Testosterone is the male sex hormone that is made in the testicles. Testosterone hormone levels are important to normal male sexual development and functions.
During puberty (in the teen years), testosterone helps boys develop male features like body and facial hair, deeper voice, and muscle strength. Men need testosterone to make sperm. Testosterone levels generally decrease with age, so older men tend to have low blood testosterone levels.
Some men have low testosterone levels. This is called Testosterone Deficiency Syndrome (TD) or Low Testosterone (Low-T). Deficiency means that the body does not have enough of a needed substance. Syndrome is a group of symptoms that, together, suggest a disease or health condition.
The American Urology Association (AUA) identifies low blood testosterone (Low-T) as less than 300 nanograms per deciliter (ng/dL). These symptoms or conditions may accompany Low-T:
There are many other possible reasons for these symptoms, such as: opioid use, some congenital conditions (medical conditions you are born with), loss of or harm to the testicles, diabetes, and obesity (being overweight). See your doctor if you have any of these symptoms.
You may need testosterone therapy (TT) if you have Low-T. Both the FDA and the AUA suggest that TT be used to treat conditions you are born with, such as Klinefelter syndrome.
You also may need TT if you harm or lose your testicles. If your testicles are removed because of a sickness such as cancer, you may need TT. Most men with Low-T (no matter what the cause) will be treated if they have both symptoms of Low-T and blood tests showing Low-T levels. Talk with your doctor if you feel that you may need TT.
TT may help you but it may have adverse (harmful) results. (See discussion of these side effects below.) The Federal Drug Administration (FDA) has said that testosterone drug labels should state that there is a risk for heart disease and stroke for some men using testosterone products. All men should be checked for heart disease and stroke before, and periodically while on, TT. The AUA however, on careful review of evidence-based peer review literature, has stated that there is no strong evidence that TT either increases or decreases the risk of cardiovascular events.
The FDA also was concerned when they found that men were being treated for Low-T due only to aging. There is ongoing research to determine more about TT in aging men. Your doctor will talk with you about the benefits and risks of TT and carefully consider how to treat your symptoms.
It is hard to know how many men among us have TD, although data suggest that overall about 2.1% (about 2 men in every 100) may have TD. As few as 1% of younger men may have TD, while as many as 50% of men over 80 years old may have TD. People who study the condition often use different cut-off points for the numbers, so you may hear different numbers being stated.
TD is more common in men who have diabetes or who are overweight. In one research study, 30% of overweight men had Low-T, compared to only 6.4% of those with normal weight. The same study found diabetes to be a risk factor for TD. In another study, 24.5% of men with diabetes had Low-T, compared to 12.6% of those without diabetes.
There are many signs and symptoms of Low Testosterone. Some are more closely related to Low-T levels (specific signs and symptoms). Others may not necessarily be linked (non-specific signs and symptoms). Your doctor will help you make sense of your own situation.
Specific symptoms are those more likely or directly linked to TD such as:
Non-specific symptoms are those that may or may not be linked to TD such as:
Having any one of the specific or non-specific symptoms may not mean that you have TD. But if you have a mix of symptoms, for instance, if you start to feel very tired and sad over a period of time and this is a change for you, you may want to check for TD.
Low sexual desire alone may not mean that you have TD. But if you have a combination of low sexual desire, reduced erectile function, and feelings of sadness and tiredness, you should talk to your doctor.
Some persons are born with conditions that cause Testosterone Deficiency (TD) such as:
Some men may develop Low-T because of conditions like these:
Basically, if your testicles keep making less testosterone than normal, your blood levels of testosterone will fall. Many men who develop TD have Low-T levels linked to:
Men with certain health problems also tend to have low testosterone. Some of these are:
Although many symptoms may be tied to Low Testosterone (Low-T), total blood testosterone level is the most important measure of testosterone deficiency. To make a diagnosis, your doctor will use other specific signs and symptoms in addition to your testosterone blood level.
At your medical visit, your health history will be taken, and the doctor will do an exam and look for some of the signs and symptoms mentioned in this article.
Your doctor may ask you about:
Your doctor will check for the following:
Your doctor may order these blood tests:
The following also may be done to help with further diagnosis:
You may hear about free testosterone or bioavailable tests for testosterone. These are not the same as total testosterone level tests. Ask your doctor about the differences and if you need these tests.
In recent years, the media has reported more about Testosterone Therpy (TT), and more men between the ages of 40 and 64 have been tested and given TT. Some men with certain symptoms may even want TT without being tested. This action may not be safe or helpful for them. Total testosterone level should always be tested before any TT.
The AUA recommends that TT be prescribed only to men who meet the clinical and laboratory definition of testosterone deficiency (Testosterone level of less than 300 ng/dL). Here are some of the things you will need to know about TT:
There are generally five different ways to take testosterone. They are: transdermal (through the skin), injection, oral/buccal (by mouth), intranasal (through the nose), and by pellets under the skin. No method is better than another. While you are taking TT, your doctor will test your blood to determine testosterone levels.
Here are some details about the five different methods:
You may want to choose how you take your testosterone based on what is best or most useful for you. In some cases, your insurance provider may decide the order in which testosterone therapies are provided. Talk about the choices with your doctor.
