What is Testosterone?
Testosterone is primarily a male hormone and is produced by both males and females and is responsible for development of male sexual characteristics.(1) Testosterone has a role to play in fertility, puberty and libido. In men, the testosterone is produced in testes and in females it is produced in the ovaries.
Men have increased levels of testosterone than females. Testosterone affects the development of various physical characteristics, such as it increases the bone mass, muscle bulk, stamina and body hair.(2)
According to the body’s needs, the testosterone levels constantly change; however, the overall testosterone level in the body changes throughout the lifetime also.
As one ages, the testosterone levels also decreases; especially, in men and sometimes if the levels dip a lot, then it can cause some side effects prompting to seek treatment for low testosterone levels. Certain lifestyle changes benefit in increasing testosterone levels, such as losing weight and doing resistance exercises. Consuming foods, which are rich in vitamin D and zinc help in maintaining testosterone levels in the normal range. Testosterone replacement therapy can also be done for treating individuals having excessively low levels of testosterone.
How to Find Out If the Testosterone Levels Are Low?
According to the Endocrine Society, the normal ranges for testosterone levels in men between the ages of 19 and 39 and who are not obese are: 264 to 916 nanograms per deciliter. (ng/dL)(3)
A testosterone test can be done to find the quantity of testosterone in the blood. The test can be ordered at a particular time in a day by the doctor. Hormone levels are at their peak in the morning, so often this test is done in the morning time between 7:00 a.m. to 10:00 a.m. the test can be repeated if the doctor wishes it.
The patient will be advised to stop taking certain medications before this test, as they can affect the levels of testosterone. So, it is important to tell your doctor about all the medications which you are taking before undergoing this test.
Some companies such as LetsGetChecked also have testosterone home-testing kits, which use saliva to assess the hormone levels and you have to send your sample to the lab for testing and results.
What are the Causes of Low Testosterone in Men?
Testosterone levels in men remain fairly constant from the beginning of puberty, which is where the levels spike until the individual is in his 30s, after which the levels gradually decline.(4)
Some of the common causes of low testosterone levels are: delayed puberty, aging, hypothalamic disease, testicular damage, pituitary disease, chemotherapy and noncancerous pituitary tumor.
What are the Symptoms of Low Testosterone Levels?
When is Testosterone a Cause of Concern in Women?
Testosterone has an important function in females too; but they have naturally low testosterone levels than men.
Commonly women having low testosterone levels do not face any problems. However, when there is excessive of testosterone in women it can cause symptoms, such as infertility, absent or irregular menstrual periods; deepening of voice and growth of facial and body hair.(6)
The high levels of testosterone women can caused by: ovarian cancer, adrenal tumor; congenital adrenocortical hyperplasia and polycystic ovarian syndrome.
How To Treat Low Testosterone Levels?
Lifestyle Changes for Treating Low Testosterone Levels
Certain lifestyle changes benefit in increasing testosterone levels, such as losing weight and doing resistance exercises.(7)
According to research, resistance exercises like lifting weights can cause a temporary surge in the testosterone levels.(7)
A study done in 1999 shows that there was increase in the testosterone levels after doing heavy resistance training and this is usually seen more in younger men than older men; and does not seem to increase the overall testosterone levels.(8)
Cardiovascular exercise especially leads to weight loss, which in turn helps in increasing testosterone levels.
Herbal Supplements to Increase Testosterone Levels
Other than lifestyle changes, there are other methods to increase the amount of testosterone in the body. Some of these are backed by science also. Whereas, a few of these claim to increase testosterone levels, but do not have sufficient evidence to back all these claims.(9) If there is any concern regarding the testosterone levels, then it is always better to consult your doctor where they will test the levels of testosterone and plan accordingly.
Herbal Supplements: There are some herbal supplements which claim to boost testosterone levels. However, there is lack of research to support their claim, and furthermore these products also may not have ingredients which support these claims.(9)
A study from 2020 study where about 50 supplements, which claimed to be “testosterone boosting” and “libido improving” were tested and it was found that less than 25% had data to back their claims.(10) Surprisingly, about 10% of these tested supplements had ingredients, which had a negative effect on the levels of testosterone.
Moreover, these products that claim to be testosterone boosters are not carefully regulated by the Food and Drug Administration, which means they are not evaluated or tested for their effectiveness and have unexpected side effects or undisclosed ingredients in them. Always consult your doctor before taking such “testosterone boosters,” and also discuss alternative treatments for treating low testosterone levels which are clinically proven to work and also approved by the FDA.
