Testosterone plays an important role in men’s health. It regulates fertility, bone growth and muscle mass distribution. It also helps with sexual function and the production of red blood cells. Testosterone production in men reaches its peak at 20 and starts declining afterward. Research suggests that testosterone production in men declines by 1.6% yearly.
The American Association of Urology defines normal testosterone levels as 300 nanograms per deciliter (ng/dl). Thus, men with testosterone levels below 300 ng/dl may experience low energy levels and terrible moods. If you’re experiencing these symptoms but want to increase your testosterone levels, you may be considering testosterone treatment.
This article will discuss the available testosterone therapy options and offer more information on their potential benefits and risks. You can also try some natural testosterone boosters. There are foods that boost testosterone too. As a result, you will weigh your options and make an informed choice for your health needs.
Subtle Symptoms Of Low Testosterone Levels
Low testosterone level is a disorder where the body fails to produce enough testosterone and is less than the average testosterone levels. This disorder is also known as male hypogonadism. Hypogonadism can occur throughout fetal development, puberty, or maturity. There are two types of hypogonadism.
Primary hypogonadism is a condition where the testes produce less testosterone. It can occur due to genetics, illnesses or accidents. Inherited conditions like undescended testicles, Klenifelters syndrome, and hemochromatosis can also cause this. Additionally, physical injury to the testes, infections, and chemotherapy can damage the testes. Primary hypogonadism can occur in an unborn baby resulting in underdeveloped male genitalia or ambiguous genitalia.
Secondary hypogonadism is caused by damage to the pituitary glands due to genetic conditions and normal aging processes. However, obesity and certain medication like opioids could also result in the same. Additionally, inflammatory diseases and physical and emotional stress can cause secondary hypogonadism.
- Reduced Muscle Mass
Testosterone is one of many elements that contribute to muscle mass growth and strength. It increases the neurotransmitters responsible for tissue growth and interacts with DNA receptors responsible for protein synthesis. Thus, low testosterone levels can cause a significant decrease in muscle mass.
- Decreased Sex Drive
Testosterone is essential for regulating sex drive, otherwise known as libido. Although sex drive naturally declines with age, men with less testosterone may experience decreased sexual desire.
- Reduced Bone Mass
Testosterone increases bone density and stimulates the bone marrow to manufacture more red blood cells resulting in a higher red blood cell count. Thus, low testosterone levels may affect bone growth. Therefore, men with low testosterone levels are at an increased risk of bone fractures and loss of muscle mass.
- Erectile Dysfunction
Male hypogonadism is one of the most common causes of erectile dysfunction. Testosterone deficiency can make it difficult to achieve and maintain an erection. The hormone stimulates the penis to produce nitric oxide. This causes the penile muscles to relax, allowing blood flow resulting in an erection. Therefore, some men with insufficient testosterone levels experience difficulties maintaining an erection.
- Emotional Challenges
Although there isn’t enough clinical evidence to support this, men and women with low testosterone levels have reported some changes. They experience anxiety, irritability and depression. They also have difficulty concentrating, sadness, and sleeping problems.
Low testosterone levels alone do not need treatment. Only those with low blood testosterone levels below 300 ng/dl and with symptoms of low T need treatment. The doctor will take your medical history for any headaches, head trauma, tumors, or brain surgeries. They also check for testicular infections or injuries, mumps, or the use of anabolic steroids.
Your doctor will also perform various physical examinations. These include finding your waist circumference for obesity, hair pattern and gynecomastia. They also find your testicular size, prostate size, and any prostate problems. The doctor will then carry out various blood tests, including.
- Total Testosterone Test: The doctor will conduct two tests before noon when testosterone levels are at their peak.
- Luteinizing Hormone Test: The test checks the levels of luteinizing hormone in the blood because it directly stimulates the testes to produce testosterone. Thus, low levels could mean damage to the pituitary gland.
- Prolactin Levels: The test checks the levels of prolactin hormone in the blood because high levels may indicate a dysfunction of the pituitary gland.
