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Testosterone has an image problem—it’s associated with aggression, ego, and brute force instead of the thoughtfulness and meme-generation abilities that are essential to modern society. But without testosterone, men literally wouldn’t be men. You probably know that testosterone is responsible for the male body’s development at puberty, but the hormone plays a key role in men’s health at every age. And when your levels of testosterone diminish, it can cause a number of symptoms that reduce your quality of life. But you don’t have to live with it. Here’s how to recognize and treat it.
What is low testosterone?
A low testosterone level (also known as hypogonadism, or low T) is an abnormally low level of testosterone in the blood.
Testosterone is produced by the testicles and adrenal glands. It’s an androgen, or male sex hormone, which is present from birth and is what makes a fetus male. During puberty, levels of testosterone surge, producing secondary sexual characteristics like muscle growth, body hair, and sperm production. And T plays an important role in men’s health throughout life, regulating libido, erectile function, sperm production, bone density, muscle mass, mood stability, and more.
Testosterone levels drop naturally with age, beginning around age 40. According to the Cleveland Clinic, aside from aging, there are many other causes of decreased testosterone levels. They include obesity, sleep problems like sleep apnea, chronic diseases, certain types of infections (like HIV), and some drugs (including opioids and steroids).
Testosterone affects a wide array of bodily functions, so low levels can have various seemingly unrelated signs and symptoms.
- Low testosterone (or low T) means you have a less-than-optimal level of a key male sex hormone in your blood.
- Testosterone (along with DHT, which comes from testosterone) causes the development of secondary sexual characteristics at puberty, but it’s important to several bodily processes throughout life.
- Testosterone levels naturally drop, starting around age 40.
- Low T can cause a variety of physical and mental symptoms, including sexual dysfunction, muscle loss, and depression.
- The condition can be addressed with testosterone replacement therapy. Research shows that several supplements may help increase testosterone in some people.
Diagnosing low testosterone
The incidence of low testosterone increases with age. A doctor can check your testosterone with a blood test. Different bodies have varying guideless for how a “normal” testosterone level defined. As a general rule of thumb, we can think of a normal testosterone level as being between 300 and 1,000 nanograms per deciliter (ng/dL). However, Testosterone levels vary significantly throughout the day. They’re highest in the morning—and they change from one day to the next. That’s why doctors usually require two early-morning testosterone levels (usually between 7 a.m. and 9 a.m.) on separate days before diagnosing a man with low T.
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Common symptoms of low testosterone
- Low sex drive. A decline in sexual desire is a common sign of low testosterone. But it’s not universal: Some men maintain a normal sex drive despite low T.
- Erectile dysfunction. This might include fewer spontaneous erections, difficulty getting erections during sexual activity, or fewer morning erections.
- Changes in sleep patterns/fatigue. Low T can disturb your sleep in an ironic cycle—it can cause insomnia or sleep disturbances, which prevent you from getting adequate shuteye. But sleep is when the body manufactures testosterone, so it’s important to get seven to nine hours of quality sleep each night.
- Decreased lean muscle mass. Testosterone contributes to the building of muscle, so when your T levels are reduced, muscle mass can decline. Body fat may increase, leading to obesity. Gynecomastia, or the development of breast tissue in men, may also result. The good news: Strength training (a.k.a. muscle-building) exercises can boost testosterone levels.
- Reduced bone density. Symptoms can include back pain or a loss of height, but often reduced bone density develops silently until a bump or fall causes bones to break. Your healthcare provider can assess your bone health with a bone mineral density (BMD) test.
- Hair loss. Most cases of hair loss in adult men are attributable to male pattern baldness, which is caused by DHT, a byproduct of testosterone that attacks hair follicles on the scalp. But in some cases, a low testosterone level can cause hair loss.
- Low semen volume.
- Low blood counts. A decline in testosterone can cause anemia, a reduction in the number of red blood cells.
- Low energy. Fatigue commonly accompanies decreased testosterone. But chronic tiredness can have many causes; if you’re experiencing it, it’s important to be evaluated by your healthcare practitioner.
- Mood changes or signs of depression. These can include irritability, fatigue, a chronic low mood, feelings of hopelessness, or lack of enjoyment of activities you previously found pleasurable.
Individuals may experience all, some, or none of these symptoms. For a definitive diagnosis, testosterone levels need to be actually measured through blood testing.
Treatment for low testosterone
If you have a testosterone deficiency, your healthcare provider might recommend TRT, or testosterone replacement therapy, an FDA-approved way to increase testosterone. Testosterone therapy can be administered in the following ways:
- Skin patch
- Surgically implanted pellets
A common side effect of testosterone replacement therapy is a low sperm count. A risk of TRT is that when you add artificial testosterone, it can trick your body into slowing down production of GnRH, LH, FSH, which are signaling hormones produced in the brain because it thinks you’re making enough. This may have the undesired side effect of slowing down sperm production and worsening your body’s ability to make its own testosterone, which could make you dependent on continued TRT.
Natural treatments for low testosterone
If you suspect you might have a low testosterone level, it’s a good idea to seek medical advice from a healthcare provider who can order tests to get a full picture of what’s going on. You might have low testosterone, or it could be another health condition that can be treated and resolved.
That said, there are some vitamins and supplements that some research indicates may boost testosterone levels.
- Vitamin D. Many Americans are deficient in the “sunshine vitamin,” so named because the body produces it naturally when the skin is exposed to the sun. That can be a particular liability for men because a low vitamin D level could contribute to low T. Some studies show that supplementing with vitamin D can improve sexual function and increase testosterone levels in men who are vitamin D deficient (Pilz, 2011).
- Magnesium. Some studies have found that magnesium supplementation can increase men’s testosterone levels (Maggio, 2014).
- Zinc. Research has shown that taking a zinc supplement can improve semen quality in subfertile men and increase testosterone levels in zinc-deficient men (Fallah, 2018).
- Ashwagandha. In a small 2019 study, overweight men who took an ashwagandha supplement for 16 weeks saw a 15% increase in testosterone compared to men who received a placebo (Lopresti, 2019).
- Fenugreek. A 12-week study found that men who took a fenugreek supplement experienced an increase in testosterone levels, morning erections, and frequency of sexual activity compared to men given a placebo (Rao, 2016).
- DHEA. This hormone, produced in the adrenal glands, is a natural booster of testosterone. Some studies have found that taking a DHEA supplement can boost free testosterone levels in conjunction with exercise (Liu, 2013).
While these studies are promising, many other studies have failed to find associations between taking supplements and testosterone levels. If you are actually diagnosed with low testosterone, you should not rely on supplements for treatment. Instead, talk to your healthcare provider about TRT.