Low testosterone at 30

Low Testosterone (Male Hypogonadism)

Low testosterone (male hypogonadism) is a condition in which the testes (testicles, the male reproductive glands) do not produce enough testosterone (a male sex hormone).

In men, testosterone helps maintain and develop:

  • Sexual features
  • Muscle mass
  • Adequate levels of red blood cells
  • Bone density
  • Sense of well-being
  • Sexual and reproductive function

Low testosterone affects almost 40% of men aged 45 and older. It is difficult to define normal testosterone levels, because levels vary throughout the day and are affected by body mass index (BMI), nutrition, alcohol consumption, certain medications, age and illness.

As a man ages, the amount of testosterone in his body gradually drops. This natural decline starts after age 30 and continues (about 1% per year) throughout his life.

There are many other potential causes of low testosterone, including the following:

  • Injury (trauma, interrupted blood supply to the testes) or infection of the testes (orchitis)
  • Chemotherapy for cancer
  • Metabolic disorders such as hemochromatosis (too much iron in the body)
  • Dysfunction or tumors of the pituitary gland
  • Medications, including opioids, hormones used to treat prostate cancer, and steroids (such as prednisone)
  • Acute (short-term) or chronic (long-term) illness
  • Alcohol abuse
  • Cirrhosis of the liver
  • Chronic renal (kidney) failure
  • Inflammatory conditions such as sarcoidosis (a condition that causes inflammation of the lungs and other organs)
  • Kallman syndrome (abnormal development of the hypothalamus, a gland in the brain that controls many hormones)
  • Klinefelter syndrome (a genetic condition in which a male is born with an extra copy of the X chromosome). Also called XXY syndrome
  • High levels of the milk-producing hormone prolactin
  • Obesity or extreme weight loss
  • Uncontrolled type 2 diabetes mellitus
  • Congenital defect (present at birth)
  • Obstructive sleep apnea
  • Aging
  • Estrogen excess (usually from an external or environmental source)
  • Previous anabolic steroid abuse
  • Severe primary hypothyroidism
  • Pubertal delay
  • Trauma (head injury)
  • Radiation exposure or prior surgery of the brain

Symptoms of low testosterone depend on the age of person, and include the following:

  • Low sex drive
  • Erectile dysfunction
  • Decreased sense of well-being
  • Depressed mood
  • Difficulties with concentration and memory
  • Fatigue
  • Moodiness and irritability
  • Loss of muscular strength

Other changes that occur with low testosterone include:

  • A decrease in hemoglobin and mild anemia
  • A decrease in body hair
  • Thinning of the bones (osteoporosis)
  • Increased body fat
  • Breast development (gynecomastia)
  • Infertility

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What is low testosterone (male hypogonadism)?

Low testosterone (male hypogonadism) is a condition in which the testicles do not produce enough testosterone (the male sex hormone).

In men, testosterone helps maintain and develop:

  • Sexual features
  • Muscle mass
  • Adequate levels of red blood cells
  • Bone density
  • Sense of well-being
  • Sexual and reproductive function

How common is low testosterone?

Low testosterone affects almost 40% of men over the age of 45.

From Up To Date:

What causes low testosterone?

As a man ages, the amount of testosterone produced in his body gradually drops. This natural decline starts after age 30 and continues at a rate of about 1% per year throughout his life.

There are many other potential causes of low testosterone including:

  • Injury or infection of the testes
  • Chemotherapy treatment
  • Metabolic disorders such as hemochromatosis
  • Dysfunction or tumors of the pituitary gland
  • Medications such as opioids, hormones used to treat prostate cancer, and steroids
  • Illness
  • Alcohol abuse
  • Cirrhosis of the liver
  • Chronic kidney failure
  • Inflammatory conditions such as sarcoidosis
  • Kallman syndrome
  • Klinefelter syndrome, also called XXY syndrome
  • High levels of the milk-producing hormone prolactin
  • Obesity or extreme weight loss
  • Uncontrolled type 2 diabetes mellitus
  • Congenital defect
  • Obstructive sleep apnea
  • Aging
  • Estrogen excess
  • Anabolic steroid abuse
  • Severe primary hypothyroidism
  • Pubertal delay
  • Head Trauma
  • Radiation exposure

Symptoms of low testosterone depend on the age of the person but include:

  • Low sex drive
  • Erectile dysfunction
  • Decreased sense of well-being
  • Depressed mood
  • Difficulties with concentration and memory
  • Fatigue
  • Moodiness and irritability
  • Loss of muscular strength

Other changes that occur with low testosterone include:

  • A decrease in hemoglobin and mild anemia
  • A decrease in body hair
  • Osteoporosis
  • Increased body fat
  • Breast development (gynecomastia)
  • Infertility

How is low testosterone diagnosed?

