Why do we need testosterone?
This drug is the key male sex hormone that regulates fertility, muscle mass, fat distribution, and red blood cell production.
When levels of testosterone drop below levels that are healthy, they can lead to conditions like hypogonadism or infertility. There are, however, sources from which people with low testosterone can boost their levels.
Low testosterone is becoming more and more common. The number of prescriptions for testosterone supplements has increased fivefold since 2012.
This article will explore what testosterone does and whether men should worry about decreasing levels of the hormone as they grow older.
Fast facts on this drug
- This drug regulates a number of processes in the male body.
- Levels of testosterone tend to drop as men age.
- Prohormone supplements do not have any effect on this drug levels.
- Testosterone supplements are prescribed only for specified conditions, and not to counteract the natural, age-related drop in testosterone levels.
- Testosterone replacement therapy (TRT) is also available. However, this can carry side effects and risks.
This drug is the hormone responsible for the development of male sexual characteristics. Hormones are chemical messengers that trigger necessary changes in the body. Females also produce testosterone, usually in smaller amounts.
It is a type of androgen produced primarily by the testicles in cells called the Leydig cells.
In men, testosterone is thought to regulate a number of functions alongside sperm production. These include:
- sex drive
- bone mass
- fat distribution
- muscle size and strength
- red blood cell production
Without adequate amounts of this drug, men become infertile. This is because testosterone assists the development of mature sperm.
Despite being a male sex hormone, testosterone also contributes to sex drive, bone density, and muscle strength in women. However, an excess of testosterone can also cause women to experience male pattern baldness and infertility.
The brain and pituitary gland control this drug levels. Once produced, the hormone moves through the blood to carry out its various important functions.
High or low levels of this drug can lead to dysfunction in the parts of the body normally regulated by the hormone.
When a man has low testosterone, or hypogonadism, he may experience:
- reduced sex drive
- erectile dysfunction
- low sperm count
- enlarged or swollen breast tissue
Over time, these symptoms may develop in the following ways:
- loss of body hair
- loss of muscle bulk
- loss of strength
- increased body fat
Chronic, or ongoing, low testosterone may lead to osteoporosis, mood swings, reduced energy, and testicular shrinkage.
Causes can include:
- testicular injury, such as castration
- infection of the testicles
- medications, such as opiate analgesics
- disorders that affect the hormones, such as pituitary tumors or high prolactin levels
- chronic diseases, including type 2 diabetes, kidney and liver disease, obesity, and HIV/AIDS
- genetic diseases, such as Klinefelter syndrome, Prader-Willi syndrome, hemochromatosis, Kallman syndrome, and myotonic dystrophy
In women, however, high testosterone levels can lead to male pattern baldness, a deep voice, and menstrual irregularities, as well as:
- growth and swelling of the clitoris
- changes in body shape
- reduction in breast size
- oily skin
- facial hair growth around the body, lips, and chin
Recent studies have also linked high testosterone levels in women to the risk of uterine fibroids.
Testosterone imbalances can be detected with a blood test and treated accordingly.
This drug levels naturally decrease as a man ages.
The effects of gradually lowering testosterone levels as men age have received increasing attention in recent years. It is known as late-onset hypogonadism.
After the age of 40, the concentration of circulating testosterone falls by about 1.6 percent every year for most men. By the age of 60, the low levels of testosterone would lead to a diagnosis of hypogonadism in younger men.
Low testosterone has been associated with increased mortality in male veterans. Late-onset hypogonadism has become a recognized medical condition, although many of the symptoms are associated with normal aging.
The following are symptoms of late-onset hypogonadism:
- diminished erectile quality, particularly at night
- decreased libido
- mood changes
- reduced cognitive function
- fatigue, depression, and anger
- a decrease in muscle mass and strength
- decreased body hair
- skin changes
- decreased bone mass and bone mineral density
- increase in abdominal fat mass
As well as sexual dysfunction, late-onset hypogonadism has also been associated with metabolic disease and cardiovascular disease.
The degree to which testosterone levels decline varies between men, but a growing number of men experience the effects of reduced testosterone levels. Life expectancy has increased, and many men now live beyond the age of 60 years.
As a result, a higher number of men see the effects of age-related testosterone depletion.
Administering treatment for hypogonadism as the result of a disease differs from treating late-onset hypogonadism in older men.
