Do you feel like you have low testosterone? Let's learn exactly about this change in the male body (Male Hypogonadism)!

Do you sometimes feel tired, uninterested in anything, or have a small question about some things related to masculinity? Perhaps the reason for this is a decrease in the hormone testosterone in your body. Today, we will talk about this decrease in testosterone levels , or as doctors call it, a condition called Male Hypogonadism . Don't worry, this is something that can happen to many people, and there are treatments for it.

What does low testosterone mean?

Simply put, low testosterone means that your testicles (the glands that produce sperm in men) are not producing enough testosterone. To be precise, this testosterone is produced by the Leydig cells inside the testicles.

This condition can present with different symptoms at different ages. Also, testosterone levels naturally decrease slightly as men age. This is called by other names, for example:

• Testosterone deficiency syndrome
• Testosterone deficiency
• Primary hypogonadism
• Secondary hypogonadism

Why is testosterone so important?

Testosterone is the most important male hormone. It is essential for the development of male characteristics and the production of sperm (spermatogenesis). Men have much higher levels of testosterone in their bodies than women.

Testosterone helps maintain and develop these things in the male body:

• Genitals
• Muscle size
• A healthy red blood cell level
• Bone density
• Good mental health
• Sexual and reproductive function

Normally, our bodies regulate the level of testosterone in our blood. It is highest in the morning and gradually decreases as the day goes on.

The hypothalamus and pituitary gland in your brain control how much testosterone your testicles produce and release.

The hypothalamus releases gonadotropin-releasing hormone (GnRH) . This signals the pituitary gland to release luteinizing hormone (LH) . LH then travels to the testicles to stimulate the production of testosterone. The pituitary gland also releases follicle-stimulating hormone (FSH) to help produce sperm.

So, if there's a problem with your testicles, hypothalamus, or pituitary gland, your testosterone levels may decrease.

What level is considered "low testosterone"?

According to the American Urology Association (AUA), an adult's blood testosterone level is considered low if it is less than 300 nanograms per deciliter (300 ng/dL).

However, some researchers and doctors don't completely agree with this opinion. Some believe that anything less than `250 ng/dL` is considered low. However, doctors will definitely consider your symptoms when determining whether you have low testosterone.

Who is at higher risk of this testosterone decline?

This condition can affect men of any age, from birth to adulthood.

However, these people are more likely to experience low testosterone:

• For older people
• For people who are obese (too fat)
• For people with poorly controlled type 2 diabetes
• For those with obstructive sleep apnea
• People with chronic diseases such as kidney failure and cirrhosis of the liver
• For those living with HIV/AIDS

How common is this condition?

It's hard for researchers to say exactly how common low testosterone is, because different studies have defined "low testosterone" differently.

According to some data, as many as 2% of men may have this condition. Other studies suggest that more than 8% of men between the ages of 50 and 79 have low testosterone levels.

What are the symptoms of low testosterone?

The symptoms of low testosterone can vary greatly from person to person, especially depending on age.

Symptoms in adult men

If you have these symptoms, there is a high chance that you may have low testosterone:

• Decreased sexual desire
• Erectile dysfunction
• Hair loss in the armpits and private areas
• Testicular shrinkage
• Hot flashes
• Reduced or absent sperm count (Azoospermia), which can cause difficulty in conceiving children.

Other symptoms may include:

• Depression (mood disorder)
• Difficulty concentrating and remembering
• Increased body fat
• Enlargement of male breasts (Gynecomastia)
• Decreased muscle strength and size
• Decreased body endurance

Symptoms in children (before or during puberty)

If a boy's testosterone levels decrease before or during puberty, he may experience symptoms such as:

• Height growth is slow, but limbs may grow disproportionately longer than other parts of the body.
• Reduced hair growth in the private area.
• Decreased growth of the testicles and testicles.
• Decreased deepening of the voice.
• Age-related decline in strength and endurance.

What are the causes of low testosterone?

There are several reasons why testosterone levels can drop. This condition falls into two main categories:

1. Primary hypogonadism: This is caused by a problem with the testicles themselves.

2. Secondary hypogonadism: This is caused by a dysfunction in the pituitary gland or hypothalamus in the brain.

Both of these types can be caused by either congenital causes or acquired causes that occur later (in childhood or adulthood).

