Our bodies are complex centers of communication. And testosterone is a hormone with a lot to say.
Almost every tissue in a man’s body has testosterone receptors, says Laurence A. Levine, MD, a urologist and professor of urology at Rush University Medical Center. That means that testosterone has some say in what goes on in each of those systems including the brain, muscles, bones, bone marrow, kidneys, liver, hair follicles, genitalia and sperm.
Low levels of testosterone mean less communication. An empty testosterone receptor has turned quiet, no longer voicing a command and activating the cellular activity that it is supposed to. During June, Men’s Health Month, the goal is to raise awareness of preventable health problems among men including issues associated with low testosterone.
Signs of low testosterone present themselves throughout the body, causing declines in many of the functions that make a man feel physically and mentally himself.
Symptoms include fatigue, frailty, weakened cognitive functioning, loss of sexual drive or inability to achieve an erection. Men with a loss in testosterone may experience sarcopenia (decreased muscle mass) or osteoporosis (diminished bone density). They could also develop decreased body hair and enlarged breasts, says Kavitha Srinivasan, MD, an internal medicine physician at NorthShore University HealthSystem.
Unlike with women, where estrogen levels drop dramatically at the onset of menopause, a man’s loss of testosterone with age is often a slow drift; not a steep drop. Stress and chronic or acute illnesses also can affect testosterone levels, Levine says, sometimes causing sudden drops. Diabetes, obesity, hypertension, chronic pulmonary disease, inflammatory bowel disease and kidney disease all have the potential side effect of diminished testosterone levels.
Another common trigger is opioid treatment for chronic pain. “Vicodin can knock out your testosterone for an entire day, right down to almost no detectable levels,” says Levine, adding that about 70 percent of men will experience very low levels of testosterone if they are taking an opioid medication on a regular basis.
Replenishing the system
A patient doesn’t usually turn up in his doctor’s office saying that he thinks he has low testosterone. Instead, he might say that he feels chronically fatigued or has lost interest in things that he used to enjoy. In many cases, it’s erectile dysfunction and low libido that finally bring a man to the doctor.
Testosterone levels are assessed with a blood test in the morning, usually between 8 and 10 a.m., Srinivasan says. Testosterone levels naturally decline during the day, so it’s important to check them early, when they are at their peak.
Physicians look at the total level of testosterone and also at the level of free testosterone. “Free testosterone is the biologically active hormone. It’s only about 1 to 2 percent of the total,” Levine says. “That’s what really acts on all the tissue.”
Levine also tests a pituitary hormone called LH, which is responsible for stimulating the testicles to produce testosterone. The test helps determine whether the testicles are failing or whether the testicles aren’t being properly stimulated to produce testosterone. In about 95 percent of cases he sees, Levine notes, the problem is that the pituitary is not properly stimulating the testicles, or the testicles are not responding properly.
Testosterone replacement therapy, also known as androgen replacement therapy, is available as injections, implants, gels or patches. The most popular treatment is gels, which must be applied daily. The aim is for men to return to normal levels, as too much testosterone can have its own negative side effects.
Levine encourages men who are considering testosterone replacement therapy to ignore the scare campaigns, referring to a couple of contentiously debated studies—one published by the Journal of the American Medical Association in 2013 and another in PLOS ONE in 2014—that purported a link between testosterone replacement therapy and increased risk of heart attack or stroke. He worries that studies like these, which have been accused of questionable analysis, deter men from seeking treatment for a problem that is rather simple to fix.
“Ten years ago, doctors would say that if you have a history of prostate cancer or are concerned about a risk of prostate cancer, you should never take testosterone. This has absolutely shown to be wrong,” Levine says. “There’s no evidence whatsoever that testosterone causes prostate cancer, and there’s no clear evidence that testosterone causes cardiac disease.”
Low levels of testosterone can cause increased side effects over time, so don’t delay in getting potential problems addressed. By seeking early treatment for symptoms, men can quickly and easily go back to enjoying life as they used to.