One proposed treatment for low testosterone comes in the form of testosterone supplements.
One type of testosterone supplement, methyltestosterone, has received approval from the United States Food and Drug Administration (FDA). However, guidelines advise doctors not to prescribe this supplement due to the speed with which the liver metabolizes testosterone.
This can lead to liver toxicity. While doctors can legally prescribe the supplement, they generally try to avoid this.
Until stronger evidence is available to support the benefits and safety of testosterone supplementation, only older adults with severe clinical symptoms of low testosterone should be candidates for these supplements.
The FDA have advised that testosterone supplements are not suitable to treat late-onset hypogonadism, and a doctor should only prescribe them for an identifiable cause.
Testosterone replacement therapy
This drug replacement therapy (TRT) can help restore some affected functions of low testosterone.
Studies have shown that TRT mainly impacts bone strength and hemoglobin levels in the blood, but not mental sharpness.
The treatment can be administered by:
- skin gels and patches
- tablets that are absorbed through the gums
These can, however, trigger side effects, including:
- increased red blood cell count
- prostate and breast enlargement
- in rare cases, breathing difficulties during sleep
- increased risk of cardiovascular disease, although this is subject to debate
Deciding to pursue a course of TRT involves deciding between the perceived benefit of the therapy on the symptoms of a particular individual and the risks of the treatment.
However, the Endocrine Society advises that doctors should not prescribe TRT to men aged less than 65 years, even if they have low testosterone levels. The risks and suggested benefits of TRT for men younger than this are unclear, as are the benefits.
Current research is conflicting. Additional studies into testosterone replacement are necessary for physicians to fully understand its potential risks and benefits, and to identify the individuals that may see the most benefit.
What Causes Low Testosterone?
As a man ages, the amount of testosterone in their body naturally gradually declines. This decline starts after age 30 and continues throughout life. Some causes of low testosterone levels are due to:
- Injury, infection, or loss of the testicles
- Chemotherapy or radiation treatment for cancer
- Genetic abnormalities such as Klinefelter’s Syndrome (extra X chromosome)
- Hemochromatosis (too much iron in the body)
- Dysfunction of the pituitary gland (a gland in the brain that produces many important hormones) or hypothalamus
- Inflammatory diseases such as sarcoidosis (a condition that causes inflammation of the lungs)
- Medications, especially hormones used to treat prostate cancer and corticosteroid drugs
- Chronic illness
- Chronic kidney failure
- Cirrhosis of the liver
- Obesity (especially abdominal)
What Are the Symptoms of Low Testosterone?
What Changes Occur in the Body Due to Low Testosterone?
Low testosterone can cause the following physical changes:
How Do I Find Out If I Have Low Testosterone?
The only accurate way to detect the condition is to have your doctor measure the amount of testosterone in your blood. Because testosterone levels fluctuate throughout the day, several measurements will need to be taken to detect a deficiency. Doctors prefer, if possible, to test levels early in the morning, when testosterone levels are highest.
Note: Testosterone should only be used by men who have clinical signs and symptoms AND medically documented low testosterone levels.
Erectile Dysfunction: Testosterone Replacement Therapy
How Is Low Testosterone Treated?
Testosterone deficiency can be treated by:
- Intramuscular injections, given anywhere from two to 10 weeks apart
- Testosterone gel applied to the skin or inside the nose
- Mucoadhesive material applied above the teeth twice a day
- Long-acting subcutaneous pellet
- Testosterone stick (apply like underarm deodorant)
Each of these options provides adequate levels of hormone replacement; however, they all have different advantages and disadvantages. Talk to your doctor to see which approach is right for you.
Who Shouldn’t Take Testosterone Replacement Therapy?
Men who have prostate cancer or breast cancer should not take testosterone replacement therapy. Nor should men who have severe urinary tract problems, untreated severe sleep apnea or uncontrolled heart failure. All men considering testosterone replacement therapy should undergo a thorough prostate cancer screening — a rectal exam and PSA test — prior to starting this therapy.
What Are the Side Effects of Testosterone Replacement Therapy?