Low testosterone is diagnosed with a blood test to measure the amount of testosterone in the blood. It may take several measurements to determine if a patient has low testosterone as levels normally fluctuate throughout the day. The highest levels of testosterone are generally in the morning, near 8 a.m.

How is low testosterone treated?

Low testosterone is treated with testosterone replacement therapy, which can be performed via:

  • Intramuscular injections every 10 to 14 days
  • Testosterone patches that are applied daily to different parts of the body
  • Testosterone gels that are applied daily to upper back and arms
  • Pellets that are implanted under the skin every two months

NOTE: Oral testosterone is not currently approved for use in the United States.

What are the side effects of testosterone replacement therapy?

The side effects of testosterone replacement therapy include:

  • Acne or oily skin
  • Swelling in the ankles
  • Stimulation of the prostate that can cause urination symptoms
  • Breast enlargement or tenderness
  • Worsening of sleep apnea
  • Smaller testicles
  • Skin irritation

Laboratory abnormalities that can occur with testosterone replacement include:

  • Increase in prostate-specific antigen (PSA)
  • Increase in red blood cell count
  • A decrease in sperm count, producing infertility

If you are taking hormone replacement therapy, regular follow-up appointments with your physician are important.

Who shouldn’t undergo testosterone replacement therapy?

Testosterone replacement therapy may cause the prostate to grow. If a man has early prostate cancer, a concern is that testosterone may stimulate cancer growth. Therefore, it is important for all men considering testosterone replacement therapy to undergo prostate screening before starting treatment. Men who are found to have prostate cancer should not undergo testosterone replacement therapy.

Guidelines suggest physicians should assess for prostate cancer risk by performing:

  • PSA tests at 3, 6, and 12 months within the first year after beginning therapy, and then every year after that
  • A digital rectal examination of the prostate at 3-6 months and 1 year after beginning therapy, and then every year after that.
  • Hematocrit levels will be checked before testosterone therapy starts, and then on a regular basis to make sure red blood cell levels remain normal.

NOTE: A digital rectal exam is recommended even for men who are not undergoing testosterone replacement therapy, as an age-related prostate cancer screening starting around age 50.

Other men who should not take testosterone replacement therapy include those who have:

  • An enlarged prostate
  • A lump on their prostate that has not been evaluated
  • A PSA measurement above 4
  • Breast cancer
  • An elevated hematocrit level
  • Severe congestive heart failure
  • Obstructive sleep apnea that has not been treated

Can low testosterone be prevented?

There are no known ways to prevent low testosterone that is caused by genetic conditions or damage to the testes or pituitary gland.

A healthy lifestyle that includes good nutrition, exercise, weight management, and that avoids excessive use of alcohol and drugs can help keep testosterone levels normal.

  • The Endocrine Society: Testosterone Therapy in Men
  • American Urological Association: What is Low Testosterone?

Younger Than 50? Yes, You Can Have Low Testosterone

Treatments for Low Testosterone in Younger Men

Not everyone with low testosterone needs treatment. “When it comes to treating low testosterone in younger men, we usually reserve treatment for those who have symptoms, such as fatigue and low libido,” Gilbert says.

In men who don’t make the hormone in their testes because of a condition such as Klinefelter syndrome, or those who have lost their testes because of cancer, the only option is testosterone replacement therapy. Such testosterone supplements come in the form of a gel, injections, patches, long-acting pellets, or oral inserts.

In these circumstances, “treatments are usually used only in the short term, and when a doctor has close observation and knowledge of the patient,” Gilbert says.

An important consideration for younger men before getting treatment is fertility. “You don’t want to give supplemental testosterone to men who want to be fertile because it can turn off sperm production,” Gilbert says.

Once a young man goes off testosterone supplementation, there’s a chance his sperm count will never return to what it was before he started. “Therefore, men of reproductive age should consider alternatives that might increase their testosterone as well as preserve their sperm production,” he says. One such alternative is a class of drugs called selective estrogen receptor modulators (SERMs).

Other treatments for low testosterone include weight loss and other lifestyle changes, such as eating healthier and increasing exercise.

