What’s Causing My Low Testosterone?

Low testosterone (low T) affects 4 to 5 million men in the US.

Testosterone, an important hormone in the human body, decreases each year after age 30. In some men this decrease can be substantial. Between 19 and 39 percent of older men may have low levels of testosterone.

Older men with low T have increasingly sought testosterone replacement therapy (TRT) in recent years. TRT addresses symptoms like low libido, poor muscle mass, and low energy.

It is not just older men that are affected by low T. Young men, even teens, can also have this problem. Click “Next” to learn more.

Low levels of testosterone are due to hypogonadism. Normal growth can be jeopardized if hypogonadism occurs during puberty. Problems occur with muscle development, deepening of the voice, and lack of body hair. There’s also the risk of undeveloped genitals, overly long limbs, and enlarged breasts.

Later in life, insufficient testosterone can lead to other problems. Symptoms include low energy levels, low muscle mass, infertility, and erectile dysfunction. Other symptoms are slow hair growth, loss of bone mass, and breast growth.

Fatigue, decreased sex drive, and mental fogginess are commonly reported mental and emotional symptoms in men with low T.

Underactive testes cause primary hypogonadism. Underactive testes do not manufacture sufficient levels of testosterone for optimal growth and health. This underactivity can be caused by an inherited trait. It can also be acquired by accident or illness.

Inherited conditions include:

• undescended testicles, in which the testicles fail to descend from the abdomen before birth
• Klinefelter’s syndrome, a condition in which a man is born with three sex chromosomes: X, X, and Y.
• hemochromatosis, in which too much iron in the blood causes testicular failure or pituitary damage

Types of testicle damage that can lead to primary hypogonadism include:

• physical injury to the testicles: Injury must occur to both testicles to affect testosterone levels.
• mumps orchitis: A mumps infection can injure testicles.
• cancer treatment: Chemotherapy or radiation can damage testicles.

Secondary hypogonadism is caused by damage to the pituitary gland or hypothalamus. These parts of the brain control hormone production.

Inherited or disease conditions in this category include:

• pituitary disorders caused by drugs, kidney failure, or small tumors
• Kallmann syndrome, a condition connected to abnormal hypothalamus function
• inflammatory diseases, such as tuberculosis, sarcoidosis, and histiocytosis, which can impact the pituitary gland and the hypothalamus
• HIV/AIDS, which can affect the pituitary gland, hypothalamus, and testes

Acquired circumstances that can lead to secondary hypogonadism include:

• normal aging: Aging affects production and response to hormones.
• obesity: High body fat can affect hormone production and response.
• medications: Opioid pain meds and steroids can affect function of the pituitary gland and hypothalamus.

You may be affected by primary, secondary, or a mixed hypogonadism. Mixed hypogonadism is more common with increased age, as well as in people undergoing glucocorticoid therapy. It also can affect people with sickle-cell disease, thalassemia, or alcoholism.

If you’re experiencing symptoms of low T, there are lifestyle changes you can make that may help ease your symptoms.

A good first step is increasing activity levels and maintaining a healthy diet in order to reduce body fat. It can also be helpful to avoid glucocorticoid medications such as prednisone as well as opioid pain medications.

You may need to begin testosterone replacement therapy (TRT) for treatment of low T. TRT can be very important for helping teenage males with hypogonadism experience normal masculine development. Sufficient testosterone levels help maintain health and well-being in adult males.

TRT has side effects, however, including:

• acne
• enlarged prostate
• sleep apnea
• testicle shrinkage
• breast enlargement
• increased red blood cell count
• decreased sperm count

A carefully formulated TRT treatment plan should avoid many of these undesirable side effects. Talk with your doctor to evaluate your options.