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The Lowdown on Low T: Understanding the Signs and Symptoms of Low Testosterone  

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As a clinic that specializes in Hormone Replacement Therapy, we frequently get calls and emails from men who are all experiencing some of the same signs and symptoms of Low Testosterone. Some of the more common things we hear from patients is “I just feel tired all the time…”  or “It’s harder to get motivated to go to the gym…” Fortunately, there are experienced physicians and clinics that can offer treatment programs to fight Low T and combat the side effects from suboptimal hormone levels. Finding a knowledgeable and experienced physician is the best first step one can take to learn more about your hormones and whether or not, low T is a problem and if Testosterone replacement  therapy is appropriate for you. 

What is Testosterone?

Testosterone is the primary male sex hormone, produced primarily in the testicles with small amounts made from the adrenal glands. It belongs to a group of hormones called androgens and it plays a crucial role in the development and maintenance of male characteristics, including the development of male sex organs, muscle mass, bone density, and the deepening of the voice during puberty. Beyond physical development, testosterone also influences sexual desire (libido), mood, energy levels, and the production of sperm.  

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What Does Testosterone Do? 

Testosterone is essential for the development of male sex organs, the deepening of the voice, and the growth of facial and body hair during puberty.  This hormone contributes significantly to the development and maintenance of muscle mass and bone density, crucial for strength and preventing osteoporosis.  Testosterone stimulates the production of red blood cells, essential for carrying oxygen throughout the body.  It plays a role in mood regulation, energy levels, and cognitive function, influencing factors like motivation, focus, and libido. Testosterone is vital for the production of sperm, a key component of male fertility.  Testosterone levels are typically highest when men are in their late teens to early twenties and then begin to decline steadily over time. So what are the signs and symptoms associated with male andropause, or Low T as it’s often called?  

Recognizing the Signs of Low T 

Low testosterone, also known as hypogonadism, can manifest in a variety of ways, often subtly, due to the nature of male hormone levels declining slowly at a rate of approximately 1% annually. The effects of suboptimal hormone levels creep up slowly and take a while before they become problematic. Here is a partial list of some of the more common signs and symptoms of Low T in men.

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Common Symptoms of Low T in Adult Males: 

Sexual Dysfunction: Reduced sex drive (libido), and decreased sexual desire are prominent signs. Testosterone is a crucial hormone for male sexual desire as it directly influences the brain centers responsible for sexual arousal and motivation.  

Erectile Dysfunction:   Testosterone plays a role in maintaining the health of blood vessels. Low testosterone levels can contribute to the narrowing of blood vessels (atherosclerosis), which can reduce blood flow to the penis, a crucial factor for achieving and maintaining an erection. It’s also involved in the proper functioning of nerves that control erections. Low levels can impair nerve signaling, making it difficult to achieve and maintain an erection and even decrease sensation and sensitivity during sexual intercourse.  Testosterone also helps maintain the health and functioning of the smooth muscle in the penis, which is essential for achieving and sustaining an erection. Low T can weaken these muscles, making it harder to achieve and maintain a full erection.   It’s important to note that these are not the only cause of ED. Some men with low T may experience ED, while others may not. Similarly, some men with ED may have normal testosterone levels.   Many other factors can contribute to ED, including, Heart disease, Diabetes, High blood pressure, Obesity, Smoking, Certain Medications and Psychological factors. If you have issues with erectile dysfunction of low sexual desire, consult with a qualified healthcare provider for any health concerns or before making any decisions regarding your health or treatment. A urologist or internist with experience in treating men’s health issues may be a good place to start. 

Physical Changes Cause by Low T:  

Decreased muscle mass and strength is a big one. Testosterone plays a crucial role in building and maintaining muscle mass so low T can lead to a decrease in muscle size and strength, making it harder to perform daily activities and increasing the risk of injuries. It also will cause a decline in athletic performance over time as there will be a decrease in speed, agility and strength and explosiveness. 

Increased body fat, particularly around the abdomen. Because testosterone helps regulate how and where body fat is distributed, low T can lead to an increase in body fat, typically in the midsection causing men to have “Bellies.”  Having extra visceral fat in the midsection surrounding the vital organs may increase the risk of certain types of cancer. This can also increase the risk of health problems such as heart disease, type 2 diabetes, and sleep apnea.    

