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LowT: Understanding Low Testosterone

LowT: Understanding Low Testosterone

By Neha Shah, MD of Edward Elmhurst Hospital and Motherhood MD

Low-T, it’s a little discussed men’s health topic. Low testosterone is commonly understood as a link to low sex drive and erectile dysfunction, but testosterone plays a more comprehensive role in our health. Testosterone is produced by the human body and plays a role in general and sexual health. Low-T affects 40% of men above the age of 45, and testosterone levels drop by 1% per year starting at age 30.

Symptoms of low testosterone are more systemic than doctors originally realized. Low testosterone has been linked to hair loss, fatigue, changes in mood, memory loss, weight gain, and adverse effects on bone health. Unfortunately, testosterone levels are not part of routine lab work and symptoms can be chalked up to the normal aging process. Many men may not discuss these symptoms with their doctor or partner.

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Baseline
Normal testosterone levels fluctuate throughout the day. Ideal testosterone levels range from 300-1000 ng/dL according to the Food and Drug Administration. Low-T is diagnosed at levels below 300 ng/dL, in addition to the symptoms mentioned above. Currently, there is insufficient evidence to recommend routine testing. Screening questionnaires have not proven effective leading to a wide range of under and over treatment by practitioners. If low-T is evident, it is recommended that a more comprehensive hormone panel be done for further evaluation. Blood work should always include prostate cancer screening for appropriate patients.

Testosterone treatment requires close monitoring with frequent assessment of physical and emotional symptoms. Unique scenarios include men with cardiovascular risk factors, as research is inconclusive on the benefit versus harm of testosterone treatment. Men interested in family planning should discuss reproductive health prior to treatment as some testosterone therapies can negatively affect fertility.

Treatment
Prescription testosterone replacement comes in a variety of modalities, including injections, patches, pills, pellets, and topical creams. Current research is mixed on testosterone treatment indications, as there is a need for additional long-term safety data.

Testosterone replacement has boomed in the last ten years into a multi-billion dollar industry. Conversely, there is the frightening wave of testosterone boosters in the unregulated supplement industry. A quick internet search provides a plethora of testosterone supplement options catered to improving male performance from the boardroom to the bedroom. Many times, supplements are marketed as “all-natural” or “natural substances only,” but this does not necessarily mean safe. As well as supplements, telemedicine cohorts are now offering at-home testosterone testing. The jury is still out on the accuracy of home testing for testosterone, and it may unsafely lead to self-medication with over-the-counter supplements.

Unfortunately, the most evidence-backed, scientifically proven treatment modality gets the least attention when it comes to low-T. Lifestyle changes and weight loss consistently show improvement to testosterone levels1. Exercise and a balanced diet have been demonstrated to boost testosterone. Other critical components include sleep, stress, and adequate vitamin D levels.

Overall, the role of testosterone therapy is rapidly evolving as we understand the spectrum of its functionality. One of the safest and most consistent interventions you can make is with improving lifestyle! I always say in medicine, knowledge is power, and you are your own best advocate!

1-Mulhall JP, Trost LW, Brannigan RE et al: Evaluation and management of testosterone deficiency: AUA guideline. J Urol 2018; 200: 423.

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