- Blood Haemoglobin: Although other reasons may cause low hemoglobin levels, testosterone is responsible for producing red blood cells.
- Follicle Stimulating Hormone: The test is performed on men who wish to start a family to determine their sperm-producing capacity. It’s also mandatory before any hormone therapy.
- Other tests for low testosterone levels include estradiol hormone, HbA1c, bone density, and MRI of the pituitary glands.
Forms of Testosterone Supplements
You can treat low testosterone with testosterone replacement treatment, which comes in various forms.
Testosterone gel is a prescription-only medication designed for topical application. It’s absorbed through the skin and enters the bloodstream to help the body achieve normal testosterone levels. The gel should be directly applied to the shoulders, upper arm, nose, or abdomen. This depends on the brand. For instance, Natesto is a testosterone gel for application inside the nose.
Apply testosterone gel only to the areas covered with cloth, and do not apply to your genitals. Additionally, do not ask someone to apply it for you because you can easily transfer it to others. Ensure to wash your hands after application and only expose the body parts involved when you have completely washed the area or showered.
Some of the most popular brands of testosterone pumps include AndroGel, Axiron, and Fortesta.
Testosterone treatments also come in transdermal patches that deliver a specified dosage through the skin into the bloodstream to achieve normal testosterone levels. The patches usually deliver testosterone over 24 hours and may be applied on different parts. These include the abdomen, arms, buttocks, or the back. Andoderma is a testosterone patch for application every 24 hours. Do not apply the patch to the same spot within seven days.
Testosterone Replacement Therapy also comes in the form of injections and is available in various forms. These include testosterone cypionate, enanthate, and testosterone undecanoate. Depo-testosterone is a liquid for intramuscular injection to the gluteal muscles. It contains testosterone cypionate in 100mg and 200mg doses. On the other hand, Xyosted is a weekly auto-injection containing testosterone enanthate.
Aveed is a testosterone replacement therapy injection containing testosterone undecanoate in 750mg intramuscular injections. You can self-administer testosterone injection at home or have a doctor inject you in their office. These injections are safe when you follow the doctor’s instructions and get constantly monitored by a doctor.
- Oral Testosterone Replacement Therapy
Testosterone treatment also comes in the form of oral tablets for long-term use. For instance, JATENZO is a prescription-only capsule containing testosterone undecanoate. The FDA recently approved it for treating men with male hypogonadism from underlying medical conditions. It comes in 158, 198 and 237mg. However, the FDA cautions against using JATENZO in treating men with age-related low testosterone levels.
On the other hand, Striant is an implantable tablet for applying to the upper gum to release testosterone into the bloodstream. The tablet is placed above the upper incisor and has fewer adverse effects on the liver than when swallowed. Oral capsules have been used to treat signs of low testosterone levels, including delayed puberty in boys.
However, Android and Methyltestosterone have been discontinued by the food and drug administration.
- Testosterone Pellets
Testosterone Replacement Therapy is also available in pellets the size of a rice grain for implantation under the skin. The pellets contain crystallized testosterone to deliver a steady and concise dosage over time. Unlike injections, testosterone implants are more convenient. They do not cause skin allergies and irritation, unlike gels. Additionally, their effects last for a long period, up to six months.
Your doctor will apply local anesthesia and make an incision near your hip or buttock to implant testosterone pellets under your skin. The procedure will only take a few minutes in the doctor’s office.
- Testosterone Boosters
Testosterone boosters are medications and herbal supplements designed to stimulate the body’s natural production of testosterone. These supplements contain natural ingredients, including D-Aspartic acid, Zinc and Vitamin D. They also contain DHEA, Vitamin B6, Magnesium, and Tribulus Terrestris.
D-Aspartic acid is an amino acid that increases testosterone production and its release into the testicles. On the other hand, Dehydroepiandrosterone (DHEA) is a hormone naturally produced by the adrenal glands. DHEA is a precursor of testosterone and estrogen, which the body converts into these hormones. Thus, DHEA supplements may increase testosterone levels.