The bottom line, though, is that if you have low testosterone symptoms, it’s important to see your doctor. Then, your doctor can rule out potentially more serious causes of your symptoms, such as high blood pressure or a thyroid problem, and offer treatment that can improve your energy and quality of life.

Low Testosterone: When Do Men Need Treatment?

With John P. Mulhall, MD, and Shalendar Bhasin, MD

While the number of men seeking testosterone treatment has tripled over the past decade, many patients who need hormone replacement for a testosterone deficiency are not receiving it.1 When low T occurs because of poor functioning testes or a tumor on the pituitary gland, for example, the result may be hypogonadism.

Recognizing this trend has led to the publication of guidelines for the diagnosis and management of testosterone deficiency in men by the American Urological Association1 (AUA) and an updated best practice recommendation from the Endocrine Society.2

“The use of testosterone therapy has increased dramatically in relatively healthy men without a clear indication of testosterone deficiency (low T), while other men in need of testosterone therapy fail to receive it due to clinician concerns regarding cardiovascular events or the development of prostate cancer,” says John P. Mulhall, MD, director of the Male Sexual and Reproductive Medicine Program at Memorial Sloan Kettering Cancer Center in New York City, and lead author of the AUA guideline.

“One goal of the AUA guideline is to outline criteria to determine who has a bona fide testosterone deficiency, how to evaluate and determine who should be treated,” he tells EndocrineWeb.

Similarly, the Endocrine Society updated their best practices guidance for testosterone therapy in men with hypogonadism, a form of testosterone deficiency.

These clinical recommendations were prepared in response to a “much higher quality of evidence published in recent years about testosterone deficiency and a wider availability of high quality assays for measuring testosterone levels, which had been a problematic issue,” said Shalendar Bhasin, MD, professor of Medicine at Harvard Medical School, and director of Men’s Health, Research Program at Brigham and Women’s Hospital, in Boston Massachusetts, who led the work on the Endocrine Society project.

How Does Low Testosterone Differ from a Hormonal Deficiency?

Testosterone—a hormone produced primarily in testicles but also to a lesser extent by the ovaries and adrenal cortex—is essential for a variety of physical, cognitive, sexual, and metabolic functions in men. This sex hormone usually peaks in adolescence and early adulthood. As men age, the ability to produce testosterone begins to decline such that testosterone levels begin to drop about 1 to 3 percent a year beginning around age 40 years.

This natural decline, however, does not imply that a man is testosterone deficient or a candidate for testosterone therapy.1,2 A deficiency in this hormone only occurs in cases where there is a low level of testosterone along with specific symptoms or signs.

“Testosterone deficiency is a very specific clinical condition that is defined by the presence of a set of specific signs and symptoms that occur as a result of decreased production of testosterone by the testes in men,” says Dr. Bhasin. “It’s extremely important that testosterone is used only as Food and Drug Administration-approved treatment for this condition.

“What’s been happening over the past couple of years is that there has been a rise in off-label use of testosterone to treat a variety of age-related conditions and symptoms that don’t qualify as a testosterone deficiency,” he says.

Diagnosing and Testing for Hypogonadism

Outside of age, there are “myriad causes for testosterone deficiency,” Dr. Mulhall adds. “They include testicular dysfunction, chemotherapy or radiation to testes, or loss of the testes,” he said. Then there are secondary testosterone deficiencies, genetic disorders, Kleinfelter syndrome, pituitary disorders, steroid use, opioid use, diabetes, and obesity.

While testosterone supplementation is being used to treat low hypoactive sexual desire, a type of sexual dysfunction, in women, “we don’t know if it’s a bona fide condition,” says Dr. Bhasin. It’s been plausible but remains only a hypothesis that hasn’t been proven definitively.

According to the recommendations issued by both the Endocrine Society and AUA,1,2 before a diagnosis of testosterone deficiency can be made, patients must demonstrate both a low testosterone levels and show signs and/or symptoms of the condition.

Signs and Symptoms Signaling a Problem:2,3

Red flag symptoms:

  • Low sex drive
  • Difficulty with erection
  • Low sperm count
  • Unexplained loss of hair
  • Hot flashes
  • Low bone density

Additional signs:

  • Testicular atrophy (changes in testes)
  • Diminished lean muscle mass
  • Increased body fat
  • Elevated hemoglobin A1c
  • Osteopenia or low trauma bone fracture
  • Problems sleeping (insomnia)
  • Fatigue
  • Difficulty concentrating, lack of motivation, depression

When and How Should a Low Testosterone be Treated?

