Testosterone is the main male sex hormone regulating fertility, muscle mass, fat distribution and the development of red blood cells.
If testosterone levels fall below safe levels they can lead to conditions such as hypogonadism or infertility. However, there are sources from which people with low testosterone can raise their levels.
Low testosterone becomes ever more common. The number of testosterone supplement prescriptions has increased fivefold since 2012
The article will discuss what testosterone is doing and whether people will worry about increasing hormone levels as they grow older.
Important facts about testosterone
- Testosterone regulates a number of processes in the male body.
- Levels of testosterone tend to drop as men age.
- Prohormone supplements do not have any effect on testosterone levels.
- Testosterone supplements are prescribed only for specified conditions, and not to counteract the natural, age-related drop in testosterone levels.
- Testosterone replacement therapy (TRT) is also available. However, this can carry side effects and risks.
What is testosterone?
Testosterone is the hormone that is responsible for forming male sexual characteristics. Hormones are chemical messengers that trigger required body changes. Females also produce testosterone, usually in smaller amounts.
It is a form of androgen primarily generated in cells by the testicles called the Leydig cells.
Testosterone is thought to regulate a number of functions in men alongside the production of sperms. Including:
- sex drive
- bone mass
- fat distribution
- muscle size and strength
- red blood cell production
A men become infertile without adequate amounts of testosterone. This is because testosterone helps to make mature sperm develop.
While a male sex hormone, testosterone also contributes to women’s sex drive, bone density and muscle strength. But excess testosterone may also cause women to suffer baldness and infertility in male patterns.
Testosterone levels are regulated by the brain and the pituitary gland. The hormone, once created, moves through the blood to perform its various important functions.
High or low testosterone levels may cause dysfunction in normally hormone-regulated parts of the body.
When a man has low testosterone, or hypogonadism, he may experience:
- reduced sex drive
- erectile dysfunction
- low sperm count
- enlarged or swollen breast tissue
Over time, these symptoms may develop in the following ways:
- loss of body hair
- loss of muscle bulk
- loss of strength
- increased body fat
Chronic or ongoing low testosterone can lead to osteoporosis, changes in mood, reduced energy and reduced testicular shrinking.
Causes can include:
- testicular injury, such as castration
- infection of the testicles
- medications, such as opiate analgesics
- disorders that affect the hormones, such as pituitary tumors or high prolactin levels
- chronic diseases, including type 2 diabetes, kidney and liver disease, obesity, and HIV/AIDS
- genetic diseases, such as Klinefelter syndrome, Prader-Willi syndrome, hemochromatosis, Kallman syndrome, and myotonic dystrophy
On the other hand, too much testosterone can cause puberty to trigger before age 9. This condition will primarily affect younger men, and is much less common.
In women, however, high testosterone levels can lead to male pattern baldness, a deep voice, and menstrual irregularities, as well as:
- growth and swelling of the clitoris
- changes in body shape
- reduction in breast size
- oily skin
- facial hair growth around the body, lips, and chin
Recent studies also related high levels of testosterone in women to the risk of uterine fibroids.
With a blood test, testosterone imbalances can be detected, and treated accordingly.
Testosterone levels and aging
The levels of testosterone naturally fall as a man ages.
In recent years, more focus has been paid to the consequences of gradually lowering testosterone levels as men age. It is known as late-onset hypogonadism.
After age 40, for most men, the concentration of circulating testosterone drops by about 1.6 percent each year. By age 60, the low testosterone levels in younger men would lead to a diagnosis of hypogonadism.
Low testosterone has been related to increased mortality among male veterans. Late-onset hypogonadism has become a recognised medical condition, though many of the symptoms are related to normal aging.
The following are symptoms of late-onset hypogonadism:
- diminished erectile quality, particularly at night
- decreased libido
- mood changes
- reduced cognitive function
- fatigue, depression, and anger
- a decrease in muscle mass and strength
- decreased body hair
- skin changes
- decreased bone mass and bone mineral density
- increase in abdominal fat mass
Late-onset hypogonadism has also been linked with metabolic disease and cardiovascular disease, as well as sexual dysfunction.
The degree to which testosterone levels decline varies among men but the effects of reduced testosterone levels are experienced by a growing number of men. Life expectancy has risen, and now many people live beyond the age of 60.
As a result, a larger number of people are seeing the symptoms of depletion of testosterone related to age.
Administering hypogonadism treatment as a result of a disease differs from treating hypogonadism in older men at a late-onset.
One proposed treatment for low testosterone comes in the form of supplements with testosterone.
The United States Food and Drug Administration (FDA ) has approved one type of testosterone supplement, methyltestosterone. However, guidelines advise physicians not to prescribe this supplement because of the speed with which testosterone is metabolized in the liver.
That can lead to toxicity to the liver. Although doctors can prescribe the supplement legally, they normally try to avoid this.
Until there is stronger evidence to support the benefits and safety of testosterone supplementation, only older adults with severe low testosterone clinical symptoms should be candidates for those supplements.
The FDA has advised that supplements with testosterone are not suitable for the treatment of late-onset hypogonadism, and a doctor should only prescribe them for an identifiable cause.
Testosterone replacement therapy
Testosterone replacement therapy (TRT) can help restore some of the affected low testosterone functions.
Studies have shown that TRT primarily affects blood bone strength and levels of hemoglobin but not sharpness.
The treatment can be administered by:
- skin gels and patches
- tablets that are absorbed through the gums
These can, however, trigger side effects, including:
- increased red blood cell count
- prostate and breast enlargement
- in rare cases, breathing difficulties during sleep
- increased risk of cardiovascular disease, although this is subject to debate
Deciding to follow a TRT course involves deciding between the perceived benefit of the therapy on a particular individual ‘s symptoms and the risks of the treatment.
Nevertheless, the Endocrine Society recommends doctors should not recommend TRT to people under 65 years of age, even though they have low levels of testosterone. For men younger than this the risks and suggested benefits of TRT are unknown, as are the benefits.
Recent work is conflicting. Additional testosterone replacement studies are needed for doctors to better understand their possible risks and benefits, and to recognize the individuals who will experience the most benefit.
Prohormone supplements and heart disease
Prohormones are a variety of steroid. Often, they are used to support weight loss and muscle building.
A number of prohormone supplements are marketed at men to treat low testosterone levels. Such supplements may include dehydroepiandrosterone (DHEA), and Tribulus terrestris, a herbal product. However, in 2014 a bill banning designer anabolic steroids was passed.
Since legal variants have emerged. There is, however, little research, if any, to indicate that these prohormone supplements affect testosterone levels. 2016 studies found no evidence, for example, that Tribulus terrestris can raise testosterone levels.
These treatments can pose health risks. The law does not mandate that herbal supplements be proved safe prior to sale, so caution is advised.
The potential side effects of prohormones plus their unproven clinical advantages make them a poor, potentially dangerous choice for testosterone boosting.
For men, it is necessary to maintain testosterone levels but they naturally decrease over time. If symptoms of severe or chronic low testosterone show up, an active disease or condition may cause the hormone deficiency.
Treatment may lead to unintended side effects, so balancing the expected benefits of testosterone supplementation with the treatment risks may be crucial. Low levels of testosterone often come without adverse physical effects and require no treatment.
Speak to a medical professional, and check if you need help.