Low testosterone affects roughly 13 million men, according to the American Diabetes Association, and although reductions in the sex hormone can happen at any age, testosterone typically begins decreasing around middle age. With so many men being affected, it's surprising to know that only an estimated 10 percent seek help for the issue.
Dr. Abraham Morgentaler, founder of Men's Health Boston, author of "Testosterone for Life," and associate clinical professor of urology at Harvard Medical School, has dedicated his time to helping men solve the problem of low testosterone, along with other issues concerning men's health. Here, Dr. Morgentaler has answered some questions about low testosterone.
What is low testosterone?
Dr. Morgentaler: Low testosterone is known in medical terms as testosterone deficiency, or hypogonadism. Many years ago I coined the term "low T" when my patients were embarrassed by their difficulty pronouncing the word "testosterone." It was frowned upon by my medical colleagues, but seems to have found a home now in popular culture. Low T is a condition when testosterone levels in the bloodstream drop low enough to cause symptoms. A man's ability to produce testosterone declines as he ages, so low T becomes increasingly common as men get older. However, it is not unusual for men in their 30s or 40s to have it, and I occasionally see it even in men in their 20s.
What causes low testosterone?
Dr. Morgentaler: In many men low testosterone appears to simply be the result of aging. However, there can be other reasons, such as testicular injuries or surgery to remove one or both testicles, varicoceles (varicose veins in the scrotum), genetic abnormalities, and pituitary tumors. There is also a strong association between low testosterone levels and common medical conditions, including diabetes and obesity. There is some evidence that stress and impaired sleep can lower testosterone too.
How can a man determine he has it? Are there warning signs or symptoms?
Dr. Morgentaler: The usual symptoms are decreased sexual desire, reduced quality of erections, lack of energy, and a sense of chronic fatigue. Other symptoms can be difficulty achieving an orgasm, depressed mood, increased abdominal fat, and decreased muscle mass and strength. Some men with low T have all of these, others just one or two. If men have these symptoms without an obvious other cause, they should have a blood test for testosterone to determine if they really do have low testosterone levels.
What are the health implications of low T?
Dr. Morgentaler: The biggest thing we notice in our patients with low T is that they are not enjoying life the way they once did. The primary reason to treat men with low T is to improve their symptoms. However, there is now considerable evidence that men with low T are at increased risk for a number of important medical issues -- diabetes, cardiovascular disease, and osteoporosis. There are several large studies that show men with low T are even at an increased risk of dying sooner than men with normal testosterone. However, one of the most important reasons we treat men with low T is because so many of them feel "alive again." Treatment doesn't work for everyone, but when it does the results can be enormously gratifying.