It's almost impossible to watch television or use the Internet these days without seeing at least one ad offering treatment for low testosterone. Judging by the number of ads, you might think “low T” is a very common problem that always requires medication —but is that really the case?
A little background: Testosterone is the hormone responsible for male characteristics such as a deeper voice, muscle growth, and development of the sex organs. Testosterone production begins in puberty and usually peaks during early adulthood; after age 30, it gradually begins to decline by about 1 percent every year.
While this gradual decline is a normal part of aging, an unusually low level of testosterone is a condition known as hypogonadism. It can cause symptoms including a decreased sex drive, erectile dysfunction and infertility, as well as depression, fatigue, insomnia, increased body fat and reduced muscle mass. Low testosterone can also cause sleep apnea and congestive heart failure to worsen, and decrease bone density.
Just because a man has these symptoms, however, does not necessarily mean he has low testosterone. Aging, thyroid problems, diabetes, depression and other conditions may also cause many them. Before beginning any kind of treatment, men should make sure their symptoms are, in fact, due to low testosterone. A simple blood test can determine whether levels are truly low. A man’s normal total testosterone range is between about 300 nanograms per deciliter (ng/dL) and 1,000 ng/dL.
If it is low, a hormone disorder is not always the reason. Diabetes, infection, liver or kidney disease, and testicular cancer all are possible causes, as well as injury and the use of some medications.
Once other causes have been ruled out, treatments for hormonal disorders aim to bring testosterone levels back up into the normal range. Before turning to prescription medication, though, men might try several lifestyle changes to see if they can increase their testosterone naturally. For example, lack of quality sleep can affect hormone production; aim to get seven to eight hours of restful sleep every night. Being overweight or underweight can also decrease testosterone, so getting back to healthy weight may remedy the problem. Staying active is another way to help maintain testosterone levels—if a man doesn’t use his muscles, his body may stop producing the testosterone needed to keep them strong. (But don’t overdo it, as excessive exercise can lower hormone levels.) Finally, men who have high stress levels may produce too much of the stress hormone cortisol, which makes it more difficult for the body to produce enough testosterone.
If lifestyle changes aren’t enough, prescription medications may help. Testosterone gels can be applied to the skin daily; the gel is absorbed through the skin into the bloodstream. Men who use testosterone gel should be very careful to wash their hands thoroughly after applying it to avoid spreading the hormone to others. A nasal gel is also available. Testosterone patches are another option; the patch is applied to the skin daily and, like a gel, continually releases testosterone. Implantable testosterone pellets can be placed under the skin in a minor surgical procedure, where they release hormones over the course of several months. The goal of these types of treatments is to maintain testosterone at a steady level and prevent symptoms from recurring.
In cases where low testosterone is causing infertility and a couple is trying to get pregnant, testosterone injections may be the recommended treatment. Injections are given every few weeks to stimulate sperm production at the same time a man’s partner is ovulating.
Dr. David Brunsting is an internal medicine specialist at Scripps Coastal Medical Center Eastlake. For more information on staying healthy or for a physician referral, please call 1-800-SCRIPPS.