Should men with symptoms of low testosterone but without hypogonadism be prescribed testosterone therapy?

Testosterone: why defining a normal level is hard to do

TRT can be given as a pill, gel, patch, injection, or implant. TRT may not be recommended for people with a history of prostate cancer, heart disease, or frequent urinary tract infections. Your healthcare provider can help you determine which formulation of testosterone is most suitable for you.

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LH then travels to your gonads (testicles or ovaries) and stimulates the production and release of testosterone. Your pituitary also releases follicle-stimulating hormone (FSH) to cause sperm production. Your body usually tightly controls the levels of testosterone in your blood. Levels are typically highest in the morning and decline through the day. After menopause, usually between ages 45 and 55 years, testosterone levels begin to decrease.

Potential signs and symptoms include a lowered sex drive (libido), erectile dysfunction, loss of facial or body hair, loss of muscle mass, thinning bones, enlarged breasts, unexplained anemia, low sperm count and reduced energy. The most common “out of balance” testosterone levels are found to be on the low side of normal; this occurs because a male’s highest testosterone level usually peaks at about age 20, and then it decreases slowly with age. It has been suggested that a 1% decrease in testosterone level per year is not unusual for middle-aged (30 to 50 years old) and older males. While this decrease may not be noticeable in some men, others may experience significant changes starting in their middle-aged years or more commonly at age 60 and above. This drop in cicli testosterone levels is sometimes termed hypogonadism, “male menopause” or andropause. The mortality of men with testosterone deficiency is significantly higher than among men with normal testosterone levels.

Healthy testosterone levels are also important for people assigned female at birth, along with other key hormones such as estrogen and progesterone. Sleep quality may also have major effects on your testosterone levels. A 2019 study involving 2,295 teenage boys and men found that impaired sleep could be linked to lower levels of testosterone. Additionally, a 2020 review found that taking a vitamin D supplement increased testosterone levels and improved erectile dysfunction. More research is needed, as other studies, such as one from 2023, yield conflicting results. A new study shows whether testosterone replacement therapy increases the risk of prostate cancer.

However, due to fluctuations in testosterone levels throughout the day, multiple tests may be necessary to confirm your levels accurately. Low testosterone (Low T) is more common than high testosterone in men. Low testosterone levels can lead to a variety of symptoms that can vary from person to person. If a clinician expects hypogonadism based on history and physical, a total serum testosterone between 8 AM and 10 AM should be drawn. If levels are low, a repeat level and FSH and LH levels should be obtained. Low testosterone in the setting of normal FSH/LH indicates secondary hypogonadism. The next steps would be to get prolactin, T4, 8 AM cortisol, iron, ferritin levels, and a brain MRI.

Symptoms include irregular periods, reduced fertility, excess or coarse hair on the face, extremities, trunk and pubic area, male-pattern baldness, darkened, thick skin, weight gain, depression and anxiety. One treatment available for many of these problems is spironolactone, a special type of diuretic (water pill) that blocks the action of male sex hormones. Testosterone deficiency during fetal development doesn’t allow male characteristics to develop normally. This is called androgen insensitivity syndrome (AIS) and occurs when someone is genetically male but is insensitive to androgens (male sex hormones).

In males, testosterone levels drop by 100 ng/dL every 10 years, starting around age 30. During infancy and childhood, testosterone levels are low in both males and females. Levels in both sexes are similar from ages 6-10 but higher in males from ages 11-20. Testosterone is essential in sex drive and sperm production in males. The hormone also affects sex drive in females, as well as the growth and development of muscles, bones, and organs. In people assigned male at birth, testosterone is responsible for the proliferation of male sex characteristics that begin during puberty. This includes increased body hair, muscle development, and the deepening of the voice.

The testes produces less testosterone, there are fewer signals from the pituitary telling the testes to make testosterone. Also, as men get older, their livers make more sex hormone binding globulin (SHBG), which binds to testosterone circulating in the bloodstream. The researchers measured several hormones in blood samples from 90 men and 62 women who came to Barnes-Jewish Hospital with symptoms of COVID-19 and who had confirmed cases of the illness. For the 143 patients who were admitted to the hospital, the researchers measured hormone levels again at days 3, 7, 14 and 28, as long as the patients remained hospitalized over these time frames. In addition to testosterone, the investigators measured levels of estradiol, a form of estrogen produced by the body, and IGF-1, an important growth hormone that is similar to insulin and plays a role in maintaining muscle mass. In women or anyone with ovaries, abnormal testosterone levels can indicate excess testosterone produced by the ovaries or other glands that produce hormones.