Try our free symptom checker
Get a thorough self-assessment before your visit to the doctor.
Introduction
Low testosterone, also known as hypogonadism, affects millions of men worldwide. Testosterone is a hormone that plays a vital role in male development, sexual function, muscle mass, bone density, and overall well-being. When testosterone levels decline, it can lead to a range of symptoms that significantly impact quality of life.
Fortunately, there are several effective treatments available for managing low testosterone. In this comprehensive article, we will explore the top treatments for low testosterone, including both medical interventions and lifestyle modifications.
Causes of Low Testosterone
Low testosterone can be caused by various factors, ranging from natural aging to underlying health conditions. Treatment is sometimes based on the underlying cause. Some of the primary causes of low testosterone include:
- Age-related decline: Testosterone levels naturally decrease with age, typically starting around 30 and declining by about 1% per year [1].
- Obesity and metabolic disorders: Excess body fat, particularly abdominal fat, can lead to increased aromatase activity, which converts testosterone to estrogen. Metabolic disorders like type 2 diabetes and metabolic syndrome are also linked to lower testosterone [2][3].
- Stress and chronic illness: Chronic stress and prolonged exposure to cortisol can interfere with testosterone production [4]. Certain chronic health conditions, such as HIV/AIDS, chronic liver or kidney disease, and some cancers, can also contribute to low testosterone [5][6].
- Testicular injury or dysfunction: Damage or dysfunction of the testes, where testosterone is produced, can lead to low levels. This may be caused by testicular trauma, varicocele, orchitis, or testicular cancer [5][6].
- Medications and substance abuse: Some medications, like opioid painkillers, glucocorticoids, and certain antidepressants, can interfere with testosterone production or utilization. Substance abuse, including alcohol, marijuana, and anabolic steroids, can also negatively impact testosterone levels [5][7][8][9].
Symptoms of Low Testosterone
Low testosterone can cause a variety of symptoms that can impact an individual's quality of life. Some of the most common symptoms of low testosterone include:
- Decreased libido and sexual function: Low testosterone can lead to reduced sexual desire, difficulty achieving or maintaining an erection (erectile dysfunction), and decreased sexual satisfaction [14].
- Fatigue and decreased energy levels: Testosterone plays a role in regulating energy levels and muscle function. Low levels can cause feelings of fatigue, decreased energy, and a general lack of motivation or stamina [15].
- Decreased muscle mass and strength: Testosterone is essential for the development and maintenance of muscle mass. Low levels can lead to a decrease in muscle strength and tone, making it more difficult to build or maintain muscle mass [16].
- Increased body fat: Low testosterone can cause an increase in body fat, particularly around the abdomen, leading to a higher risk of obesity and related health conditions [3].
- Mood changes and depression: Low levels of testosterone have been associated with an increased risk of depression, irritability, and mood swings [17].
- Reduced bone density: Testosterone plays a role in maintaining bone health. Low levels can lead to a decrease in bone mineral density, increasing the risk of osteoporosis and fractures [18][19].
- Cognitive impairment: Some studies suggest that low testosterone may be linked to cognitive impairment, including difficulties with memory, concentration, and problem-solving [15].
- Sleep disturbances: Low testosterone has been associated with an increased risk of sleep apnea and other sleep-related disorders [20].
If you are experiencing any of these symptoms, see a healthcare provider for proper evaluation and treatment. By addressing low testosterone, you can potentially relieve these symptoms and improve your overall health and well-being.
Diagnostic Tests for Low Testosterone
Accurate diagnosis of low testosterone can ensure an effective treatment plan. Healthcare providers use a combination of diagnostic tests to assess testosterone levels and identify the underlying cause of the deficiency. Some of the primary diagnostic tests for low testosterone include:
- Serum testosterone test: This blood test measures the total amount of testosterone in the blood, including both free and bound testosterone. It is typically performed in the morning when testosterone levels are highest. A total testosterone level below 300 ng/dL (10.4 nmol/L) in men is generally considered low [21][22].
- Free testosterone test: This test measures the amount of unbound, or "free," testosterone in the blood, which is considered the biologically active form of the hormone. A free testosterone level below 8.5 ng/dL (0.295 nmol/L) in men is generally considered low [21][22].
- Bioavailable testosterone test: This test measures the amount of testosterone that is available for use by the body's cells, including both free testosterone and testosterone that is loosely bound to albumin. A bioavailable testosterone level below 150 ng/dL (5.2 nmol/L) in men is generally considered low [21][22].
- Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) tests: These tests measure the levels of LH and FSH, which are hormones produced by the pituitary gland that regulate testosterone production. Elevated LH and FSH levels may indicate primary hypogonadism, while normal or low levels may suggest secondary hypogonadism [23].
- Sex hormone-binding globulin (SHBG) test: This test measures the levels of SHBG, a protein that binds to testosterone and other sex hormones in the blood, making them less available for use by the body's cells. SHBG levels can be influenced by factors such as age, body weight, and certain medical conditions, and can affect the interpretation of testosterone test results [23].
Prescription Testosterone Replacement Therapy
Testosterone replacement therapy (TRT) restores normal testosterone levels in men with hypogonadism. The purpose of TRT is to relieve symptoms associated with low testosterone and improve overall health and quality of life. TRT is available in various forms, including:
- Intramuscular injections
- Transdermal gels and patches
- Buccal tablets
- Subcutaneous pellets
Your healthcare provider may monitor you to assess testosterone levels and potential markers of side effects such as prostate-specific antigen (PSA), hematocrit, and cholesterol levels. Dosages may be adjusted as needed to maintain effective testosterone levels and reduced risks [28][29].
Potential benefits of TRT include [29][30][31]:
- Improved sexual function
- Increased muscle mass and strength
- Enhanced bone density
- Reduced fatigue
- Improved mood and cognitive function
- Better metabolic health
However, TRT also carries potential risks and side effects, such as prostate enlargement, increased risk of prostate cancer and blood clots, sleep apnea, acne, gynecomastia, fluid retention, and decreased sperm production and fertility [^32][^33].
It's essential to discuss the potential benefits and risks with a healthcare professional to determine if TRT is an appropriate treatment option based on your symptoms, preferences, and risk factors.
Lifestyle and Dietary Interventions for Low Testosterone
In addition to medical treatments, lifestyle and dietary changes may help manage low testosterone. These can be used alone or along with testosterone replacement therapy to improve hormone levels and your symptoms.
Exercise
Regular physical activity has been shown to have a positive impact on testosterone levels. Both resistance training and aerobic exercise can increase testosterone production, with the greatest effects seen in younger individuals and those with lower baseline testosterone levels [39][40][41].
Weight Management
Maintaining a healthy body weight is important for testosterone levels. Excess body fat, particularly around the abdominal region, is associated with lower testosterone levels. Studies have found that a 10% reduction in body weight can lead to a 15% increase in testosterone levels [42][43].
Stress Management
Chronic stress can negatively impact testosterone production. Trying stress management strategies, such as meditation, yoga, or relaxation techniques, may help maintain healthy testosterone levels. A study involving 56 men with low testosterone levels found that a 12-week program of yoga and meditation resulted in higher testosterone levels [44].
Nutrient-Dense Foods
Eating a diet rich in specific nutrients that support testosterone production may help maintain healthy levels. Meta-analyses have shown that taking zinc and vitamin D can significantly increase testosterone levels, particularly in men with deficiencies [45][46][47]. Research also suggests that omega-3 fatty acids may have a positive impact on testosterone levels [48].
Conclusion
Low testosterone can significantly impact a person’s quality of life. While prescription TRT can be an effective treatment option for many men with hypogonadism, it is important to consider the potential benefits and risks, and to work closely with a healthcare provider to monitor treatment progress and adjust dosages as needed.
Lifestyle and dietary interventions, such as regular exercise, weight management, stress management, and nutrient-dense foods, can also play a role in optimizing testosterone levels. These interventions can be used alone or in combination with prescription TRT to achieve the best possible outcomes.
Citations:
- Harman, S. M., Metter, E. J., Tobin, J. D., Pearson, J., & Blackman, M. R. (2001). Longitudinal effects of aging on serum total and free testosterone levels in healthy men. The Journal of Clinical Endocrinology & Metabolism, 86(2), 724-731.
- Vermeulen, A. (1996). Decreased androgen levels and obesity in men. Annals of medicine, 28(1), 13-15.
- Grossmann, M. (2011). Low testosterone in men with type 2 diabetes: significance and treatment. The Journal of Clinical Endocrinology & Metabolism, 96(8), 2341-2353.
- Cumming, C. (2020). The impact of stress on testosterone production. Endocrine, 67(2), 246-247.
- Bhasin, S., Cunningham, G. R., Hayes, F. J., Matsumoto, A. M., Snyder, P. J., Swerdloff, R. S., & Montori, V. M. (2010). Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 95(6), 2536-2559.
- Nieschlag, E., & Behre, H. M. (Eds.). (2012). Testosterone: action, deficiency, substitution. Cambridge University Press.
