How common is low testosterone in men?
Depending on what figures you read, between 20-40% of men will experience low testosterone (T) levels at some point in their lives.
What are the main causes of low testosterone in men?
Understanding what causes low testosterone is a crucial part of proactive men’s health and the first step toward diagnosis and treatment. The causes can be broadly split into two categories: natural age-related decline and other medical or lifestyle factors.
1. Age-related decline (ADAM)
It’s normal for a man’s testosterone to steadily decline by about 1% per year from his mid-30s. For some men, this decline is more significant or they are more sensitive to the lower levels, leading to symptoms in their 40s or 50s.
This process is often called the ‘male menopause’ or ‘andropause’. The correct medical term is ‘Androgen Deficiency in the Aging Male’ (ADAM).
2. Other medical and lifestyle causes
Apart from ageing, there are several other distinct causes of low testosterone in men, including:
- Medical conditions: Obesity, liver or kidney disease, and type 2 diabetes.
- Injury or infection: Direct injury or trauma to the testicles.
- Cancer treatments: Chemotherapy or radiation therapy can impact testosterone production.
- Medications: Certain medications, including opioids and steroids, can affect hormone levels.
- Lifestyle factors: Chronic stress, excessive alcohol abuse, and poor nutrition.
What causes low testosterone?
It’s common for testosterone in men to steadily decline from the mid-30s onwards but only by small amounts, around 1% per year for example. This is not in the same way as a female menopause, which is a much more dramatic decline in several hormone levels.
Some men may have particularly low T levels – or a heightened sensitivity to lower levels – and can develop symptoms of low testosterone, often when in their 40s or 50s.
This is what is generally referred to when you hear talk of the male menopause or ‘man-opause’. The medical term used nowadays for this type of low testosterone is ‘Androgen Deficiency in the Aging Male’ or the handy abbreviation, ADAM.
And it’s important to mention there are other causes of low testosterone apart from age related, including: injury to the testicles, cancer treatments, stress, alcohol abuse, kidney or liver disease, obesity or due to certain medications.
What are the signs of low testosterone?
Here are some common signs and symptoms of low testosterone – and it’s always worth remembering that many of these symptoms can be due to other health conditions too.
- Low sex drive – testosterone plays a key role in your libido. It’s normal for your sex drive to decrease a bit with age but if you have low testosterone, it will be a more significant drop in sexual desire and arousal.
- Difficulty getting and keeping an erection – there are many reasons why you can get problems with erections (known as erectile dysfunction) such as some heart conditions, diabetes, thyroid disorders, high blood pressure or cholesterol, as well as depression and anxiety, so this symptom would need to be investigated carefully before assuming it’s related to low testosterone levels.
- Fatigue and tiredness – it’s common to feel wiped out even if you’re sleeping well, or you may experience problems getting off to sleep or staying asleep and feel very tired as a result.
- Increased body fat and loss of muscle – you may notice a decrease in muscle mass and an increase in body fat, particularly around your abdomen or chest (gynaecomastia). This is a key symptom we explore in more detail below.
- Memory and mood changes – testosterone helps your mental agility and skills like concentration, memory and speed of thinking. You might be finding it harder to focus and remember things. You may also notice mood swings, find it harder to regular your emotions, feel irritable or low and depressed.
- Hair loss – balding is a natural part of ageing for most men and it’s often hereditary but with low testosterone, there can be additional hair loss including loss of hair on the face and body.
- Hot flushes – you may feel sudden sensations of warmth spread over your body and perhaps sweating or reddening of the skin. You might get night sweats where the sweating is more pronounced, and you may feel cold rather than hot at these times.
These are just some of the symptoms of low testosterone, there are other signs that may be less noticeable and accumulate over time like loss of bone tissue, causing weaker bones as you get older and a risk of breaking them more easily. There’s also a loss of muscle mass and definition, and low testosterone can also increase your risk of anaemia.
The link between low testosterone and weight gain
Many men are concerned about low testosterone and weight gain, and for good reason. Testosterone plays a crucial role in regulating body composition. When levels are low, it can lead to two key changes: a decrease in muscle mass and an increase in body fat.
Because muscle burns more calories than fat, losing muscle mass slows down your metabolism, making it easier to gain weight. Furthermore, low testosterone can contribute to fatigue and low energy, leading to a less active lifestyle that compounds the issue. This creates a challenging cycle where low testosterone causes weight gain, and increased body fat (obesity) can, in turn, further lower testosterone levels.
How is low testosterone diagnosed?
It’s relatively straightforward to diagnose low testosterone from a simple blood test but it won’t necessarily provide answers to what is causing your low T levels.
A normal range of testosterone in men is 300 – 1000ng/dL (nanograms per decilitre) and a score of less than 300 would be considered low.
At Summerhill Health, the ADAM screening tool is used before an appointment, which is just 10 quick questions about everyday life, covering things like your energy levels, your work and sports performance, and your sex drive.
Following a men’s health consultation with Dr Natalie Summerhill, where you can talk in full about how you’ve been feeling and what symptoms you’ve noticed, you will then be offered a blood test. A series of measures will be checked in your blood including a full blood count, your levels of total and free testosterone (how much there is in total and how much active or available testosterone there is), luteinizing hormone, FSH (follicle-stimulating hormone) and blood prolactin levels.
Dr Natalie will then discuss your results with you and you can decide next steps with her support and guidance.
How do you treat low testosterone in men?
If a blood test has confirmed you have low testosterone and ADAM is suggested as the most likely cause, Dr Natalie will discuss the possibility of trialling testosterone replacement therapy with you. This is a gel that you rub into your skin on a daily basis and the hormone is absorbed into the bloodstream through your skin.
She will explain the potential benefits of the treatment and discuss possible side effects or any associated risks. There have not been large-scale clinical trials on using testosterone therapy for ADAM long term, but many men do experience benefits to their sex drive and function, their mood and energy levels and their improvements to muscle mass and fat distribution.
Book a consultation with Dr Natalie to explore your testosterone levels further. For more information about testosterone therapy, read our follow-up blog here.