Testosterone Replacement Therapy and Supplements for Treating Low Testosterone
Consuming foods, which are rich in vitamin D and zinc help in maintaining testosterone levels in the normal range.
An animal study done in 2018 shows that zinc supplements can increase fertility and testosterone level in those having mild zinc deficiency.
Testosterone replacement therapy can also be done for treating individuals having excessively low levels of testosterone.
Abnormally low testosterone levels affects the function of the body and can cause decreased libido, mood changes, decreased muscle mass and erectile dysfunction.
Testosterone replacement therapy consists of taking prescribed testosterone medication in the form of injections, pills, gel and patches which you apply to the skin.
One of the more common forms of testosterone replacement therapy are testosterone injections, which are given by a doctor and need to be taken less frequently when compared to other forms of this therapy.
What are the Side Effects of Testosterone Replacement Therapy?
There are many risks and side effects of testosterone replacement therapy. When undergoing testosterone replacement therapy, the patient has to get frequent blood tests to check the levels of testosterone and also to assess the potential side effects, which can include: acne; fluid retention, decreased fertility; blood clots; prostate enlargement; sleep apnea and increased red blood cells. Side effects also depend on the type of testosterone therapy used.
What are the Benefits of Testosterone Replacement Therapy?
Some of the benefits of testosterone therapy for patients suffering from low testosterone are: improved sexual function, increased bone density, better libido, improved mood and a sense of well-being and increased muscle mass.
How Effective is Testosterone Replacement Therapy?
According to a 2017 clinical review there is contradictory evidence regarding benefits of testosterone therapy in men who experience natural decline in their testosterone levels as they age.(13)
Some studies have shown an improvement in erectile dysfunction in older men; whereas some don’t.(11, 14) Currently there is no evidence to support that testosterone therapy improves erectile dysfunction in men having normal testosterone levels.
However, testosterone therapy does seem to increase lumbar spine bone density in middle-aged men having testosterone deficiency. Testosterone therapy also helps in increasing lean mass along with fat mass.
What are the Adverse Effects of Testosterone Replacement Therapy in Men and Women?
Side effects of testosterone therapy in men are: acne, decreased sperm production, erythrocytosis and increased risk of subclinical prostate cancer.(16)
Side effects of testosterone therapy in women are: acne, weight gain, extra hair growth, voice deepening, mood changes, fluid retention and rarely there can be clitoral enlargement and baldness.
What are the Cardiovascular Risks of Testosterone Therapy?
According to a 2015 advisory, the FDA has warned that the use of testosterone can be associated with increase in cardiovascular risk. (15) However, other studies did not find any evidence of an increased cardiovascular risk. Currently risk of testosterone therapy on cardiovascular health is under research.
When To Consult Your Doctor
The American Urological Association says that patient should seek medical attention when having any of the following symptoms of low testosterone, such as: erectile function, decreased libido; fatigue, irritability, depression and decreased lean muscle mass.(12)
What Happens If Low Testosterone Is Not Treated?
Men naturally experience lowered testosterone levels as they grow old. However, if there is excessive lowering of the levels, then it can cause short-term as well as long-term symptoms, which can affect the quality of life of the patient.
If excessively low testosterone levels are not treated then some of the problems one can experience are low libido, erectile dysfunction, depression, difficulty in concentration and increased body weight.(12) Other long-term symptoms, which can develop if low testosterone levels are not treated, are loss of muscle mass and osteoporosis where the bones in the body become brittle and weak.(12)
Can a Person Get Back Their Normal Testosterone Levels?
Getting back to normal testosterone levels primarily depends on the type of treatment you are getting. If the patient is trying to improve their testosterone levels by lifestyle changes, then there can be an improvement in the testosterone, however, it is not likely that the levels will get back to what they used to be in 20s with only exercise, diet changes and supplements.
Testosterone injections and creams help in replenishing a significant amount of the low testosterone levels; however, as each individual responds in a different manner to treatment and it is may be possible that the testosterone levels will be completely replenished.
It is important to monitor the results and side effects of testosterone replacement therapies and do not overuse them. Never ever increase the frequency of use or the dosage without consulting your doctor first. Misusing these treatments can result in acute side effects ranging from heart attack, stroke, increased risk of prostate cancer, enlarged prostate gland and liver diseases.
Testosterone levels in men decrease gradually with age. However, if the levels become excessively low, then it can cause symptoms which affect the quality of life. Treatment is needed for this and should be started after consulting your doctor. Tests will be done by the doctor to confirm the low levels of testosterone as well as to determine its cause.
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