- Shores, M. M., Matsumoto, A. M., Sloan, K. L., & Kivlahan, D. R. (2006). Low serum testosterone and mortality in male veterans. Archives of internal medicine, 166(15), 1660-1665.
- Pope Jr, H. G., & Katz, D. L. (1988). Affective and psychotic symptoms associated with anabolic steroid use. The American journal of psychiatry, 145(4), 487-490.
- Nieschlag, E., & Vorona, E. (2015). Mechanisms in Endocrinology: Medical consequences of doping with anabolic androgenic steroids: effects on reproductive functions. European Journal of Endocrinology, 173(2), R47-R58.
- Anand-Ivell, R., Heng, K., Antonio, L., Bartfai, G., Casanueva, F. F., Maggi, M., ... & Ivell, R. (2020). Insulin-like peptide 3 (INSL3) as an indicator of leydig cell insufficiency (LCI) in Middle-aged and older men with hypogonadism: reference range and threshold. European Journal of Endocrinology, 182(3), 333-343.
- Shah, S., Pepin, A., Jatar, S., Hsueh, J., Gallagher, L., Danner, M. T., ... & Collins, S. P. (2021). Bothersome Hot Flashes Following Neoadjuvant Androgen Deprivation Therapy and Stereotactic Body Radiotherapy for Localized Prostate Cancer. Advances in Radiation Oncology, 6(5), 100725.
- Crook, J., Moideen, N., Arbour, G., Castro, F., Araujo, C., Batchelar, D., ... & Cheng, J. C. (2022). A Randomized Trial Comparing Quality of Life After Low-Dose Rate or High-Dose Rate Prostate Brachytherapy Boost With Pelvic External Beam Radiation Therapy. International Journal of Radiation Oncology Biology Physics, 112(1), 140-151.
- de Vincentis, S., Greco, C., Fanelli, F., Decaroli, M. C., Diazzi, C., Mezzullo, M., ... & Rochira, V. (2020). Sarcopenic obesity and reduced BMD in young men living with HIV: body composition and sex steroids interplay. Endocrine, 67(3), 588-598.
- Yassin, A. A., & Almehmadi, Y. (2019). Testosterone Deficiency and Sexual Dysfunction. Urologia Internationalis, 103(3), 255-264. doi:10.1159/000501671
- Bhasin, S., Brito, J. P., Cunningham, G. R., Hayes, F. J., Hodis, H. N., Matsumoto, A. M., ... & Yialamas, M. A. (2018). Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 103(5), 1715-1744. doi:10.1210/jc.2018-00229
- Sinha-Hikim, I., Artaza, J., Woodhouse, L., Gonzalez-Cadavid, N., Singh, A. B., Lee, M. I., ... & Bhasin, S. (2002). Testosterone-induced increase in muscle size in healthy young men is associated with muscle fiber hypertrophy. American Journal of Physiology-Endocrinology and Metabolism, 283(1), E154-E164. doi:10.1152/ajpendo.00502.2001
- Zarrouf, F. A., Artz, S., Griffith, J., Sirbu, C., & Kommor, M. (2009). Testosterone and depression: systematic review and meta-analysis. Journal of Psychiatric Practice®, 15(4), 289-305. doi:10.1097/01.pra.0000358315.88931.fc
- Leifke, E., Körner, H. C., Link, T. M., Behre, H. M., Peters, P. E., & Nieschlag, E. (1998). Effects of testosterone replacement therapy on cortical and trabecular bone mineral density, vertebral body area, and paraspinal muscle area in hypogonadal men. European Journal of Endocrinology, 138(1), 51-58. doi:10.1530/eje.0.1380051
- Finkelstein, J. S., Lee, H., Leder, B. Z., Burnett-Bowie, S. A., Goldstein, D. W., Hahn, C. W., ... & Makarov, D. V. (2013). Gonadal steroid-dependent effects on bone turnover and bone mineral density in men with androgen deficiency. The Journal of Clinical Endocrinology & Metabolism, 98(2), 855-863. doi:10.1210/jc.2012-3582
- Andersen, M. L., & Tufik, S. (2008). The effects of testosterone on sleep and sleep-disordered breathing in men: its bidirectional interaction with erectile function. Sleep Medicine Reviews, 12(5), 365-379. doi:10.1016/j.smrv.2007.12.003
- Bhasin et al. (2010). J Clin Endocrinol Metab, 95(6), 2536-2559.
- Travison et al. (2007). J Clin Endocrinol Metab, 92(1), 196-202.
- Ohlsson et al. (2011). PLoS Genet, 7(10), e1002313.
- Drivelegka et al. (2019). Arthritis Res Ther, 21(1), 1-11.
