Testosterone deficiency
is the medical term for having low level of the hormone testosterone
This is a disease awareness campaign initiated and funded by Grünenthal for the UK general public.
What is testosterone deficiency (TD)?
Low testosterone or hypogonadism, is a medical condition in which the testes (testicles, the male reproductive glands) do not produce enough testosterone (a male sex hormone).
Testosterone is an important hormone in men that helps maintain characteristics such as muscle mass, bone density, and sperm production.
While it is common for testosterone levels to progressively decline in men as they get older,1 low testosterone can occur even in young men, especially if they have developed a belly or have an excess amount of body fat.2
Testosterone levels may be affected by excessive stress,3 and certain medications such as painkillers, antidepressants and drugs for cholesterol.4
In younger men, causes may include underlying genetic conditions, environmental factors, or past injuries and infections.5
What are the signs & symptoms of low testosterone?
Common signs and symptoms of hypogonadism (low testosterone) in men.
Testosterone deficient men may not experience all these symptoms.
Metabolic symptoms / signs
- Obesity (BMI 30 or higher)
- Abnormal (belly) obesity (waist circumference 102cm or higher)
- High blood pressure
Insulin resistance, prediabetes or type 2 diabetes
Sexual symptoms
- Decreased sexual desire and activity
- Erectile dysfunction
- Delayed ejaculation
- Decreased volume ejaculate
- Decreased frequency or absent morning or night time erections
- Shrinking testes
Infertility
Psychological symptoms
- Depressed mood
- Loss of energy
- Reduced motivation
- Poor concentration
- Decreased well-being and/or poor self-rated health
- Irritability
- Sadness
Impaired memory
Physical symptoms
- Decreased muscle mass and strength
- Reduced physical performance
- Hot flushes or sweats
- Sleep disturbances
- Fatigue
- Reduced bone mineral density, osteoporosis,
- Low trauma fractures
- Decreased body hair
- Gynaecomastia (enlarged breasts)
What causes low testosterone?
Although many people think the main cause of low testosterone is ageing, some studies looking at risk factors have seen a link between obesity in men and low levels of testosterone.1,6,7
This means that by living a healthy lifestyle with regular exercise and healthy food habits, you improve your chances of maintaining your testosterone in the healthy range even as you get older. In other words, low testosterone – while common – is not inevitable in men as they get older, as menopause is in women.
Other possible factors for low testosterone levels may include metabolic syndrome8-10 and type 2 diabetes.11-13 Chronic diseases, such as high blood pressure, heart disease, liver disease, kidney disease, arthritis, stroke, emphysema, rheumatoid arthritis and depression may also be risk factors for low testosterone.12
Which men are most at risk of TD?
Men with...
Erectile dysfunction
Among men with erectile dysfunction, over one third (36%) can have low testosterone levels.3 Low testosterone can cause erectile dysfunction and/or non responsiveness to treatment for erectile dysfunction. Therefore, according to medical guidelines, it is recommended that men with erectile dysfunction have testosterone levels measured. This is particularly important if your erectile dysfunction treatment doesn’t appear to be working well.
Men with...
Type 2 diabetes
50% of obese diabetic men aged 45 and over can have low testosterone.16 The frequent occurrence of low testosterone in men with type 2 diabetes prompted medical guidelines to recommend that testosterone levels are measured in men with type 2 diabetes who have symptoms.
Men with...
High stress and unhealthy habits
Among men with sexual dysfunction, more than 40% who report a high degree of work stress were observed to have low testosterone.3 Unhealthy habits, such as obesity, stress, alcohol abuse, smoking, excess caffeine intake, and a lack of exercise are associated with low levels of testosterone.17
Think you’ve got low testosterone?
Regardless of age, if you’re rarely in the mood for sex and perhaps have difficulties getting an erection, often feel tired/lethargic and have a depressed mood, you may be experiencing symptoms of low testosterone.
References
- Travison TG, Araujo AB, Kupelian V, O’Donnell AB, McKinlay JB. The relative contributions of ageing, health, and lifestyle factors to serum testosterone decline in men. J Clin Endocrinol Metab. 2007;92(2):549-555.
- Gapstur SM, Gann PH, Kopp P, Colangelo L, Longcope C, Liu K. Serum androgen concentrations in young men: a longitudinal analysis of associations with age, obesity, and race. The CARDIA male hormone study. Cancer Epidemiol Biomarkers Prev. 2002;11(10 Pt 1):1041-1047.
- Guay A, Seftel AD, Traish A. Hypogonadism in men with erectile dysfunction may be related to a host of chronic illnesses. Int J Impot Res. 2010;22(1):9-19.
- Atmaca, M. Neuropsychiatric disease and treatment, 2020;16,1043.
- Cohen J, et al. Frontiers in endocrinology, 2020;10, 916.
- Wu FC, Tajar A, Pye SR, et al. Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European Male Ageing Study. J Clin Endocrinol Metab. 2008;93(7):2737- 2745.
- Camacho EM, Huhtaniemi IT, O’Neill TW, et al. Age-associated changes in hypothalamic-pituitary-testicular function in middle-aged and older men are modified by weight change and lifestyle factors: longitudinal results from the European Male Ageing Study. Eur J Endocrinol. 2013;168(3):445-455.
- Caldas AD, Porto AL, Motta LD, Casulari LA. Relationship between insulin and hypogonadism in men with metabolic syndrome. Arq Bras Endocrinol Metabol. 2009;53(8):1005-1011.
- Laaksonen DE, Niskanen L, Punnonen K, et al. The metabolic syndrome and smoking in relation to hypogonadism in middle-aged men: a prospective cohort study. J Clin Endocrinol Metab. 2005;90(2):712-719.
- Singh SK, Goyal R, Pratyush DD. Is hypoandrogenemia a component of metabolic syndrome in males? Exp Clin Endocrinol Diabetes. 2011;119(1):30-35.
- Biswas M, Hampton D, Newcombe RG, Rees DA. Total and free testosterone concentrations are strongly influenced by age and central obesity in men with type 1 and type 2 diabetes but correlate weakly with symptoms of androgen deficiency and diabetes-related quality of life. Clin Endocrinol (Oxf). 2012;76(5):665-673.
- Mulligan T, Frick MF, Zuraw QC, Stemhagen A, McWhirter C. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract. 2006;60(7):762-769.
- Rezvani MR, Saadatjou SA, Sorouri S, Hassanpour Fard M. Comparison of serum free testosterone, luteinising hormone and follicle stimulating hormone levels in diabetics and non-diabetics men- a case-control study. J Res Health Sci. 2012;12(2):98-100.
- Molina-Vega M, Asenjo-Plaza M, García-Ruiz MC, et al. Cross-Sectional, Primary Care-Based Study of the Prevalence of Hypoandrogenemia in Nondiabetic Young Men with Obesity. Obesity (Silver Spring). 2019;27(10):1584-1590.
- Pellitero S, Olaizola I, Alastrue A, et al. Hypogonadotropic hypogonadism in morbidly obese males is reversed after bariatric surgery. Obes Surg. 2012;22(12):1835-1842.
- Dhindsa S, Miller MG, McWhirter CL, et al. Testosterone concentrations in diabetic and nondiabetic obese men. Diabetes Care. 2010;33(6):1186-1192.
- Koh K, Kim SS, Kim JS, Jung JG, Yoon SJ, Suh WY, Kim HG, Kim N. Relationship between Alcohol Consumption and Testosterone Deficiency according to Facial Flushes among Middle-Aged and Older Korean Men. Korean J Fam Med. 2022 Nov;43(6):381-387.