Causes of primary hypogonadism

What happens in this case is that there is a problem with the testicles, which prevents them from producing testosterone normally.

Another name for this is hypergonadotropic hypogonadism . This is when the pituitary gland produces more of the hormones LH and FSH (also known as gonadotropins) because of low testosterone. Normally, when these hormones are high, the testicles are told to make more testosterone and sperm. However, if the testicles are damaged (often due to chemotherapy for cancer) or if the testicles are missing, they cannot respond to these increased gonadotropins. As a result, very little or no testosterone and sperm are produced.

Sometimes in primary hypogonadism, gonadotropin levels can be elevated even though testosterone levels are within the normal range. Your specialist will explain this to you and whether treatment is necessary even if testosterone is normal.

Congenital causes:

• Absence of testicles at birth (Anorchia)
• Cryptorchidism (failure of the testicles to descend from the scrotum)
• Incomplete development of Leydig cells in the testicles (Leydig cell hypoplasia)
• Klinefelter's syndrome (males are born with an extra X chromosome instead of XY - XXY)
• Noonan syndrome (rare genetic condition, can cause delayed puberty, undescended testicles, or infertility)
• Myotonic dystrophy (a group of inherited muscle weakness diseases)

Acquired causes:

• Injury to or removal of the testicles.
• Inflammation of one or both testicles (orchitis). This is often caused by a bacterial infection (e.g. sexually transmitted infections), or it can also be caused by a viral infection such as mumps.
• Giving chemotherapy or radiation therapy to the testicles.
• Some types of cancer.
• Anabolic steroid use.

Causes of secondary hypogonadism

Secondary hypogonadism is caused by conditions that affect the function of the hypothalamus and/or pituitary gland. This is also called hypogonadotropic hypogonadism , because there are low levels of the hormones `LH` and `FSH`. These low levels lead to low testosterone and sperm production.

Congenital causes:

• Isolated hypogonadotropic hypogonadism (low GnRH levels from birth)
• Kallmann syndrome (rare genetic condition, failure to develop nerve cells in the hypothalamus that produce GnRH. Loss of smell may also occur)
• Prader-Willi syndrome (a rare genetic multi-system disorder that can impair the function of the hypothalamus)

Acquired causes:

• Hypopituitarism (this can be caused by a pituitary tumor (adenoma), infection, injury, radiation therapy, or surgery)
• Hyperprolactinemia (increased levels of the hormone prolactin)
• Excessive iron in the body (Hemochromatosis)
• Brain or head injury
• Cushing's syndrome
• Cirrhosis of the liver
• Kidney failure
• HIV/AIDS
• Alcohol use disorder
• Poorly controlled diabetes
• Obesity (being too fat)
• Obstructive sleep apnea
• Certain medications (e.g. estrogen, mood-altering drugs, metoclopramide, opioids, some drugs for prostate cancer)

Late-onset hypogonadism (LOH) is a type of secondary hypogonadism that occurs with normal aging. As men age, testosterone and/or sperm production declines due to impaired hypothalamic-pituitary function and Leydig cell function.

LOH and low testosterone are common among men with type 2 diabetes, overweight, and/or obesity.

In one study, 30% of overweight men had low testosterone levels, compared to only 6% of normal-weight men. In another study, 25% of men with type 2 diabetes had low testosterone levels, compared to only 13% of men without diabetes.

How do you know for sure if you have low testosterone?

If you have symptoms of low testosterone, a doctor will do a physical exam. They will also ask you questions about your medical history, medications you take or have taken, whether you smoke, and any current symptoms. They will then order several blood tests.

To make a diagnosis, the doctor will consider your symptoms and blood test results.

What kind of tests are done?

These tests can help confirm low testosterone and find the cause:

• Total testosterone level blood test: This usually requires two blood samples to be taken between 8 and 10 a.m., as that is when testosterone levels are highest. You should tell your doctor if you have been sick or have recently recovered from an illness. In the event of an emergency, the results may be falsely low.
• Luteinizing hormone (LH) blood test: This helps determine if a problem with the pituitary gland is the cause of low testosterone.
• Prolactin blood test: High prolactin levels can be a sign of a problem or tumor in the pituitary gland.