Fatigue and decreased energy levels. This can happen due to several factors. Testosterone influences metabolism, affecting how the body uses energy from food so Low T can disrupt this process, leading to decreased energy production and increased fatigue.  It can also contribute to sleep disturbances, such as insomnia and sleep apnea. Poor sleep quality can significantly impact energy levels, leaving individuals feeling tired and sluggish throughout the day.  Low T can also contribute to mood changes, including depression and irritability. These mood disturbances can further exacerbate fatigue and decrease overall energy levels.    

Reduced bone density. Testosterone is essential for maintaining bone density. Low T can increase the risk of osteoporosis, a condition that weakens bones and increases the risk of fractures. Its one of the reasons that older men are more susceptible to fractures and breaks when they fall. 

Hot flashes. Hypogonadism can be a contributing factor to hot flashes in men, although it's not as common as in women. While primarily associated with estrogen decline in women, hormonal imbalances, including low testosterone, can disrupt the body's temperature regulation system. This can lead to sudden sensations of heat, sweating, and flushing, which are characteristic of hot flashes. 

Loss of body hair (armpits, pubic area) When testosterone levels decline, it can lead to a decrease in body hair growth. It’s usually a slow process over time and doesn’t just “fall out” overnight. Other factors besides andropause can contribute to hair loss, such as genetics (male pattern baldness), age, certain medications, and underlying medical conditions. The impact of low T on body hair can vary significantly from one person to the next. Some men may experience noticeable hair loss, while others may not see any hair loss at all. 

You might notice thinning or loss of hair in areas like:  

• Armpits 

• Pubic area 

• Facial hair (beard, mustache)    

• Chest and back hair 

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Mood and Cognitive Changes from Low T:  

Depression and Irritability. Low testosterone (low T) can contribute to depression in several ways. Reduced Dopamine Levels: Testosterone plays a role in the brain's reward system, influencing the release of dopamine, a neurotransmitter associated with pleasure, motivation, and reward. Low T can lead to decreased dopamine levels, which can contribute to feelings of apathy, anhedonia (loss of interest in pleasurable activities), and low mood, all of which are common symptoms of depression in men Low dopamine levels due to low T can also contribute to feelings of frustration, irritability, and decreased overall satisfaction, making individuals more prone to anger and annoyance..    

Impact on Brain Chemistry: Testosterone interacts with other neurotransmitters involved in mood regulation and can indirectly impact chemicals such as serotonin and norepinephrine. Low T can disrupt the balance of these neurotransmitters, contributing to depressive symptoms.  Some research suggests that testosterone supplementation may increase the number of serotonin transporters in certain brain regions however more research is needed to understand this complex relationship. 

Physical Symptoms of Low T: Many physical symptoms of low T, such as decreased energy levels, reduced muscle mass, Erectile Dysfunction and changes in sleep patterns, can also significantly impact mood and contribute to feelings of depression.    

Social and Psychological Impact: The physical and emotional changes associated with low T can have a significant impact on a man's self-esteem and confidence, leading to social withdrawal, relationship problems, and increased feelings of isolation, which can further exacerbate depression and exacerbate hormone decline which can cause the cycle to continue and the problems increase.  The relationship between low T and depression is complex and not yet fully understood. It's possible that depression can also contribute to low T levels. All of these factors combined can have an impact on other areas of cognition and the brain for men suffering from lower testosterone levels. For example, men with Low T often show signs of having Difficulty concentrating, have Memory problems and Decreased motivation.  

Recognizing the Signs of Low T 

Low testosterone, also known as hypogonadism, can manifest in a variety of ways, often subtly. How and why someone may have Low T is complicated and often requires the expertise of a licensed healthcare provider such as an endocrinologist or urologist to test, diagnose and treat. Blood tests, ultrasounds, cat scans may be used to test for Low T. No two people are alike so a medical history and evaluation of the signs and symptoms will provide the provider with valuable insight into potential causes.  

Causes of Low T 

Low testosterone can arise from various underlying issues, broadly categorized as: 

Primary Hypogonadism.  This typically describes problems that directly affect the testicles, such as Congenital Conditions like Undescended testicles (cryptorchidism) , Klinefelter syndrome or other genetic conditions affecting the testes. Acquired Hypogonadism which can result from testicular injury or removal, Infections (e.g., orchitis), Chemotherapy or radiation therapy from cancer treatments and even from certain medications.  Secondary Hypogonadism refers to problems with the hypothalamus or pituitary gland, which control testosterone production. Some Congenital causes could be Kallmann syndrome, a rare genetic disorder that affects the development of the reproductive system. Individuals with Kallmann syndrome often fail to go through puberty or experience incomplete development of secondary sexual characteristics (e.g., facial hair, deepening of the voice in males. It is a form of hypogonadotropic hypogonadism (HH), where the body produces insufficient levels of sex hormones due to problems with the hypothalamus or pituitary gland, the brain regions that regulate hormone production. Acquired Secondary Hypogonadism can be linked to Pituitary gland tumors, Head injury, Infections and Certain medications (e.g., opioids, some antidepressants) which may impact the pituitary gland or other regions of the brain responsible for hormone production. 

