"After age 30, most men begin to experience a gradual decline in testosterone," says David Samadi, MD, chairman of the urology department at Lenox Hill Hospital in nyc.
Although testosterone levels never reach zero (as estrogen levels do in women during menopause), low testosterone levels men to experience symptoms such as fatigue, low sex drive, and reduction of muscle mass.
While low testosterone is more prevalent in older men, it may occur in younger men also. Fortunately, every one of the causes of low testosterone in young guys are treatable, so if you encounter such symptoms at any given age, there is no reason to ignore it.
Causes of Low Testosterone in Younger Men
For younger guys, a drop in testosterone levels can be caused by some illnesses, including type 2 diabetes, chronic liver or kidney disease, COPD or other lung disease, or pituitary gland problems, based on Dr. Samadi.
Genetic causes of low testosterone in men include the diseases Klinefelter syndrome, Kallmann syndrome, Prader-Willi syndrome, and Myotonic dystrophy. Another disorder which can cause low testosterone is hemochromatosis, making the body shop too much iron.
"Low testosterone can also result when something happens, like trauma or steroid use, that prevents the testes from making the hormone," states Bruce Gilbert, MD, PhD, an adjunct clinical professor of urology and reproductive medicine at Weill Cornell Medical College and director of reproductive and reproductive medicine at the Smith Institute for Urology of their North Shore-LIJ Health System.
Additional causes of low testosterone in men younger than 50 include pituitary gland tumors, HIV infection, and radiation treatment or chemotherapy for cancer.
Doctors categorize causes of low testosterone as primary or secondary.
"Primary hypogonadism stems from a problem in the testicles," Samadi says. In secondary hypogonadism, the testicles are normal but function improperly because of a problem with the hypothalamus or pituitary gland."
Is It Low Testosterone?
Irrespective of the cause, low testosterone symptoms are the same.
"Symptoms include low libido, erectile dysfunction, fatigue, decreased mental acuity, and moodiness," Dr. Gilbert states.
Not everyone with low testosterone needs treatment. "When it comes to treating low testosterone in older men, we usually reserve treatment for people who have symptoms, such as fatigue and reduced libido," Gilbert says.
In men who don't make the hormone in their testes because of a condition such as Klinefelter syndrome, or those who have lost their testes because of cancer, the only option is testosterone replacement therapy. Such testosterone supplements come in the form of a gel, injections, patches, long-acting pellets, or oral inserts.
In these circumstances,"treatments are often used just in the short term, and if a physician has close observation and knowledge of the individual," Gilbert says.
An important consideration for younger men before getting treatment is fertility. "You don't wish to offer supplemental testosterone to guys who want to be fertile since it can turn off sperm production," Gilbert says.
Once a young man goes off testosterone supplementation, there's a chance his sperm count will never return to what it was before he started. "Therefore, men of reproductive age should consider alternatives which may increase their testosterone as well as preserve their semen production," he states. One such alternative is a class of drugs called selective estrogen receptor modulators (SERMs).
Other treatments for low testosterone include weight loss and other lifestyle changes, such as eating healthy and increasing exercise.
The bottom line, however, is that in the event that you have low testosterone symptoms, then it is very important to see your doctor. Then, your doctor can rule out potentially more significant causes of your symptoms, such as hypertension or a thyroid problem, and offer treatment that could enhance your energy and quality of life.