil), should also have their testosterone level evaluated.
If testing indicate a low testosterone level, referral to a urologist or andrology expert would normally be advised. They may give additional testing to identify whether an issue with the testicles (testes) or a pituitary gland disorder is the reason. These subsequent testing may include:
Testing for additional hormone levels (some pituitary gland problems impact more than one hormone).
Semen analysis.
Pituitary computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan.
Genetic testing.
Testicular biopsy.
Treatment of low testosterone
Can low testosterone be prevented?
Early diagnosis in males may help avoid complications from delayed puberty. Testosterone medication may induce puberty and the development of sex characteristics, such as increased muscle mass, beard and pubic hair growth, and enlargement of the penis.
Early diagnosis and therapy in adult males gives superior protection against loss of bone density (osteoporosis) and cardiovascular disease. Treatment may also enhance weariness, overall well-being, erectile dysfunction and sex desire.
The therapy for low testosterone also relies on the underlying reason.
For males without any underlying reason, keeping a healthy body weight is vital. Obesity in young men is growing and there has been proven to be an increased number of young men with low testosterone levels in the United States, resulting from obesity.
Testosterone replacement
Testosterone therapy is commonly delivered in the form of a gel. Other kinds of testosterone therapy include long-acting injections or utilizing a patch put to your skin.
Side-effects of testosterone replacement
Testosterone replacement has been proven to cause:
Worsening sleep apnoea.
Acne.
Benign prostatic hypertrophy (non-cancerous enlargement of the prostate gland).
Growth of prostate cancer (in males who already have prostate cancer).
Gynaecomastia (enlargement of breast tissue).
Shrinking of the testicles (testicular atrophy) and decrease in sperm count.
Red blood cell production over-development (which might lead to higher risks of blood clots in the legs or lungs).
Increased rage and hostility yet not increased physical violence.
Worsening of heart failure (in males who already have heart failure).
There are worries regarding possibly elevated risks of heart disease and probable hazards of prostate cancer development – neither of which have been firmly proven in studies to yet.
Testosterone replacement is contra-indicated (not permitted) in patients with male breast cancer, prostate cancer, men with severe heart failure, men with a significantly increased haematocrit (a measure of red blood cell formation) and males actively trying to have a child in the future.
Other therapies
If low testosterone is caused by a pituitary gland condition, therapy with pituitary hormones may boost sperm production and enhance fertility. Testosterone replacement treatment may be utilized.
If a pituitary tumor is the source of low testosterone then this may need treatment, such as surgical removal, chemotherapy or radiation, as well as replacement therapy with other hormones.
Although there’s frequently no effective therapy to restore fertility in a guy with primary testosterone insufficiency, infertility therapies may be useful.
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