Testosterone is the key male sex hormones that regulates fertility, muscle mass, fat distribution, and red blood cell production. According to the American Urological Association, about 2 men in every 100 have low testosterone. Washington University Urology experts answer common patient questions below.
Low testosterone is called hypogonadism. It is a failure of the testicles to produce the male sex hormone testosterone.
Low testosterone suggests that there is an inadequate amount of testosterone to stimulate the male hormone receptors on some cells in the body, such as in the male reproductive organs, muscles and bone.
Low testosterone can be treated most directly be taking hormone replacement therapy – testosterone supplement.
Testosterone can be taken as a:
- Skin patch – applied every evening to provide a slow release of testosterone through the skin
- Gels – topical gels applied daily to the underarm, back, upper arms, or thighs
- Pellets – injected into the buttock for sustained slow release of testosterone for several months
- Injections – often given by the patient every few weeks
- Oral medication – not recommended for the treatment of age related hypogonadism due to potential liver toxicity
Alternative methods to increase testosterone include improved diet and exercise.
There are 8 common signs of adult onset low testosterone:
- Erectile dysfunction
- Low sperm count (infertility)
- Depressed mood
- Decreased libido (sex drive)
- Lethargy (loss of energy)
- Sleep disturbances
- Decrease in muscle mass and strength
- Loss of pubic, facial and underarm body hair
The above symptoms are not diagnostic of low testosterone; all the above symptoms could be due to other causes. It is important to present your symptoms to your doctor for examination and testing.
If you have one or more of the above symptoms of low testosterone, your testosterone is level is measured with a blood sample.
An adult male’s testosterone should be between 270 and 1000 ng/dl. Testosterone levels peak at about the age of 20 years, and then the testosterone slowly declines with age. In younger men, the average testosterone level is in the range of 650 ng/dl. When the testosterone is under 300, we often will consider a several-month trial of replacement therapy.
Low testosterone can be due to a defect in the testicles or pituitary hormone axis. Primary testicular problems can be congenital, due to a genetic defect, or due to a loss of testicular function from radiation therapy, trauma, chemotherapy, mumps or testicular cancer. In older men, low testosterone is often due to a drop in the stimulation of the testes by the pituitary gland.
Many men can maintain good erections despite a low testosterone level. However, with low testosterone, there is commonly a loss of interest in sex and a resultant difficulty with achieving an erection.
Testosterone levels in the normal range help men to have a better overall sense of well-being and health. Low testosterone can lead to mood changes, anxiety and loss of energy. Men often become sedentary. A sedentary lifestyle relates directly to weight gain and ED.
Vitamins, nutritional supplements and “testosterone boosters” are not proven to increase testosterone levels. Supplements that contain precursors along the testosterone production pathway such as DHEA could improve testosterone levels, but there is no evidence that these increase the testosterone level in healthy men or men with a primary testicular defect.
Washington University Urology can provide options and treatments for low testosterone. Meet our specialists below.
Arnold Bullock, MD
Dane Johnson, MD