In general, testosterone replacement therapy is safe. It is associated with some side effects, including:
- Acne or oily skin
- Mild fluid retention
- Stimulation of prostate tissue, with perhaps some increased urination symptoms such as a decreased stream or frequency
- Increased risk of developing prostate abnormalities
- Breast enlargement
- Increased risk of blood clots
- Worsening of sleep apnea (a sleep disorder that results in frequent night time awakenings and daytime sleepiness)
- Decreased testicular size
- Increased aggression and mood swings
- May increase risk of heart attack and stroke
Laboratory abnormalities that can occur with hormone replacement include:
- Changes in cholesterol and lipid levels
- Increase in red blood cell count
- Decrease in sperm count, producing infertility (especially in younger men)
- Increase in PSA
If you are taking hormone replacement therapy, regular follow-up appointments with your doctor are important.
Like any other medication, directions for administering testosterone should be followed exactly as your doctor orders. If you are unsure or have any questions about testosterone replacement therapy, ask your doctor.
What Are Steroids?
The word has different meanings. Steroids are chemicals, often hormones, that your body makes naturally. They help your organs, tissues, and cells do their jobs. You need a healthy balance of them to grow and even to make babies. “Steroids” can also refer to man-made medicines. The two main types are corticosteroids and anabolic-androgenic steroids (or anabolics for short).
What Are Corticosteroids?
They’re medicines that quickly fight inflammation in your body. These lab-made steroids work like the hormone cortisol, which your adrenal glands make. Cortisol keeps your immune system from making substances that cause inflammation. Corticosteroid drugs, like prednisone, work in a similar way. They slow or stop the immune system processes that trigger inflammation.
What Do Corticosteroids Treat?
They help treat conditions that cause irritation and swelling. They can ease symptoms of:
- Rheumatoid arthritis
- Chronic obstructive pulmonary disorder (COPD)
- Lupus and other autoimmune disorders
- Multiple sclerosis
- Rashes and skin conditions like eczema
Your doctor may also suggest you take them for a short time to treat allergic reactions, like a severe poison ivy rash.
How Do You Take Them?
There are many forms of corticosteroids. Which one your doctor recommends depends on why you need it and the part of your body that’s affected. Your medicine might come in a:
- Pill or liquid
- Nasal spray
- Skin cream
- Tube that goes into a vein (IV)
Corticosteroid Side Effects
These depend on the dose and how long you take the drug. Short-term use can cause weight gain, puffy face, nausea, mood swings, and trouble sleeping. You might also get thinner skin, acne, unusual hair growth, and spikes in blood sugar and blood pressure. Because corticosteroids turn down your immune system, taking them makes you more likely to get infections.
Taking high doses of corticosteroids for a long time can cause serious side effects like brittle bones that break easily (osteoporosis), slow growth in kids, and a life-threatening condition called adrenal insufficiency, where the body cannot respond to stress such as surgery or illnesses. Other side effects are muscle weakness, eye problems (including cataracts), and a higher risk of diabetes.
What Are Anabolic Steroids Used For?
They’re man-made versions of testosterone, a male sex hormone that helps build bigger muscles. You take them by mouth or get a shot into a muscle. A doctor can legally prescribe them if your body doesn’t make enough testosterone. An example would be boys with delayed puberty. Doctors also prescribe them to men with low testosterone and people who lose muscle mass because of cancer, AIDS, and other health conditions.
Misuse of Anabolics
Their performance- and muscle-boosting powers have led to widespread misuse and abuse. Abusers tend to use extremely high doses. Some take 100 times the dose legally prescribed for health problems.
Side Effects of Anabolics
These steroids can cause bad acne and fluid retention. Long-term use can stop the body from making this drug. In men, this causes smaller testicles, lower sperm counts, infertility, and breast growth. Women may have male-pattern baldness, facial hair growth, periods that change or stop, and a deeper voice. Teens who use them might stunt their bone growth and height. High doses can lead to extreme mood swings, anger, and aggression called “roid rage.”
Long-term anabolic use, especially high doses, can damage your liver, kidneys, and heart. Severe fluid retention can cause heart swelling and heart failure. These drugs can also raise your LDL “bad” cholesterol, which can make you more likely to have heart attacks and strokes at any age.
How to Stop Taking Steroids
Stopping them abruptly is a bad idea. It can trigger mood swings, fatigue, restlessness, achy muscles, and depression. Halting anabolics may knock down your sex drive. If you were taking steroids to treat an illness, those symptoms may come back, too. It’s safer to slowly reduce, or taper, your dose. Your doctor can te