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Are you feeling sluggish? Is your sex drive low? It’s completely normal to want the problem fixed pronto when symptoms like these begin impacting your life. Low testosterone (low T) might be to blame for struggles with low energy or low interest in sex, or it might not.
Before making assumptions about your health and taking over-the-counter supplements that may not be right for you, it’s important to understand that low testosterone (low T) is a medical diagnosis with a lot of nuances to consider.
Testosterone is an important and sensitive hormone the body produces mainly in the gonads (testicles). For males, it’s responsible for traits like muscle and bone mass, sex drive, and traditionally masculine characteristics like facial hair. It helps regulate mood, fat, and red blood cells.
While testosterone levels can vary with age, they often begin to decline around age 40. Clinical studies on low T often use varying data points that make it difficult to pinpoint exactly how many males live with the condition today. In general, the Urology Care Foundation says data estimates two in every 100 males may have low T.
Prolonged low T that goes untreated could impact mental health, weight, and bone density due to the role testosterone plays in keeping them strong. It’s good to wonder about low levels and also make medically guided decisions around when it’s appropriate to replace testosterone.
From my perspective as a urologist, there are six important things I want you to know about low T and testosterone-boosting treatments no matter your age. Be sure to talk with your doctor about whether your testosterone level—or another condition—may be cause for concern.
1. Low energy doesn’t always mean Low T.
Low energy is commonly associated with low T, but it’s also a common symptom for countless other health conditions.
Before assuming testosterone is the culprit, assess your stress level, how much sleep you’re getting and its quality, and reflect on any other testosterone-related warning signs you may be experiencing such as:
- Erectile dysfunction or other erection issues
- Low libido
- Males in their 20s or 30s may find it difficult to gain muscle mass despite appropriate workouts
- Overweight males may notice a swelling or tenderness of the breast called gynecomastia
If you notice these symptoms, it may be time to talk with your doctor. Testosterone might be to blame, but it’s best to make sure.
Related reading: How Reconstructive Urology Can Help Restore Urinary and Sexual Function.
2. Common causes of Low T: Obesity, cancer treatment, aging.
Fat deposits in the male body can sometimes turn testosterone into estrogen, a hormone that’s more predominant in females than males. This conversion can have numerous side effects including the symptoms associated with low T.
The good news for obesity-induced low T is that healthy weight loss can boost testosterone levels for some overweight males, helping naturally balance hormones to improve symptoms while supporting better overall well-being.
Related reading: Mindful Eating for Healthy Weight Loss.
Some types of cancer treatments can be a common cause of low T, particularly those for testicular or prostate cancer. Hormone-based androgen-involved therapies curb the production of testosterone, often triggering low T symptoms. Despite stopping these medications after successful cancer treatment the symptoms can persist.
The natural aging process also plays a big part in low T. Very low levels of testosterone could affect bone health. It’s linked to osteoporosis in older males just as low estrogen is linked to osteoporosis in older females, which is another reason why it’s important to speak with your primary care provider sooner rather than later.
3. Store-bought testosterone supplements aren’t a surefire fix.
The ingredients in these types of store-bought testosterone-boosting supplements aren’t regulated by the U.S. Food and Drug Administration, which means there are no laws that require printed ingredients on the bottle. That makes it difficult to clearly know what’s in the supplement.
In 2020, a “male enhancement supplement” sold in Virginia was found to contain sildenafil and glyburide. These potent chemicals led to several calls to the poison control center, because people who took them experienced major hypoglycemia, or low blood sugar. Unlabeled, unregulated supplements can be dangerous.
Furthermore, store-bought supplements are often more expensive than prescribed testosterone replacement therapies that are medically proven to treat a low T diagnosis, and they can’t be customized to consider an individual’s unique health needs. A one-size-fits-all approach doesn’t always work. You doctor can help tailor a solution that’s right for your body.
4. Prescription testosterone replacement therapy is safe.
If testosterone levels can’t be boosted naturally, through weight loss for example, then medically prescribed replacement therapy is a safe, evidence-backed treatment to consider.
Typically, I test my patients for low T with two easy blood tests. I consider testosterone levels that are less than 300 to be low—a normal range for a healthy male in their 30s or 40s is usually 400 to 500. For perspective, a teenager’s testosterone level could be more than 700 during puberty.
When low T is diagnosed, patients have different treatment channels to choose from but in general the medication is the same: testosterone to help replace lost hormone.
Testosterone replacement options include:
- Injection (the most common choice)
- Nasal spray
- Topical gel
Patients can carry out any of these therapies independently and conveniently in the comfort of their own home, with monitoring from the doctor at least every three months to be sure testosterone levels are on the right track.
Your doctor can help determine if low T is truly causing your symptoms and partner with you to pinpoint treatment options that might be best.
5. Low T replacement therapy can have side effects.
As important as it is to understand treatment options for low T, it’s equally important to understand the possible side effects of medically prescribed hormone replacement therapy.
- Fertility problems. Testosterone replacement therapy can sometimes damage sperm production and maturation, which negatively impacts fertility. Men who hope to someday expand their family should keep this possibility in mind and discuss it with their partner and doctor.
- Increased red blood cell production. Testosterone can increase red blood cell counts. Some patients choose to regularly donate blood to reduce the risk of building up too many red blood cells (called erythrocytosis) while helping improve—or even save—another person’s life.
- Monitoring is key. Your testosterone levels must be checked after treatment starts. Routine monitoring by your healthcare provider not only ensures testosterone levels are where they should be, but it also makes sure blood counts are normal and helps spot other possible risks that aren’t well understood, like prostate cancer.
6. Don’t make assumptions about your hormone health.
Getting older doesn’t guarantee that low testosterone is the root of sexual or energy-level concerns. Try not to jump to self-diagnosed conclusions when it comes to male testosterone production and treatment.
Instead, make it a priority to talk with your primary care provider about your symptoms to get to the bottom of concerns. If low T does turn out to be the cause, partner with your healthcare team to put a safe and effective treatment plan in place.