Five million American men suffer the effects of low testosterone, according to the National Institutes of Health. This condition is called hypogonadism or androgen deficiency. Ninety percent of men experiencing low testosterone levels don't seek treatment, according the National Diabetes Association.
Testosterone is the most important of the male sex hormones. Produced mainly in the testes and secondarily by the adrenal glands, testosterone is critical for creating and maintaining male sex features. Besides its role in developing male sex features, this hormone is essential for producing sperm cells, driving sexual interest, and keeping muscles and bones big and strong.
Low Testosterone Defined
The brain determines how much testosterone is produced. A message from the hypothalamus to the pituitary gland sets the stage for action by the testes, the actual producers of testosterone.
Testosterone levels vary throughout the day. A blood test is used to diagnose low testosterone. The testing is usually done in the early morning when the level peaks. A normal level is anything between 300 and 1200 ng/dl.
Symptoms of Low T
When a man's testosterone level is too low, he may experience any of the following symptoms:
Decreased sex drive
Low sperm count
No, or inadequate, erections
Increased breast size
In more severe cases, there may be additional symptoms, including loss of body hair and muscle mass, bone fractures, and decreased size and firmness of the testes.
Causes of Testosterone Deficiency
There's no single cause of testosterone deficiency. Aging is a factor, with testosterone production decreasing about one percent per year after the mid-30s. Disease, accidental testicular cell damage, inflammation, and side effects of medical treatments may also lead to low testosterone levels.
Men's Journal points out societal testosterone levels have dropped in the last 20 years. This may be explained in part by the rising obesity levels, since body fat converts testosterone into estrogen. Environmental toxins that mimic this effect may also be partly to blame.
A recent study by Northwestern University even suggests raising children may contribute to lowering of testosterone levels, although the reasons are subject to debate.
People with diabetes are twice as likely as those without the condition to suffer from low T, according to the American Diabetes Association.
Low Testosterone Treatments
Testosterone replacement therapy is a life-long treatment. That's because once the brain detects a normal blood testosterone level, it shuts off production. Some of the long-term treatment risks common to all forms of TRT include shrunken testicles, hair loss, acne, breast enlargement, and sterility. TRT can cause elevated hematocrit levels, increasing the risk of stroke and heart attack.
Treatments aimed at boosting testosterone levels come in the form of injections, pills, gels, patches, and buccal medication. Each treatment carries specific benefits and risks.
The NIH does not recommend pill treatments, saying they're not effective enough in low concentrations and create too much risk of liver damage in high concentrations.
Deep muscle injections, given every 1 to 3 weeks, are the least expensive treatment available but result in fluctuating hormone levels.
Gels and patches are easy to use, as they are placed on the skin and provide consistent hormone levels. Their disadvantages include the need to keep women and children from touching the skin where the patch is applied, and they may cause irritation, itching, or blisters.
Buccal medication is a gum placed between the lips and teeth every 12 hours. It works like a patch, and kissing is not contraindicated. This treatment can cause temporary taste distortion, mouth irritation, and headache.
Men who suffer from medical conditions like heart, kidney, or liver disease or certain cancers are not good candidates for testosterone replacement therapy.