Low Testosterone (Hypogonadism)

Low testosterone, clinically known as hypogonadism, is most commonly seen in older cisgender men as well as those with obesity and type 2 diabetes. Cisgender women may also develop it. Testosterone is a sex hormone, and insufficient levels of it cause low sex drive (low libido), erectile dysfunction (ED), infertility, and loss of energy and muscle mass, among other symptoms.

This article provides an overview of the symptoms and potential causes of low testosterone. It also discusses risk factors as well as when to seek testing and treatment for your symptoms.

Symptoms of Low Testosterone

Not having enough testosterone in the body can have a severe impact on your health. Common signs include:

• Loss or decline in sex drive
• Erectile dysfunction (the inability to achieve or maintain an erection)
• Low sperm count
• Enlargement or tenderness in the breasts
• Fatigue or reduced energy
• Lower muscle mass
• Increases in body fat
• Reduction in the size of the testicles
• Irritability, difficulty concentrating, and depression
• Hot flashes

This issue doesn’t just affect men; cisgender women also produce testosterone and may experience symptoms when they have insufficient levels. In women, hypogonadism may cause:

• Low libido
• Reduced muscle mass
• Fatigue
• Osteoporosis (weakening of the bones)
• Difficulty concentrating
• Irregular menstrual cycles

Causes of Low Testosterone

Testosterone is produced in the sex glands: the gonads in the testes of men and the ovaries of women. Production is regulated by the pituitary gland and the hypothalamus in the brain.

There are two types of low testosterone: primary hypogonadism and secondary hypogonadism. Primary hypogonadism arises due to disorders in the glands. Secondary hypogonadism arises due to problems in the brain or pituitary gland.

Your testosterone levels naturally fluctuate as you grow older, and aging is by far the most common cause. In fact, researchers have found nearly 40% of men over age 45 experience the condition, with the number climbing to 50% for those 80 and older. This affects women too with hypogonadism often accompanying menopause.  

However, a wide range of disorders, diseases, and other health issues can also cause low testosterone. The most common of these include:

• Testicular injury: Castration, burning, or other kinds of injury to the testes interrupts or completely halts the production of testosterone, leading to low levels.
• Chronic conditions: Long-standing health issues, such as type 2 diabetes, obesity, sleep disorders, liver and kidney diseases, as well as human immunodeficiency virus (HIV/AIDS), can all lead to low testosterone.
• Hormone and genetic disorders: High levels of the hormone prolactin, thyroid disorders, and tumors or dysfunction of the pituitary gland lead to low levels of testosterone. It’s also a hallmark of genetic diseases: Klinefelter syndrome, Kallmann syndrome, and hemochromatosis (excessive levels of iron in the body), among others.  

What Medications Can Cause Low Testosterone?

Low testosterone can also arise as a side effect of medications or treatments. These include: 

• Cancer treatment: There are many side effects of radiation therapy and chemotherapy drugs for cancer. Low testosterone is often associated with the treatment of testicular cancer.
• Opioids: This class of medication, which includes Percocet (oxycodone and acetaminophen), Vicodin (hydrocodone and acetaminophen), and many other drugs, is prescribed to manage severe pain. Opioids have many side effects and should be taken sparingly because of their addictive potential.
• Corticosteroids: Injections of corticosteroids may help manage inflammation and swelling in the joints. This is a common treatment for arthritis.
• Anabolic steroids: Anabolic steroids, such as Anadrol and Oxandrin, are synthetic hormones prescribed for anemia and certain health conditions, including low testosterone. However, these are also taken illicitly to build muscle, which can lead to dangerous side effects.

How to Treat Low Testosterone

Treatment for low testosterone primarily involves testosterone replacement therapy (TRT): the administration of synthetic formulations of this hormone. There are several kinds as well as several ways to administer them. These include:

• Injections: A common approach involves injections of testosterone formulations, such as Depo-Testosterone or Delatestryl every two weeks. Aveed is a longer-acting option, requiring administration once every six weeks.
• Transdermal: Transdermal gels, such as Testim or AndroGel, are applied on the skin daily, providing a more sustained release of testosterone. Androderm patches are another TRT option.  
• Nasal and buccal: Testosterone formulations are also available via a nasal spray, Natesto, strips placed under the tongue, sold as Andriol.
• Pellets: Testopel is a pellet that’s implanted beneath the skin in the buttocks, abdomen, and thigh. These need to be replaced every three to six months.  
• Oral: Jatenzo is an oral form of testosterone that has been approved to be taken once or twice daily with food.

Additionally, treating the underlying conditions and diseases and adjusting medications can restore testosterone levels. Managing obesity by improving your diet, getting good sleep, and incorporating exercise, may also be a means of taking on hypogonadism.

Complications and Risk Factors

If low testosterone isn’t treated, it can cause more severe, long-term effects, such as:

• Loss of body hair
• Infertility
• Osteoporosis, or loss of bone mass
• Low red blood cell count
• Reduced musculature
• Smaller testes

It’s also important to understand the factors that increase the risk of developing hypogonadism. These include:

• Obesity
• Alcohol consumption
• High cholesterol
• Erectile dysfunction
• Consuming too many iron-rich foods or iron supplements

Are There Tests to Diagnose the Cause of Low Testosterone?

To determine what might be causing your low testosterone, your healthcare provider may use several tests:

• Testosterone levels test: Testosterone levels can be measured with a blood sample. The healthy range is 300–1,000 ng/dL (nanograms per deciliter), with levels below this considered hypogonadism. Testing should occur between 7 a.m. and 10 a.m. when the hormone levels are highest.
• Blood panels: Alongside testosterone levels, your provider may also screen for other health factors, such as hormone disorders, elevated iron levels, or chronic diseases. Your blood pressure and cholesterol levels will also be screened.
• Genetic testing: Because several inherited conditions can also be at the root of low levels, you may also undergo genetic screening and evaluation. Samples are taken from blood or saliva.
• Sperm sample: Your provider may ask to collect a sperm cell to check your sperm count because this is a frequent sign of hypogonadism and other conditions.
• Bone density scan (DEXA scan): Because osteoporosis is a common cause of low testosterone, your doctor may employ a specialized X-ray test, the DEXA scan, to assess the density of your bones.
• Magnetic resonance imaging (MRI): To screen for secondary hypogonadism in the pituitary gland—low testosterone due to gland dysfunction—you may undergo an MRI. This imaging approach relies on the use of magnetic fields to develop three-dimensional images for diagnosis.

When to See a Healthcare Provider

If you’re displaying multiple signs or symptoms of low testosterone, you should call your provider. Particularly concerning symptoms include:

• Erectile dysfunction
• Lack of sexual desire
• Depression
• Frequent fatigue or lack of energy

If you’re experiencing symptoms, it’s especially critical to get help when you have:

• Klinefelter syndrome, Kallmann syndrome, or a diagnosis of hereditary hypogonadism
• Damage to or loss of testicles
• Multiple symptoms accompanied by blood tests confirming low testosterone levels

Summary

Low testosterone is a common condition that most often affects older men, though women may also experience it. It can be a natural result of aging or arise due to health conditions or diseases. People manage this by following their doctor’s recommendations and making lifestyle changes.

A Word From Verywell

Living with low testosterone is often difficult. This issue affects not only your physical health, but it can also have a severe impact on your mental health. Though it may be distressing, it’s important to remember you’re far from alone if you experience this condition, and that help is available. If you suspect you have low testosterone, don’t suffer in silence. Call your provider and start on the path back toward good health.