Zinc is an essential mineral that may increase natural testosterone production. Tribulus Terrestris is a traditional aphrodisiac that may boost libido in men with low testosterone levels. Vitamin B6 lowers the level of prolactin hormone and stimulates the hypothalamus to produce testosterone. It also stimulates dopamine synthesis, which has a direct influence on testosterone levels. Vitamin D is essential in men’s health and may help maintain strong muscles and healthy testosterone levels.
Although testosterone boosters are generally safe, some users have reported various side effects. These include hair loss, acne, gynecomastia, and kidney abnormalities. Additionally, some are associated with increased blood cell count and increased risk of blood clotting.
Benefits of Testosterone Replacement Therapy
When it comes to testosterone therapy, it’s difficult to predict because men are different. Although some of the benefits are barely noticeable, below are the most obvious benefits of testosterone products.
- Improved Heart and Blood Health
Testosterone regulates the production of red blood cells in the bone marrow. Thus, testosterone deficiency may increase the risk of various cardiovascular events, including heart attack. Research indicates that low testosterone levels increase the risk of death from different cardiovascular conditions. Therefore, treatment may significantly reduce these risks by improving the red blood cell count.
- Increased Muscle Mass
Testosterone is responsible for regulating muscle mass in men. Several studies suggest that testosterone increases protein synthesis resulting in increased muscle mass. However, there isn’t sufficient evidence that testosterone increases muscle strength. Thus, combining testosterone treatment with strength training exercises may improve muscle strength.
- Increased Fat Reduction
Testosterone decreases fat mass, resulting in more weight control and increased energy levels. A study was conducted to determine the effect of testosterone therapy on overweight and obese men with testosterone deficiency. The participants reported a significant decrease in waist circumference, BMI, and weight after the treatment. The participants also reported increased energy levels and motivation after the treatment.
- Stronger Bones
Testosterone is responsible for building and maintaining strong bones in men. Thus, bone density decreases with age due to reduced testosterone levels and increases osteoporosis risk. A review helped determine the effects of testosterone treatment on volumetric bone density in older men with testosterone deficiency. It showed that treatment for one year significantly increased bone density and strength for the participants.
- Improved Libido
Low testosterone decreases a man’s desire to have sex and negatively affects his sexual performance. Thus, men with higher testosterone have a higher libido than those with low testosterone levels. Several studies published in the international journal of clinical endocrinology suggest that testosterone therapy may improve libido in men with low testosterone levels. However, increasing testosterone in normal men may not affect their sexual function or libido.
- Improved Mood and Overall Wellbeing
Low testosterone is often associated with low mood, mental fatigue, anxiety, and depression. Simply put, it can affect your quality of life. There’s research to determine the effect of testosterone treatment on mood and overall wellbeing in men with erectile dysfunction and low testosterone levels. The researchers performed a randomized trial on 140 participants.
Some participants received sildenafil alone, while the rest received sildenafil combined with testosterone gel for 14 weeks. Researchers evaluated the psychological wellness and mood of the participants at the end of the treatment period. The results indicated improved mood and overall wellbeing in the testosterone therapy participants.
- Improved Memory and Mathematical Reasoning
Cognitive ability and memory decline with age as testosterone levels decrease. Research into the relationship between testosterone and spatial abilities suggests that men have better spatial abilities than women due to their higher testosterone levels. Other studies indicate low testosterone levels are associated with a higher risk of Alzheimer’s disease. The same studies suggest low testosterone levels may cause poor cognitive function in older men.
Risks of Testosterone Therapy
Scientists and medical experts have not yet performed a major clinical trial to determine testosterone treatment’s benefits or adverse effects. However, it’s often associated with unwanted side effects. For instance, it can irritate the injection site, cause skin irritation from topical applications, and cause skin allergies. Testosterone treatment may also worsen the following health conditions.