“Testosterone replacement shouldn’t be used to treat a naturally occurring, age-related decline in this hormone or simply for a low T number,” says Dr. Bhasin, “but if a man has a testosterone deficiency or classical hypogonadism, the benefits of treating the condition with testosterone is favorable and outweighs any risks.”

According to Dr. Bhasin, over the last two to three years there has been greater availability of high quality lab providing good results for testosterone levels, which until recently has been a problematic when trying to make a firm diagnosis.

To confirm the existence of low testosterone requiring treatment, the patient should have two separate blood tests on nonconsecutive days in the early morning (testosterone levels fluctuate during the day and are highest in the early hours) that are analyzed by reliable laboratories certified by the Centers for Disease Control and Prevention, Dr. Bhasin told EndocrineWeb.

A normal range for testosterone levels is 300 ng/dL to 1,000 ng/dL, with the Endocrine Society considering low testosterone below 263 ng/dL, says Dr. Bhasin.

Your doctors should also determine if you (your spouse) shows signs or symptoms of a testosterone deficiency. One problem with the symptoms for testosterone deficiency is many are “incredibly nonspecific” Dr. Mulhall cautions, which is why getting accurate testosterone levels is vital.

“If a man had a testosterone level less than 220 and shows signs of osteopenia, the testosterone is low because the patients has bone density loss,” says Dr. Mulhall, “but you can’t just go on the number alone.”

Monitoring, Managing, and Follow-Up Care

Both sets of guidelines stress the importance of monitoring T levels during treatment to make sure the hormone falls within a desired range and to check the status of other health conditions such as sex, heart and bone health.

“While the number of men using testosterone has increased, it’s concerning that about 20 to 25 percent of men who go on testosterone never get their levels double checked before treatment, and a percentage of men who go on testosterone who don’t get their levels checked at all while they’re on the treatment,” says Dr. Mulhall.

There are a number of health reasons to monitor testosterone treatments. For example, low testosterone is a risk factor for cardiovascular events, but “giving a patient testosterone cannot be said to definitively raise or lower the risk for cardiovascular issues,” Dr. Mulhall says.

While testosterone replacement therapy does not cause prostate cancer, Dr. Bhasin notes that increasing testosterone could raise PSA levels, which may lead to an increased risk for prostate cancer, particularly in the 30% of men over 70 years of age who may have with an early stage prostate that has not yet become detectable.4

“One important goal of monitoring testosterone levels is to minimize the risk of unnecessary biopsies,” he adds.

Know the Health Warnings of T Supplementation

When it comes to treatment, there are a variety of forms of testosterone—from gels to adhesive pellets to injections—that can be administered to men.

However, you should be aware that patients who use transdermal gels to restore normal T levels should be careful to avoid any risk of transferring testosterone gels to women and children.4 Covering the shoulders or upper arms where the gel has been applied is sufficient to protect against accidental exposure of this hormone to others.

From a reproductive standpoint, both professional organization guidelines note that men who are trying to conceive should not receive testosterone treatments because it impairs sperm production.

“Even when testosterone replacement is stopped, there will be a period of time during which it will take sperm production a while to recover,” says Dr. Mulhall.

“There’s no magic to diagnosing or treating testosterone deficiency,” says Bhasin. “Like any other condition it’s really important to have accurate measurements and be rigorous in the diagnosis and a major concern has been starting treatments without an appropriate diagnosis.

“The result has been that half the people never refill their prescriptions and about three quarters of men given a testosterone prescription will not be using testosterone after the first year,” he said. “It’s a bona fide condition that is under diagnosed and over treated.”

Last updated on 05/07/2018 Continue Reading Low Testosterone Treatments View Sources

What you need to know about CNN’s story on young men and low testosterone

For several years now, the term “low T” has been used to market testosterone to older men who are concerned about losing their sex drive.

Critics say this marketing has convinced many men to take potentially risky drugs that they don’t need.

Now CNN has come along to alert young men that perhaps they, too, should be worried about “low T.”

In the piece Low testosterone, or ‘male menopause,’ no longer just for older men, Ian Kerner, whose identifies him as a licensed psychotherapist, wrote:

“In my practice, I’ve noticed that an increasing number of younger guys are complaining of sexual concerns, such as diminished libido and erectile problems, more commonly seen in older men.”

Kerner offers no evidence that libido or erectile problems are increasing in young men, or that low testosterone is to blame.