What is the treatment for low testosterone?

Doctors treat low testosterone with Testosterone Replacement Therapy (TRT) . There are several ways to do this:

• Testosterone gel (applied to the skin): This gel should be applied daily to clean, dry skin as directed by your doctor. Most importantly, do not let the gel come into contact with anyone else through the skin. This is the most common method used in the United States.
• Intramuscular testosterone injections: You or a doctor can give you this injection into a muscle every 1-2 weeks. There are also long-acting testosterone injections that are given every 10 weeks. There are also subcutaneous injections that are given under the skin.
• Testosterone patch (skin patch): This patch should be applied to the skin daily as directed by your doctor. The application site should be rotated regularly to prevent skin reactions.
• Testosterone pellets (subcutaneous): A specialist will implant these pellets under the skin for three to six months. These provide a steady dose of testosterone over a long period of time.
• Buccal testosterone tablets: These are sticky tablets that are placed on the gums twice a day. Testosterone is quickly absorbed into the bloodstream through the gums.
• Testosterone nasal gel: This gel should be applied to both nostrils three times a day.
• Oral testosterone: A type of testosterone called undecanoate is given to men who have low testosterone due to certain medical conditions, such as Klinefelter syndrome, or tumors that have damaged the pituitary gland.

However, you may not be able to receive testosterone replacement therapy if you have a history of any of the following conditions:

• Prostate cancer.
• An unexamined prostate lump. (Everyone should have their prostate checked before starting testosterone therapy.)
• Breast cancer.
• Uncontrolled heart failure.
• Untreated obstructive sleep apnea.

What are the side effects of testosterone replacement therapy?

The following may occur as side effects of this treatment:

• Acne-prone or oily skin.
• Ankle swelling due to slight fluid accumulation in the body.
• Symptoms such as difficulty urinating due to prostate stimulation.
• Breast enlargement or pain.
• Worsening of sleep apnea.
• Small testicles.
• If you use testosterone applied to the skin, you may experience skin itching and inflammation.

Changes that can be seen in laboratory reports:

• Increased prostate-specific antigen (PSA).
• Increased red blood cell count.
• Low sperm count, leading to infertility (inability to have children). This is especially important for young men who are trying to have children.

Can testosterone decline be prevented?

Doctors and researchers do not yet know of a way to prevent testosterone decline, whether due to genetic causes or damage to the testicles, hypothalamus, or pituitary gland.

However, these lifestyle habits can help keep testosterone levels normal:

• Eating a healthy diet.
• Exercising.
• Weight control.
• Avoid excessive alcohol and drug use.

What happens if you have low testosterone? What can you expect?

There is no one-size-fits-all solution to low testosterone. However, with continued, appropriate hormone replacement therapy, you can improve your sex drive, reduce symptoms of depression, and increase your energy. Treatment can also increase muscle mass and bone density.

Men with testosterone deficiency have a significantly higher mortality rate than men with normal testosterone levels. However, it is unclear whether restoring testosterone levels to normal levels will reduce this increased mortality rate. Treatment is largely focused on managing symptoms, not targeting testosterone levels.

In cases of congenital hypogonadism, testosterone replacement therapy often helps prevent problems associated with delayed puberty.

When should you see a doctor about low testosterone?

If you are taking hormone replacement therapy, it is very important to see your doctor regularly for checkups.

If you have symptoms of low testosterone, such as decreased sex drive or hot flashes, talk to a doctor. He or she will examine you and order blood tests.

If your child is not showing signs of puberty by the age of 14, talk to his pediatrician.

Many people dismiss the symptoms of low testosterone as a normal part of aging. However, if you have symptoms that are affecting your quality of life, it's definitely worth paying attention to. If you're experiencing troubling symptoms of low testosterone, see a doctor to discuss treatment options.

The most important thing to remember from this article (Take-Home Message)

Low testosterone is a condition that can affect men. It can cause a variety of physical and mental problems. The best thing to do is not to be afraid or embarrassed about it, but to seek medical advice. If you have symptoms, don't dismiss them as normal aging.

With the right diagnosis and appropriate treatment, you can live a comfortable life. Remember, you are not alone, and help is available.

` Testosterone, male hormones, hypogonadism, sexual health, hormone therapy, men's health, lack of energy