What Are the Symptoms of Low Testosterone (Deficiency)?
Hypogonadism is the medical term for the condition in males that is caused when the body is not producing sufficient amounts of testosterone. What most people don’t realize is that in addition to sexual desire, testosterone also affects lean body mass, strength, bone density, mental focus, mood, fat loss, and other important factors in both males and females.
Common complaints for men with hypogonadism include: lower sexual desire (libido), erectile dysfunction (softer erections or lack of erections), depression, low energy and appetite, changes in body composition (lower lean body mass and higher abdominal fat), lower strength, reductions in body and facial hair, less mental focus and decreased height and osteoporosis (decrease in bone density).
As list shows, normalizing testosterone in people who have lower than normal levels has dramatic benefits, among which are increased sexual desire, lean body mass, bone density, strength, mood, motivation, mental focus, and stamina. However, these benefits can be erased if proper monitoring, dose adjustment, and appropriate choice of testosterone replacement option are not accomplished.
Benefits of Normalizing Testosterone
- Restored sexual desire
- Improved erectile function
- Improved mood/ sense of wellbeing
- Increased lean body mass, strength and stamina
- Improved bone density
- Decreased fat mass
Determining If You Have Testosterone Deficiency
In addition to blood tests and physical examination, a brief screening instrument has also been developed by researchers at St. Louis University to aid in the diagnosis of hypogonadism. Known as the Androgen Deficiency in the Aging Male (ADAM) questionnaire:
- Do you have a decrease in sex drive?
- Do you lack energy?
- Have you experienced a decrease in strength and/or endurance?
- Do you feel shorter? Have you lost height? (Lower bone density can decrease height.)
- Have you noticed a decreased enjoyment of life?
- Are you sad and/or grumpy?
- Are your erections less strong or gone?
- Has it been more difficult to maintain your erection throughout sexual intercourse?
- Are you falling asleep after dinner?
- Has your work performance deteriorated recently?
Other questions that are usually not asked by doctors, but which I’ve found to be important are the following:
- Are you relating well with people around you?
- Are you being loving to your lover or life partner?
- Are you able to pay attention when someone talks to you?
Note that several of the above-mentioned problems can be caused by many other issues unrelated to low testosterone. Depression, anxiety, stress, medications and/or sleep disorders can cause nine of those 10 symptoms (decrease in height would be the only item unrelated to anything but bone loss or back surgery). This questionnaire is not a perfect predictor of low testosterone and should not replace tests for testosterone blood levels.
The benefit of this questionnaire is that it may encourage some men to seek medical advice. Then they can get their testosterone checked and have a physical examination to help determine whether they are indeed hypogonadal.
Causes of Testosterone Deficiency
Hypogonadism is caused when the testicles fail to produce normal levels of testosterone. In one type of hypogonadism, testosterone levels are low, while LH and FSH are elevated. In another, there is not enough secretion of LH and FSH needed to tell the testicles to produce needed testosterone.
Some commonly used medications such as Megace (an appetite stimulant), Nizoral (an anti-fungal agent), Prednisone (an anti-inflammatory corticosteroid) and Tagamet (an antacid) can also lower testosterone production. Illness and aging can cause a decrease in testosterone and/ or an increase in sex hormone binding globulin (SHBG). Furthermore, high prolactin hormone levels may suggest a pituitary tumor that may be causing a decrease in testosterone production.
It is important that your doctor measure hormones in the HPGA cascade to diagnose what kind of hypogonadism you have. The most common kind of hypogonadism presents low testosterone with normal or elevated FSH and LH levels, which indicates that your testicles are not responding to the signals of both LH and FSH. This is what is called primary hypogonadism.
There are several reasons that testosterone levels may be low:
- Too much free testosterone is being bound by SHBG. This would be especially apparent if a male’s total testosterone level is in the high reference range but his free testosterone (unbound) level is low. As previously mentioned, aging and illness increase SHBG.
- The pituitary gland, which controls testosterone production through the production of LH, is not secreting enough LH to stimulate production of testosterone by the testicles. In this case, total testosterone would be low.
- The hypothalamus is not functioning properly. LH levels of less than 2 ng/mL suggest a lesion in this part of the HPGA.
- The testicles have lost their ability to produce testosterone, despite adequate amounts of LH. In this case, the level of LH would be high (greater than 10 ng/mL) despite a low testosterone level.
- Dehydroepiandrosterone (DHEA) level is abnormally low. DHEA is a hormone produced by the adrenal glands that has a lot of the same benefits as testosterone. It also is a precursor to testosterone in women.
- Disease or infections.
- Street drugs, prescription or over-the-counter medications (more on this later)
- Lab error.
- High prolactin levels, which may indicate the presence of a pituitary tumor that impairs production of hormones that tell your testicles to produce testosterone (rare condition but worth mentioning!)
- Defects in genes that affect LH and FSH production.