- Sleep Apnea
Sleep apnea is a sleeping disorder where a person’s breathing is constantly interrupted by repeatedly starting and stopping. It can occur when throat muscles relax (obstructive sleep apnea), or the brain fails to send proper signals to the respiratory muscles (central sleep apnea). It is common in older obese men and can affect their sleep quality by causing loud snoring and daytime tiredness even after an entire night. Additionally, sleep apnea may cause severe health problems. These include high blood pressure and increased risk of a heart attack, especially if you have existing heart disease. A systematic review suggests that testosterone replacement therapy worsens sleep apnea by changing the airways’ structure, muscles, and metabolic structures.
Low testosterone levels may affect sleep quality. However, treatment with high doses of endogenous testosterone may cause sleep duration abnormalities and worsen obstructive sleep apnea symptoms.
- Benign Prostatic Hyperplasia
Also known as prostate enlargement, Benign Prostatic Hyperplasia (BPH) is a common condition in an aging male that occurs when the prostate gland cells multiply. As a result, the glands swell, resulting in enlargement and limitation of urine flow. BPH may occur due to changes in testosterone levels, genetics, or in men whose testes were removed early.
BPH causes lower urinary tract symptoms. These include difficulty in passing urine, incontinence and incomplete bladder emptying. There is also an increased frequency of urination, among others. Studies suggest that high testosterone levels may reduce BPH risk. However, the FDA warned that testosterone replacement therapy might increase or worsen the symptoms of Benign Prostatic Hyperplasia.
- Prostate Cancer
Prostate cancer develops in a man’s prostate gland when the cells multiply abnormally. It can progress slowly in some, requiring minimal or no treatment, and rapidly in others, increasing the risk of spreading to other parts. Prostate cancer has various symptoms. It could be frequent urination at night, painful urination or ejaculation or blood-stained urine or semen.
The risk of prostate cancer increases with age, genetics, and diet. For instance, African-American and Caribbean men of African origin are at a high risk of developing prostate cancer. Additionally, diets rich in animal fats may stimulate testosterone production and promote cancer cell growth. Thus, testosterone replacement therapy may worsen prostate cancer.
Medical experts recommend screening for prostate cancer before initiating any testosterone replacement therapy. The doctor will conduct blood tests for prostate-specific antigen (PSA). The normal levels should fall below 4ng/ml, although BPH drugs may lower PSA levels despite prostate cancer.
- Blood Clots
Testosterone may stimulate the overproduction of red blood cells. This could result in abnormal blood thickening, a condition known as polycythemia. The condition increases the risk of deep vein thrombosis in the deep veins or pulmonary embolism, where blood clots occur in the lungs. Both conditions are potentially fatal and can cause reduced oxygen supply to the vital organs resulting in organ damage or death. The FDA requires that testosterone replacement therapy should bear a precaution about increasing the risk of blood clots.
Enlarged breasts characterize gynecomastia in men. This is due to an imbalance in testosterone and estrogen levels, resulting in breast tissue growth.
The condition may occur at birth when an infant has enlarged breasts due to the mother’s estrogen levels. It may also occur at puberty due to fluctuating hormones. In adulthood, it is due to low testosterone levels or excessive fatty tissues due to obesity. Testosterone Replacement Therapy is often associated with gynecomastia and may worsen the symptoms of an existing condition.
- Congestive Heart Failure
Congestive heart failure is when the heart cannot handle the blood volume. This results in blood accumulating in other body parts, including the lungs, feet, and arms. The heart pumps blood slower, producing less oxygen and nutrients for the vital organs. As a result, the heart muscles may overstretch to hold more blood and become thick and stiff.
Due to the lack of enough oxygen and nutrients, the kidneys may retain more fluids or have them accumulate in other body parts. Congestive heart failure may be caused by coronary artery disease that decreases blood flow to the heart. It could cause cardiomyopathy, high blood pressure and heart attacks. It also causes kidney disease, diabetes, thyroid disease, and certain congenital disabilities.
Although men with low testosterone levels are at a higher risk of developing heart disease, treatment with endogenous testosterone may worsen the symptoms of congestive heart failure. Testosterone use may increase red blood cell count and cause blood to thicken. As a result, the weakened heart muscles may be unable to pump blood and nutrients to the vital organs.
