Low Testosterone (Hypogonadism)

What is Testosterone?

Testosterone helps to maintain men’s muscle strength and mass, facial and body hair, and a deeper voice. Testosterone levels can affect men’s sex drive, erections, mood, muscle mass and bone density. Testosterone is also needed for men to produce sperm.

What is Low Testosterone?

A man’s testosterone level normally decreases with age. About 4 out of 10 men over the age of 45 have low testosterone.

What are the Signs of Low Testosterone in Men?

There are sexual and non-sexual signs of low testosterone. Sexual signs include:

  • Low sex drive
  • Poor erections (weaker and fewer)
  • Wanting sex less often

Non sexual signs include:

  • Increase in body fat
  • Lower energy
  • Reduced muscle mass
  • Feeling depressed
  • Anemia (low iron)
  • Loss of calcium from bone

What are Risk Factors for Hypogonadism?

Men with certain health problems also tend to have low testosterone. Some of these are:

  • High blood pressure (about 40 out of 100 also have low testosterone)
  • High cholesterol (about 40 out of 100 also have low testosterone)
  • Diabetes (about 50 out of 100 also have low testosterone)
  • Overweight (about 50 out of 100 also have low testosterone)
  • HIV (about 30 out of 100 also have low testosterone)
  • AIDS (about 50 out of 100 also have low testosterone)
  • Long-term opioid use (almost 75 out of 100 also have low testosterone)

How is Hypogonadism Diagnosed?

Low testosterone is found with a blood test. In general, a diagnosis of low testosterone is made if your hormone level is below 300 ng/dL.

Testosterone Replacement Therapy (TRT)

If you have signs and symptoms of low testosterone that bother you, there are many choices for raising the levels. Not everyone chooses treatment. Testosterone replacement therapy (TRT) can be given using:

  • Skin gel
  • Shots
  • Long-acting pellets
  • Patches
  • Pills

Side effects can include:

  • Acne (pimples)
  • Breast swelling or soreness
  • A high red blood cell count
  • Swelling of the feet or ankles
  • Smaller testicles
  • Infertility

Frequently Asked Questions

What are safety issues with using testosterone?

  • Men with known breast cancer or known or suspected prostate cancer should not take testosterone.
  • Men with kidney, liver, or heart problems may have a higher risk of water retention (edema).
  • If you are trying to father a child, you should not be on TRT. TRT can decrease your sperm count and fertility. Taking testosterone for a long time may harm fertility.

What are common side effects from testosterone treatments?

  • Skin gels can cause rashes or skin reactions.
  • Some men experience tenderness in the breast, or enlarged breasts.
  • Some men experience dizziness, lightheadedness, or feeling faint.
  • Some men become more emotionally sensitive, with mood swings.
  • Testosterone creams can impact women and children in close contact, especially pregnant women. Women and children should not touch unwashed clothes after treatment.

Does taking testosterone cause prostate cancer?
So far, studies have found no increase in prostate cancer risk among men who take testosterone compared to men who don’t. This issue needs further research.

Does taking testosterone affect cardiovascular health?
There are major concerns that taking testosterone can raise the risk of heart problems. These can include blood clots, heart attack and stroke. Two recent studies have suggested that TRT raises the risk of heart attack in men. The U.S. Federal Drug Administration is studying the risk of heart attack, stroke and death in men taking TRT.

What if I don’t treat low testosterone?
Symptoms of low testosterone will remain. You may find other ways to increase your energy level or you may choose to live with changes in your sexual desire and body.

Will testosterone treatment help with erectile dysfunction?
Erectile dysfunction (ED) is not the same as hypogonadism. It has other causes and requires other treatments. It’s important to talk about ED with your doctor as a separate issue. If you have normal testosterone levels, using TRT will not help your erection problems.