Low Testosterone

What is low testosterone?

Testosterone is a hormone in the body that has a vital role in masculine growth and development. Though testosterone levels naturally decrease with age, low testosterone also has been linked to obesity, an increased risk of disease and premature death.

Low testosterone––also known as hypogonadism­––is a condition in which the body fails to produce enough testosterone, has an impaired ability to produce sperm or both.

There are two basic types of low testosterone:

• Primary: Also known as primary testicular failure, this type develops as the result of an issue in the testicles.
• Secondary: This type of low testosterone signifies a problem with the hypothalamus or pituitary gland. Both of these parts of the brain work together to trigger the testicles to produce testosterone using different hormones.

 Low testosterone of either type may be present at birth (congenital) or following an incident later in life (acquired), such as an infection or an injury. In some cases, both primary and secondary low testosterone may occur together.

What are the causes of low testosterone?

Primary low testosterone may be caused by:

• Cancer treatments, such as chemotherapy or radiation therapy, which can interfere with how the body manufactures testosterone and sperm
• Hemochromatosis, a condition in which there is too much iron in the blood, resulting in pituitary gland dysfunction or testicular failure
• Klinefelter syndrome, a congenital abnormality of the sex chromosomes in which two or more X chromosomes are present in addition to one Y chromosome (which determines sex), resulting in abnormal development of the testicles and underproduction of testosterone
• Mumps orchitis, an infection of the salivary glands that can spread to the testicles and affect normal function and testosterone production
• Testicular injury, resulting in damage to the testicles
• Undescended testicles, a condition where the testicles do not descend from the inside of the abdomen and, left untreated, could result in faulty testicles

Secondary low testosterone may be due to:

• HIV/AIDS, which can have an impact on the function of the hypothalamus, pituitary gland or the testicles
• Inflammatory diseases that involve the hypothalamus and pituitary gland (e.g., tuberculosis, sarcoidosis), which can affect testosterone production
• Kallmann syndrome, an abnormal development of the hypothalamus that can result in low testosterone
• Obesity, which may be linked to low testosterone at any age
• Pituitary abnormalities that can impair the release of hormones from the pituitary gland to the testicles, such as a tumor, surgery or radiation therapy
• Simultaneous illnesses that can result in excessive stress on the body, resulting in a temporary shutdown of the reproductive system
• The aging process, which causes the body to naturally produce less testosterone over time 

What are the symptoms of low testosterone?

Symptoms of low testosterone depend on when the condition develops.

Fetal Development

If the body fails to produce an adequate amount of testosterone (and at the right times during development of the fetus), a genetic male may be born with:

• Female genitals
• Genitals that are neither clearly female or male (ambiguous genitals)
• Underdeveloped male genitals

Puberty

Low testosterone in puberty-age males may delay the process of puberty or cause incomplete or lack of normal development, including:

• Decreased development of muscle mass
• Extreme growth of the arms and legs in relation to the trunk of the body
• Growth of breast tissue (gynecomastia)
• Impaired growth of body hair, penis and/or testicles
• Lack of voice deepening

Adulthood

In adults, low testosterone may alter male characteristics or impede normal functions of the body, including:

• Decrease in body hair production
• Decrease in muscle mass
• Erectile dysfunction (ED)
• Growth of breast tissue (gynecomastia)
• Infertility
• Loss of bone mass (osteoporosis)

Low testosterone in adults may also cause menopause-like changes in men, such as:

• Decreased sex drive
• Difficulty with concentration
• Fatigue
• Hot flashes

What are the treatment options for low testosterone?

Testosterone replacement therapy (TRT) is the primary treatment for low testosterone. In adults, TRT may be utilized to:

• Alleviate erectile dysfunction
• Increase sex drive
• Prevent bone loss
• Promote a sense of well-being
• Restore muscle strength
• Stimulate sperm production

In boys, TRT can stimulate puberty and secondary sex characteristics, including body hair growth, increased muscle mass and penile growth. In addition, pituitary hormones may be used to stimulate testicle growth.

Types of TRT may include:

• A patch that can be applied to the back, abdomen, upper arm or thigh
• Application in the nostrils as a gel (reduces the risk of person-to-person transference of testosterone via the skin)
• Application to the natural depression where the gums meet the upper lip (buccal cavity)
• Gel application to the upper arm, under each armpit (using an applicator) or on the front and inner thigh
• Injections
• Surgical implantation of testosterone pellets under the skin every three to six months

What are the risks of testosterone replacement therapy?

Risks of TRT may include:

• Blood clot formation
• Breast enlargement
• Increased sleep apnea
• Limited sperm production
• Stimulation of noncancerous growth of the prostate

What are some natural ways to increase testosterone levels in the body?

There are some lifestyle changes that patients can make in order to naturally increase testosterone production, and are good for overall health as well. These include:

• Eating a balanced amount of protein, fat and carbohydrates (constant overeating or dieting can disrupt testosterone levels)
• Exercising regularly and lifting weights
• Getting a good night’s sleep
• Keeping stress to a minimum (high levels of the stress hormone cortisol in the body can reduce testosterone levels)

For more information about low testosterone or to schedule an appointment with one of our specialists for an evaluation, contact Partners In Urology today.