Age-Related Decline is perhaps the most common reason that we see from patients. 

Testosterone levels naturally decline with age, a condition known as late-onset hypogonadism (LOH). This decline is often exacerbated by factors like obesity, diabetes, and sleep apnea and as a result we tend to see men between the ages of 40 and 60 as the most likely population to come seek treatment for low T 

Diagnosis and Testing of Low T 

Diagnosing low testosterone typically involves the physician or provider obtaining a Medical History. A detailed review of symptoms, medical history, medications, and lifestyle factors can help the doctor determine root causes and possible treatment options and even possible outcomes. Its difficult to gauge to success of treatment as we are all unique, however an experienced physician can get a pretty good idea and even predict the likelihood of success and symptom relief for a patient starting TRT. 

Physical Examination: To assess for signs of low testosterone, such as reduced muscle mass, decreased testicular size, and gynecomastia (enlarged breasts) a healthcare provider may perform a physical exam.    

Blood Tests are the only way to get accurate date regarding actual levels of testosterone in the body.  A doctor may test for some of the following hormones and biomarkers: Total Testosterone: Measures the overall level of testosterone in the blood.  Luteinizing Hormone (LH): Helps determine if the problem originates from the pituitary gland. Follicle-Stimulating Hormone (FSH): Provides further insight into the cause of low testosterone. Prolactin: To rule out conditions that can interfere with testosterone production. Estradiol: When testing for low testosterone (Low T), a doctor may also test for estradiol because it plays a crucial role in the overall hormonal balance and health of the body, particularly in men. Estradiol, a form of estrogen, is produced in small amounts in men through the conversion of testosterone by an enzyme called aromatase. Monitoring estradiol levels provides valuable insights into the underlying causes and consequences of Low T. Testing for prostate-specific antigen (PSA) is important, particularly when evaluating or treating conditions related to testosterone replacement therapy (TRT) or other prostate-related concerns. Testosterone can stimulate prostate tissue, so knowing baseline PSA levels helps monitor any changes during therapy. PSA is a protein produced by the prostate gland, and its levels in the blood can provide insights into prostate health. 

Treatment Options 

The primary treatment for low testosterone is testosterone replacement therapy (TRT), which aims to restore hormone levels to within a normal range.  There are several methods that doctors and providers may use to start a patient on TRT some of which include, Testosterone Gels: Applied to the skin daily. Injections: Administered intramuscularly or subcutaneously, ranging from weekly to every 10 weeks. Patches: Applied to the skin daily.  Pellets: Implanted under the skin, providing sustained release for several months.  Buccal Tablets: Placed between the cheek and gum, allowing for rapid absorption. And Nasal Gel: Applied to the nostrils.    

Important Considerations before starting TRT: 

Side Effects: TRT can have potential side effects, including acne, oily skin, fluid retention, increased red blood cell count, and potential prostate enlargement. Talk to your doctor about the possible benefits as well as risks as all medications may cause unwanted side effects. Knowing what to look for can help your doctor address and correct an issue prior to it becoming a more serious matter.  

Monitoring: Regular monitoring by a healthcare provider is essential to assess treatment effectiveness, monitor for side effects, and adjust dosage as needed.  Getting blood work a few times a year will help to look for any fluctuations which may be related to treatment. 

Eligibility: TRT is not suitable for everyone. Individuals with prostate cancer, breast cancer, untreated sleep apnea, and certain other conditions may not be eligible for this treatment. Be honest with your doctor during the consultation and give a detailed and thorough medical history to ensure you receive the best care and treatment possible for your individual health concerns. 

Living with Low T 

Low testosterone can significantly impact a man's quality of life. However, with proper diagnosis and treatment, many men can experience significant improvements in their symptoms, including:    

• Increased energy levels 

• Improved mood and libido 

• Enhanced muscle mass and strength 

• Improved sexual function 

• Increased bone density 

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When to See a Doctor for Low T 

If you are experiencing any of the symptoms of low testosterone, it's crucial to consult with a healthcare provider for evaluation and appropriate management. 

Disclaimer: This information is for general knowledge and informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider for any health concerns or before making any decisions regarding your health or treatment. 

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