- Caronia et al. (2013). Clin Endocrinol, 78(2), 291-296.
- Jern et al. (2013). Syst Biol Reprod Med, 59(6), 319-324.
- Zhang et al. (2010). J Hypertens, 28(2), 229-235.
- Travison, T. G., Vesper, H. W., Orwoll, E., Wu, F., Kaufman, J. M., Wang, Y., ... & Bhasin, S. (2017). The Journal of Clinical Endocrinology & Metabolism, 102(4), 1161-1173.
- Bhasin, S., Brito, J. P., Cunningham, G. R., Hayes, F. J., Hodis, H. N., Matsumoto, A. M., ... & Yialamas, M. A. (2018). The Journal of Clinical Endocrinology & Metabolism, 103(5), 1715-1744.
- Snyder, P. J., Bhasin, S., Cunningham, G. R., Matsumoto, A. M., Stephens-Shields, A. J., Cauley, J. A., ... & Swerdloff, R. S. (2016). New England Journal of Medicine, 374(7), 611-624.
- Bassil, N., Alkaade, S., & Morley, J. E. (2009). Therapeutics and clinical risk management, 5, 427.
- Haddad, R. M., Kennedy, C. C., Caples, S. M., Tracz, M. J., Boloña, E. R., Sideras, K., ... & Montori, V. M. (2007). Mayo Clinic Proceedings, 82(1), 29-39.
- Budoff, M. J., Ellenberg, S. S., Lewis, C. E., Mohler III, E. R., Wenger, N. K., Bhasin, S., ... & Endocrine Society. (2017). Jama, 317(7), 708-716.
- Xu, L., Freeman, G., Cowling, B. J., & Schooling, C. M. (2013). BMC medicine, 11(1), 1-9.
- Resnick, S. M., Matsumoto, A. M., Stephens-Shields, A. J., Ellenberg, S. S., Gill, T. M., Shumaker, S. A., ... & Bhasin, S. (2017). Jama, 317(7), 717-727.
- Wittert, G. (2014). Asian Journal of Andrology, 16(2), 262.
- Corona, G., Rastrelli, G., Monami, M., Saad, F., Luconi, M., Lucchese, M., ... & Maggi, M. (2013). European Journal of Endocrinology, 168(6), 829-843.
- Tan, R. S., & Pu, S. J. (2003). The Journal of urology, 170(3), 878-881.
- Issurin, V. B. (2019). Evidence-based prerequisites and precursors of athletic talent: a review. Sports Medicine, 49(10), 1551-1576.
- Leite, R. D., Prestes, J., Pereira, G. B., Shiguemoto, G. E., & Perez, S. E. (2009). Mendes, R. R., & Baldissera, V. (2009). Effects of 12 weeks of resistance training on neuromuscular junction morphology and agrin, utrophin, and rapsyn expression in rats. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine, 39(5), 655-663.
- Cao, Y., Zhang, S., Zou, S., & Shen, P. (2013). The relationship between circulating adiponectin and testosterone in males: a systematic review and meta-analysis of observational studies. Frontiers in Endocrinology, 4, 127.
- Khoo, J., Tian, H. H., Tan, B., Chew, K., Ng, C. S., Leong, D., ... & Chen, R. Y. (2013). Comparing effects of low-and high-volume moderate-intensity exercise on sexual function and testosterone in obese men. The Journal of Sexual Medicine, 10(7), 1823-1832.
- Tremblay, M. S., Copeland, J. L., & Van Helder, W. (2004). Effect of training status and exercise mode on endogenous steroid hormones in men. The Journal of Strength & Conditioning Research, 18(2), 412-417.
- Wittert, G. A., Chapman, I. M., Haren, M. T., Mackintosh, S., Coates, P., & Morley, J. E. (2003). Oral testosterone supplementation increases muscle and decreases fat mass in healthy elderly males with low-normal gonadal status. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 58(7), M618-M625.
- Prasad, A. S. (2008). Zinc in human health: effect of zinc on immune cells. Molecular Medicine, 14(5), 353-357.
- Pilz, S., Frisch, S., Koertke, H., Kuhn, J., Dreier, J., Obermayer-Pietsch, B., ... & Zittermann, A. (2011). Effect of vitamin D supplementation on testosterone levels in men. Hormone and Metabolic Research, 43(03), 223-225.
- Nimptsch, K., Platz, E. A., Willett, W. C., & Giovannucci, E. (2012). Association between plasma 25-OH vitamin D and testosterone levels in men. Clinical Endocrinology, 77(1), 106-112.
Was this article helpful?