Written by Philip Cheng, MD on September 12, 2024
Testosterone deficiency is also referred to as low testosterone, “low T,” hypogonadism, and hypoandrogenism. Testosterone deficiency is frequent, affecting roughly 4-5 million males in the USA. Starting across the age of 30, testosterone ranges in males typically begin to decline. About 7% of males of their 50s have low testosterone and the incidence will increase with age.
What’s testosterone?
Testosterone is without doubt one of the hormones naturally produced by each women and men, however is extra pronounced in its results for males, the place it’s produced primarily within the testicles. Testosterone is vital for sexual growth, fertility/sperm manufacturing, intercourse drive/sexual operate, and constructing bone and muscle mass.
Indicators and signs of low testosterone
Regardless of being referred to as a intercourse hormone, testosterone is crucial for extra than simply sexual operate; it’s vital for regular functioning and growth of the male physique. Low testosterone can lead to a wide range of indicators and signs, similar to low libido, erectile dysfunction, lowered semen quantity, fatigue, issue with exercising and gaining muscle, weight achieve, elevated physique fats, decreased bone density, temper swings, low motivation, impaired focus/reminiscence, issue with sleep, decrease sperm counts, smaller than ordinary penis or testicles, and anemia.
How does testosterone impression male fertility?
A fragile hormonal stability is critical for optimum sperm manufacturing, with testosterone enjoying a vital function. Having low testosterone can result in decrease sperm counts, and thus, infertility. It might appear counterintuitive, however exogenous testosterone given by way of treatment, is definitely problematic for fertility. The physique will sense an extra of testosterone and shut down the testes, resulting in decrease or absent sperm manufacturing.
What causes testosterone deficiency?
Other than the pure decline with advancing age, there are particular circumstances that may trigger low testosterone in males of all ages, even in younger males and youngsters. There are two kinds of hypogonadism, major and secondary.
- Main hypogonadism: That is attributable to underactive testes. The issue arises as a result of the testicles don’t produce the degrees of testosterone required for optimum well being and progress. This may be attributable to an inherited attribute or consequence from harm or sickness. Some circumstances embrace undescended testicles, Klinefelter syndrome, and hemochromatosis. Some kinds of harm, versus inherited circumstances, that may trigger major hypogonadism embrace bodily harm to the testicles, mumps orchitis, and a historical past of most cancers remedy, similar to chemotherapy and radiation.
- Secondary hypogonadism: Secondary hypogonadism is when the reason for low testosterone shouldn’t be straight associated to the testicles. It outcomes from injury to the pituitary gland or hypothalamus within the mind, which management hormone manufacturing by the testicles. It may be the results of both inherited circumstances or acquired circumstances. Inherited causes embrace issues of the pituitary gland ensuing from medication, kidney failure, or tumors, Kallmann syndrome, inflammatory ailments like tuberculosis, and HIV/AIDS. Acquired circumstances that may result in secondary hypogonadism embrace regular getting old, weight problems, and drugs, similar to opioids and anabolic steroids.
The best way to diagnose testosterone deficiency
Usually, a prognosis of hypogonadism relies on two elements: a measurement of low testosterone ranges within the blood and the show of a number of the indicators and signs of low testosterone. Affirmation is required with two separate blood checks within the early morning on non-consecutive days. It is because testosterone ranges sometimes fluctuate all through the day however are at their peak within the morning. Generally, a prognosis requires signs of hypogonadism and ranges beneath 300 ng/dL. Some sufferers do have regular whole testosterone ranges however might be handled if their free testosterone or bioavailable testosterone ranges are low.
Therapy for testosterone deficiency
Generally, issues which are good to your well being, similar to maintaining a healthy diet meals and sustaining a physique mass index within the regular vary will help increase testosterone ranges.
Sure meals which are wealthy in vitamins similar to vitamin D and zinc will help increase testosterone. Some examples embrace fish, low-fat milk enriched with vitamin D, egg yolks, oysters and shellfish, and legumes.
Nonetheless, food plan alone typically shouldn’t be a treatment for hypogonadism. Medicine is usually mandatory and there are numerous totally different formulations of testosterone alternative. You will need to understand that nearly all testosterone formulations will suppress sperm manufacturing.
- Testosterone injections: Common (sometimes weekly) injections can substitute pure testosterone ranges. Nonetheless, injections needs to be used cautiously as they nearly at all times suppress sperm manufacturing.
- Transdermal (topical) testosterone: This entails the applying of testosterone gel or patches on the pores and skin. It’s a non-invasive methodology to complement testosterone however shares the identical threat of suppressing sperm manufacturing.
- Testosterone pellets: Implanted beneath the pores and skin, sometimes close to the hip or buttocks, these pellets step by step launch testosterone and final for about 4 months. They supply a gradual hormone launch however have the identical dangers as injections and topical testosterone on the subject of suppressing sperm manufacturing
- Oral testosterone: Oral formulations of testosterone alternative require taking a tablet twice a day. These formulations are efficient however could not get ranges as excessive as injections.
- Testosterone nasal gel: That is the one formulation of testosterone that tends to protect sperm manufacturing as a result of it is extremely short-acting. The draw back is that it must be administered by way of every nostril two to a few instances a day.
- Clomiphene citrate (Clomid), anastrozole (Arimidex), and human chorionic gonadotropin (hCG): These drugs work otherwise from testosterone dietary supplements. As an alternative of supplementing testosterone, they stimulate the testicles to supply extra testosterone and may subsequently protect and even enhance sperm manufacturing. Sadly, these drugs will not be efficient in everybody. Some males won’t have a lift in testosterone ranges and others could have a lift however could not expertise symptomatic enchancment.
Who can diagnose and deal with testosterone deficiency?
The best choice is to see a urologist who makes a speciality of hypogonadism and male infertility, also referred to as a reproductive urologist. These docs are particularly skilled to diagnose and deal with low testosterone and associated circumstances.
Whereas the checks may very well be administered by your major care doctor (PCP), many PCPs will not be adequately skilled to diagnose and deal with testosterone deficiency. In addition they is probably not accustomed to the entire totally different hormone drugs accessible, particularly the fertility-friendly choices. Sadly, quite a lot of physicians who prescribe testosterone alternative remedy don’t successfully counsel sufferers about how these drugs can suppress sperm manufacturing and what different choices can be found. Thus, these sufferers typically find yourself seeing a reproductive urologist for additional administration.
When you’re a Progyny member, please contact your devoted Affected person Care Advocate (PCA) for extra data.
