Low testosterone: Symptoms, causes, and treatment

Low testosterone: Symptoms, causes, and treatment

For the treatment of low testosterone in men who wish to conceive children, SERMs (clomiphene or tamoxifen) are usually the first choice due to its ease of use (it comes in pill form) and relatively low cost. Historically, clomiphene was the more commonly used SERM, but in 2023 production of the generic form of clomiphene was stopped for some reason. Brand name clomiphene (Clomid) is still available but it is much more expensive- the use of tamoxifen has therefore picked up recently since the mechanisms of action is similar but the price is much lower. When your testosterone level is low, you may not be able to get or keep an erection. Testosterone fuels the male sex drive, so when you’re running low, you may lose interest in sex. With a decrease in testosterone comes the possibility of weight gain. Fortunately, working out to lose excess weight can help to boost testosterone and lessen the effects of LT symptoms.

Due to pituitary suppression, these men often do not respond well initially to SERMs or anastrazole, and going straight to HCG is sometimes the best choice. Men without a functional pituitary (e.g. prior pituitary surgery or radiation) are not going to respond to the use of SERMs either. When a man’s testosterone hormone level is low, it can reduce his sex drive, and cause both irritability and erectile dysfunction. Low T may also cause weight gain, fatigue, decreased muscle, and increased body fat.

This might include additional blood tests, and sometimes imaging such as a pituitary MRI. Every so often I have a patient who cannot get total testosterone levels above 300 ng/dL despite maximal therapy (e.g. HCG 4,000 IU three times a week combined with anastrazole 1 mg daily). In this situation, the Leydig cells that produce testosterone within the testicles are presumably not functioning properly and do not respond to LH stimulation.

Often, we find that the patient’s LH production has been suppressed. Unlike many low-T clinics, we calculate bioavailable testosterone by measuring levels of two proteins, sex hormone binding globulin and albumin, that typically bind to testosterone. It’s possible to have a normal total testosterone level and experience low-T symptoms if this balance is off. Testosterone is a natural hormone produced primarily in the testicles, and it helps men maintain everything from bone density and body hair to sex drive and sperm production. However, you don’t have to hit a certain number or level despite what the constant flow of ads may tell you. In fact, testosterone does fuel sex drive and muscle mass, but it also regulates mood and bone strength.

For older adults who have low testosterone and symptoms of hypogonadism due to aging, it’s less clear how well testosterone replacement works. See your health care provider if you have symptoms of male hypogonadism. Finding the cause of hypogonadism is an important first step to getting appropriate treatment. A better combination in terms of T production is combining anastrazole with either SERMs or HCG. Since anastrazole works in a completely different manner than SERMs or HCG, it can complement their effect on testosterone production while also keeping estradiol levels from getting too high. Hormone values tend to respond within two weeks of starting a man on therapy.

Patients on short-acting IM or short-acting SQ pellets (testosterone cypionate or enanthate) should have their testosterone measured after several cycles such that testosterone level equilibration has been achieved. The Panel recommends that this be completed no earlier than three to four cycles. While no data exist on the optimal timing of the blood draw within a cycle, it has historically been recommended that blood draws be conducted mid-cycle. The main driving force behind such a strategy is convenience for patients and clinicians, although such timing has no ability to define peak and trough levels. In addition to issues relating to the reliability of compounded products themselves, appropriate clinical studies on pharmacokinetics are lacking. As such, even if consistent testosterone levels could be achieved, providers issuing prescriptions for compounded testosterone need to consider performing additional monitoring and dose adjustments to ensure appropriate therapeutic levels. There are limited data in men on active surveillance who are candidates for testosterone therapy.

At this time, there is no definitive evidence indicating what the optimal time interval should be between the two separate tests. Likewise, while some literature suggests that food ingestion might affect testosterone levels, the evidence is particularly weak, and the Panel does not recommend that clinicians insist on fasting prior to testing. The Panel explicitly uses the term testosterone therapy rather than testosterone replacement therapy or testosterone supplementation to be in keeping with the beliefs of the current thought leaders in the field. Testosterone is a hormone that plays an important role in a man’s health, particularly his sexual health. In other words, a variety of bodily functions rely on testosterone. If yours is low, you could be feeling “off” or experiencing specific symptoms, such as ED, low sex drive, mood changes, or hair loss.

Most doctors agree that a “normal” reading falls anywhere between 300 to 1,000 nanograms per deciliter (ng/dL). About 40% of men over age 45 will have levels that come in below that range. Low testosterone may affect different body systems, resulting in symptoms that affect memory, mood, bone, muscle, sex drive, and the ability to get or maintain an erection. Low testosterone levels may lead to an increase in body fat mass. Low testosterone in food list (male hypogonadism) is a condition in which the testicles do not produce enough testosterone (the male sex hormone). It is possible to have low levels and not experience symptoms.

The Panel recommends that clinicians use the same laboratory with the same method/instrumentation for serial total testosterone measurement. Where possible, clinicians should use LCMS to measure total testosterone levels to maximize accuracy and limit CV between tests in men undergoing testing, particularly in men with very low total testosterone levels. The Panel recognizes that not all laboratories use LCMS technology, and immunoassays may be the only measurement tool available to clinicians. Some authorities have advocated that free testosterone should be the primary measure used to define testosterone deficiency. This is based on the concept that the free testosterone fraction is believed to be the most biologically active component.

These medications cause a man’s body to produce more testosterone. As men get older, they tend to have lower levels of total testosterone. Clearly, a dip in your testosterone level can wreak havoc in your life.