Many causes of erectile dysfunction

In fact, there’s good reason to question this premise. Justin Lehmiller, PhD, an assistant professor of social psychology at Ball State University, recently pointed out a paucity of data to back up the idea that there’s an epidemic of diminished sexual function in young men.

Even if true, Lehmiller said it would be impossible to pinpoint a cause, although he does note that “young people today are much more likely to be using antidepressants than they were in the past, which we know can cause a number of sexual side effects. There may also have been changes in condom use patterns—we know that a lot of guys have erectile difficulties when using condoms, so if guys today are using more condoms, that could translate to more difficulties.”

Of course, he’s speculating.

But in fact, sexual dysfunction in young men can result from many things, including obesity, stress, drinking, smoking, lack of exercise, depression, side effects of prescription drugs, and a host of medical conditions.

Where’s the evidence?

So if you’ve got problems in this department, low testosterone isn’t necessarily the cause. Further, studies have shown that testosterone treatment does not significantly improve erections in men with low testosterone, according to Choosing Wisely.

Nevertheless, Kerner used this opportunity to offer lifestyle advice from an $80 book edited by Andrew Weil, MD, who, Kerner writes, “recommends ‘an integrative approach to sexual health’ that assesses all the many factors that affect testosterone.”

That approach includes a wide range of interventions for which no evidence is cited — including lifting weights, eating coconut oil and grassfed beef, consuming vitamin D and zinc, and taking herbal supplements.

The column does not mention that Weil sells vitamins and herbal supplements on his .

One of our contributors, Richard Hoffman, MD, MPH, director of the Division of General Internal Medicine at the University of Iowa Carver College of Medicine and the Iowa City VA Medical Center, took a look at the medical literature on these suggested interventions.

His overall impression? While some research shows associations between those lifestyle interventions and higher testosterone, there’s little to suggest a meaningful benefit. “Exercising, getting enough sleep, and maintaining a healthy weight are pretty reasonable recommendations for everyone, but I won’t be recommending them to increase testosterone levels,” he said via email.

Also weighing in was another contributor, Kathleen Fairfield, MD, DrPH, a clinician-scientist based at Maine Medical Center.

“Some of the recommendations are prudent, like getting adequate sleep and avoiding a diet with excessive processed foods and simple carbs,” Fairfield said via email. “But the claims about vitamin D, zinc, and herbs for increasing testosterone are not evidence-based.”

A baseline testosterone check?

The column also suggested young men get a “baseline” check of their testosterone “so you know what’s normal for you.”

That piece of advice was also shot down by our experts. Fairfield called it “not based in science” and “not common practice.”

Another of our contributors, Alan Cassels, a pharmaceutical policy researcher at the University of Victoria, said via email, “It’s hard to see why you’d get a ‘baseline’ level other than to alter that level, with drugs.”

And again, more testosterone won’t necessarily solve your sexual performance issues.

‘Like grey hair or wrinkles’

As Hoffman put it: “Low T is a treatment in search of a disease.”

Cassels called this column a “fluff piece targeting insecure men.” He likened it to direct-to-consumer ads for testosterone drugs, which he’s criticized as inflating the market for these products, which have not shown significant benefits and have potential harms.

Cassels has also questioned terms that medicalize male aging — like “adult-onset hypogonadism” — which seem calculated to get men to worry about natural declines in testosterone.

“Let’s face it, ‘low T’ is something that is so natural most men will get it if they live long enough, kinda like grey hair or wrinkles,” he said.

Disclaimer: This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.

Common causes of low testosterone

Low testosterone is when a man’s testosterone levels stay below 300 ng/dL. One of the main causes of low testosterone is hypogonadism—a condition in which the testicles either don’t make enough testosterone or they don’t receive the proper signals from the brain to make testosterone. Other causes of low testosterone (low T) include:

  • Diabetes
  • Obesity
  • Poor diet
  • Alcohol abuse

Obesity is a major contributor to low T, partly because fat cells can turn testosterone into estrogen and because of a reduction in sex hormone-binding globulin (SHBG).

Testosterone levels in men change

If your testosterone levels are low, don’t panic. Testosterone levels in men decline by about 1% every year after peaking in their 20s. That’s why low testosterone is more common for men in their 50s and 60s. Your testosterone levels also change constantly throughout the day.

Men typically have more testosterone in the morning than at night. So make sure you get tested in the morning and talk to your doctor about how your testosterone levels compare to normal levels relative to your age, lifestyle, habits, and other health risks. Everyone is different.

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