Testosterone is a hormone produced by the testicles. It is responsible for your sex drive, sperm production, and helps to build bone and muscle mass. As a man ages, his body’s ability to produce testosterone decreases. The American Urological Association has stated that approximately 2 out of 10 men who are older than 60 years of age have low levels of testosterone. These levels further decrease as men reach their 70s and 80s.
Testing for Low Testosterone
The normal range of testosterone is 300 to 1,000 nanograms (ng) per deciliter (ng/dL). When a man’s level drops below 300, he is considered to have low testosterone or Low-T. The following blood tests may determine if you are experiencing Low-T:
Blood hemoglobin or Hgb. Before doing this test, your doctor will look for other reasons for low Hgb such as climate level (like climate altitude), sleep apnea, or tobacco smoking.
MRI of the pituitary gland
Luteinizing hormone (LH). This test is done to help find the cause of Low-T. This hormone controls how you make testosterone. Abnormal levels may indicate a pituitary gland problem.
Follicle stimulating hormone (FSH). This test checks for sperm-making function if you want to have children. You may also need to have semen tests. These tests will be done before any hormone therapy.
Blood prolactin level. If your prolactin level is high, your doctor may repeat the blood test to make sure there is no error. High prolactin levels also may be a sign of pituitary problems or tumors.
Total testosterone level. This test should be done at two different times on samples taken before noon. Testosterone levels are lower later in the day. If you are ill, the doctor will wait until you are not sick because your illness may cause a false result.
Estradiol hormone. This test is done if the breasts are enlarged.
HbA1C. A blood test to check for diabetes.
Bone density tests.
Karyotype (Chromosome tests).
Signs of Low Testosterone (Low-T)
Signs of Low-T vary from male to male, but here are the ‘dirty dozen’ that are common complaints of my male patients.
- Low Sex Drive: Many men say once they are aroused, they have no problem with sexual performance, but their libido (sex drive) just isn’t the same as it used to be. They are not as interested in sex as they used to be.
- Erection Issues: Getting an erection and maintaining it relies on nitric oxide. If the brain doesn’t produce nitric oxide, this can adversely affect a man’s ability to achieve and maintain his erection. Testosterone is responsible for stimulating neuroreceptors in the brain to produce nitric oxide for erections. Research has not determined that testosterone replacement therapy will result in successfully achieving or sustaining erections. Note: low testosterone is not the only root cause for erectile dysfunction. Many other health-related conditions that can cause erectile dysfunction are: stress, anxiety, depression, smoking, excessive use of alcohol, diabetes, thyroid conditions, hypertension and some pharmaceutical drugs.
- Seminal Volume: Semen is the white, milky substance where sperm lives. Semen helps the sperms motility and is ejaculated from the penis. Testosterone is a key player in the production of semen. If a man has a Low-T level, there will be a noticeable decrease in the amount of ejaculate.
- Hair Loss: Many men go bald at a certain age and this can be genetic, but when a man has a Low-T level, he will notice that his beard is not as full, nor is his bodily hair.
- Fatigue: Just as women suffer unexplained fatigue and a lack of motivation to exercise with their decreased levels of estrogen as they age, so do men. Men who are experiencing low levels of testosterone often complain that they are tired even though they are getting 8 hours of good sleep and living a fairly clean life. They will very often state they lack the same motivation to work out as they did 3 to 5 years earlier.
6/7. Decrease of Muscle and Bone Mass: Sorry fellas, but it is what it is. As you age, your muscle mass decreases. You’ll still be strong and function well during physical exercise, but the ‘guns’ just won’t look the same. Testosterone plays a role in the producing and maintaining strong bones. Low levels of testosterone can lead to lower bone density and the possibility of fractures.
- Body Fat: When a man’s testosterone levels decrease, his bioavailable levels of estrogen will naturally become higher. This imbalance might result in increased body fat (even though you’re watching your dietary intake and working out) and in some cases, a man can develop gynecomastia (enlarged breasts).
9/10. Psychological and Memory Changes: Mood swings are common as a man’s testosterone levels decrease. Decreased concentration, depression or irritability are common signs of Low-T. Memory loss can be attributed to low T levels, but further testing would be needed to draw definitive conclusions.
- Testicular Size: Testosterone is needed to develop the penis and testicles, therefore, if a man has lower levels of testosterone, the size of the testicles can become disproportionate to the size of the penis…get the visual…
- Anemia: The jury is still out but some research has found a correlation between low T and anemia. Anemia can cause leg cramps, dizziness, confusion and sleep disorders.
Some men may experience Low-T for other reasons such as infection, autoimmune diseases, HIV/AIDS, damage to testicles due to trauma, surgical removal of the testicles, chemotherapy and radiation.
Testosterone Therapy Before you begin any testosterone replacement therapy, consult with your urologist and trusted general practitioner. Sometimes, adjusting your lifestyle habits can help with signs of Low-T. But if you and your M.D. determine that testosterone therapy (TT) is the road you’re going to travel, you have a number of treatment options. There are topical creams, liquids and patches, but you must be careful that women and children do not touch these elements as they are transmitted via the skin. Injections can be given weekly, monthly or bimonthly. Additionally, nasal gels can be pumped into the nose. An M.D. can also administer pellets, which are placed under the skin of your buttocks or hips. Oral medication is easier to ingest, but can cause headaches. There are positives and negatives to all these treatment options which should be discussed at length with your doctor.
Traditional Chinese Medicine and Testosterone
While there is no ‘magic bullet’ to resolve naturally decreasing levels of testosterone, it is possible to enhance what you have with the combined treatments of acupuncture and Chinese herbal formulas. Fortunately, there are no side effects from treatment. In most cases, regularly scheduled weekly treatments can help with the signs of decreased levels of testosterone. The ancient Chinese believed in long life and virility, and this philosophy is over 2500 years old. For more information or to schedule an appointment, please contact the office.