- Limiting Sperm Production
Although testosterone is essential for sperm production, men with low blood testosterone levels could have normal sperm production. This is because the hormone is high in the testes where sperms are produced. Follicle-stimulating hormone is the main hormone responsible for stimulating sperm production. However, testosterone is essential for continued spermatogenesis and increased sperm counts.
Increasing testosterone levels decreases follicle-stimulating hormone levels and reduces sperm production. As a result, it may cause irreversible infertility. Thus, men with low testosterone levels and planning to start families should avoid testosterone replacement therapy.
- Acne and Skin Reactions
Acne is a skin condition characterized by white heads, pimples, nodules, cysts, and blackheads. It occurs when hair follicles get blocked by sebum, dead skin cells, and other particles. It can cause emotional distress and skin scarring and may lower self-esteem. Testosterone stimulates the sebaceous glands to produce more oil that could block the hair follicles. Thus, high testosterone levels from treatment may cause overproduction of sebum resulting in acne breakouts and difficulty in disease control.
Testosterone Replacement Vs. Performance Enhancing Steroids
There is a common misconception that testosterone replacement therapy is similar to performance-enhancing steroids.
Athletes and bodybuilders use Performance-enhancing steroids to increase their muscle mass and strength and improve their physical appearances. Additionally, they use steroids to promote faster recovery after exercise.
Performance-enhancing steroids contain synthetic testosterone or chemicals that mimic the effects of natural testosterone.
Although some performance-enhancing steroids may contain similar ingredients to testosterone replacement therapy, the difference comes in dosing. Steroid users consume unusually high doses and combine several doses to achieve faster results. On the other hand, testosterone replacement therapy contains precise doses to help the body achieve a normal testosterone level. Additionally, performance-enhancing steroids have not been medically reviewed, unlike testosterone replacement therapies.
Testosterone replacement therapy is generally safe for men with low testosterone levels, while the safety of performance-enhancing steroids has not yet been established. Furthermore, testosterone treatment is not addictive.
Unlike testosterone treatment, where there is close monitoring by wellness professionals, bodybuilders use steroids without any monitoring by doctors. Additionally, doctors subject patients to tests before initiating testosterone therapy. However, with performance-enhancing steroids, no previous tests are done to determine the eligibility for treatment.
Although both have potential side effects, athletes and bodybuilders are at a higher risk because they use steroids without regard to specific dosages and treatment durations. On the other hand, testosterone treatment regimens follow a specific dosage and duration of treatment, pausing a lower risk of adverse effects.
The FDA has not medically reviewed or approved the use of performance-enhancing steroids. On the other hand, testosterone replacement therapy has been tested and approved by the FDA and thus is legal.
Conclusion: Can Low Testosterone Levels Be Treated?
Testosterone is an important hormone in a man’s health. It’s responsible for his physical, emotional, physiological, and sexual wellbeing. Although the body naturally produces testosterone, it reaches its peak in puberty and declines by 1.6% every year from age 20. Thus, a man can have low testosterone at some point.
Men with low testosterone levels may experience reduced muscle mass and bone density, decreased libido, low moods, and erectile dysfunction. Low testosterone levels are treatable when blood concentration levels fall below 300 nanograms per deciliter and are accompanied by the above symptoms.
Testosterone products include gels, injections and patches. They could also be oral tablets or capsules and testosterone boosters. In addition, they have various potential benefits. These include increasing muscle mass, improving libido and memory, and promoting stronger bones. However, testosterone use has multiple side effects. These include irritation at the injection site, worsening sleep apnea symptoms, gynecomastia, and congestive heart failure. It also worsens prostate cancer, acne, blood clots, and benign prostate hyperplasia.
Although testosterone therapies may seem similar to performance-enhancing steroids, they are more concise with better dosage control than steroids. Besides, testosterone replacement therapy is FDA approved, while performance-enhancing steroids are not.
After considering the available testosterone products and the potential benefits and risks of testosterone replacement therapy, it’s important to consult your doctor to determine the best treatment for low testosterone levels.