Hey guys — are you feeling tired or depressed? Are nights not so hot in the bedroom anymore? If so, it's probably time to visit your family doctor to see if you have low T.
Do you have low T?
Low T refers to low testosterone, also known as hypogonadism. Haidee Zamora, an endocrinologist with Asante Physician Partners in Grants Pass, says that according to population-based surveys, 6 percent of middle-aged and older men have symptomatic androgen (male sex hormones including testosterone) deficiency or symptomatic low T. According to the Endocrine Society, 2 percent to 5 percent of men under age 40 have low T. Symptoms of this condition include decreased energy, reduced sex drive, depression, erectile dysfunction and decreased bone and muscle growth.
Men with low sex drive and low energy should have their testosterone levels checked, according to Jason Hedges, a urologist with the Male Fertility Clinic at Oregon Health & Science University in Portland. It could be low T or another condition that needs to be treated. "The problem is that other situations can mirror those symptoms," he says. But if the problem is low testosterone, it should be addressed. "There is a high percentage of men who have low T that aren't evaluated or offered treatment," Hedges says. "They should be. There's a medical reason to justify it."
A blood test determines the level of testosterone. The normal range is typically said to be between 300 and 800 nanograms per deciliter (ng/dl). It differs per lab, Zamora explains, with 280 to 300 as the lower normal. The upper limit can be up to 1000. It depends on the lab — based on the population it is testing. The range is usually based on young, healthy males.
If a patient has a level below 300 and is exhibiting symptoms, Hedges says he would discuss testosterone supplements. Zamora also might prescribe a testosterone supplement if the number is in the lower range and symptoms are exhibited. "You don't always treat the number," she says.
Hedges notes that there has been an advertising push in products to treat low T. In the past, doctors often neglected to offer treatment to patients, especially older patients since low T was assumed to be a normal part of aging. "More people are talking about it," he says.
The level of testosterone does decrease naturally with age, Zamora confirms.
However, she explains, a lot of older men fall into range of having low testosterone because normal levels are based on healthy young males. But regardless of age, she tries to determine the reason for low testosterone levels with all of her patients who have low T and are exhibiting symptoms before prescribing testosterone supplements. Using pain medications long-term can cause low T as can steroids including prednisone. Illness, lack of sleep and too much stress can cause low testosterone. Lack of physical activity and being overweight are also factors with low T. If these problems can be fixed, testosterone levels may go back to normal. "There are a lot of causes for why testosterone is low," Zamora says. "I don't just push a pill. I always want to ask why."
Treatment options and risks
There are three treatment options for testosterone therapy. Topical formulas are applied once a day, typically to the shoulders or upper arms. A patient can opt for injections, which are necessary once a week or once every two weeks, at a clinic or he can learn to give himself injections. A final option is having testosterone pellets inserted under the skin, which last for three to six months.
The health risks for men who have low T and use supplements include heart attack, stroke, shrinking testicles, reduced fertility, thick blood, acne and enlarged breasts. It can also promote prostate and breast cancers. "There are still a lot of questions about its long-term safety," Zamora says of testosterone therapy.
Having low T is unhealthy too as it can cause low energy, low libido and osteoporosis. But if a patient with low T doesn't want to take supplements, Zamora doesn't push the therapy. Osteoporosis, for example, can be treated another way.
If you have low sex drive and low energy, it's not necessarily low T, but it's wise to see a doctor. "It would be appropriate to get it checked," Zamora advises.