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Testosterone, long considered the primary male sex hormone, is just as essential for female well-being. Men and women with low testosterone levels often report a lack of sexual desire, fatigue, weight gain, bone and muscle loss, and impaired mental abilities. Forgetfulness, depression, and even thinning hair are warning signs that testosterone production may be on the downslide. In this essential review, we cover what you need to know about Low T, including where your testosterone levels should be for optimum health, the causes of the potential decline, and symptoms to know that can lead to an early diagnosis and treatment.
For people asking how to tell if you have low testosterone, do I have the symptoms of Low T is a common question and one that we will answer in the next section.
Is an endocrinologist or urologist or gynecologist the best option to contact, or can a primary care physician diagnose and treat low testosterone?
Whenever a problem exists with any hormone levels in the body, it is imperative to turn to a specialist who has the knowledge and experience in the field of hormone replacement for adults. In most instances, this will be an endocrinologist as endocrinology is the study of the endocrine system – where most hormones are made.
Although some urologists and gynecologists have a general understanding of certain hormones, the treatment of low testosterone is best left to endocrine specialists. There is more to increasing testosterone levels than just providing some form of testosterone medication. Once testosterone levels increase, they can lead to changes in other hormone levels, including estrogen, dihydrotestosterone (DHT), growth hormone, cortisol, ghrelin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), insulin growth factor 1 (IGF-1), insulin, and more. Some of these changes are directly affected by testosterone; others occur indirectly, such as:
- Conversion of testosterone into estradiol (estrogen)
- Conversion of testosterone into DHT
- Telling the hypothalamus that testosterone levels are low which results in LH and FSH release
- Cortisol promoting ghrelin release and inhibiting growth hormone production (cortisol levels increase as testosterone levels decrease – they are antagonistic of one another)
- Growth hormone stimulating IGF-1 secretion (testosterone helps stimulate the hypothalamus which increases GH release from the pituitary gland)
That is why hormonal balancing is best left to a hormone replacement therapy (HRT) specialist.
Low testosterone (Low T) can affect men and women and maintaining testosterone hormone balance is crucial for a healthy body and mind.
The Definition and Role of Testosterone in the Human’s Body
Testosterone is a fat-soluble androgen (steroid) hormone produced primarily in the male gonads (Leydig cells in the testes) and the female ovaries. The adrenal glands supply a small amount of testosterone (the primary source once a woman reaches menopause).
Testosterone fulfills many roles in the adult body, including:
- maintaining strong muscles and bones
- the formation of new red blood cells
- regulating metabolism
- promoting healthy hair growth
- stimulating crucial brain functions
- providing sleep support
- reducing cortisol (stress hormone) levels
- increasing spermatogenesis (sperm cell maturation)
- improving ovarian follicle sensitivity (helps female fertility)
- balancing emotions
- stimulating libido and supporting sexual functions
These roles require an adequate supply of testosterone each day to ensure their healthy functions.
What does low testosterone mean for men and women?
When an adult has low testosterone levels, he or she may find problems occurring in any of the areas mentioned above. The lists below show the most common early warning signs of Low T for men and women:
Male’s low testosterone signs:
- low libido
- muscle loss
- erectile dysfunction
- hair loss/balding
- joint pains
- weight gain
- decreased drive
Female’s low testosterone signs:
- mood swings
- low sex drive
- vaginal dryness
- weight gain
- forgetfulness/brain fog
- hot flashes
- night sweats
- muscle loss
- thinning hair
It can be dangerous to let low testosterone go undiagnosed and untreated. People with Low T have a higher risk of developing the following health conditions:
- high blood pressure
- cardiovascular disease
- type 2 diabetes
- metabolic syndrome
- high LDL and total cholesterol
- osteopenia and osteoporosis
Left untreated, low testosterone can increase the risk of more dangerous health conditions.
Normal Levels of Testosterone in Men and Women
According to the American Urological Association, men with a total testosterone level lower than 300 ng/dL may have low testosterone. However, one number does not tell the entire story of hormonal deficiency, especially with Low T.
Testosterone levels can differ considerably based on the lab running the tests. The charts below highlight these differences with some of the most renowned labs.
LabCorp Total Testosterone:
- Total Testosterone Levels in Males Over Age 18: 264.0 – 916.0 ng/dL
- Premenopausal Women Total Testosterone Levels: 10.0 – 55.0 ng/dL
- Postmenopausal Women Total Testosterone Levels: 7.0 – 40.0 ng/dL
LabCorp Free Testosterone:
- Females Over Age 19: 0.0 – 4.2 pg/mL
- Males Age 30 – 39: 8.7 – 25.1 pg/mL
- Males Age 40 – 49: 6.8 – 21.5 pg/mL
- Men Age 50 – 59: 7.2 – 24.0 pg/mL
- Males Over Age 59: 6.6 – 18.1 pg/mL
Mayo Clinic Total Testosterone:
- Total Testosterone Levels in Males Over Age 18: 240.0 – 950.0 ng/dL
- Total Testosterone Levels in Females Over Age 18: 8.0 –60.0 ng/dL
Mayo Clinic Free Testosterone Chart By Age: Measured in ng/dL, not pg/mL
The following charts detail the reference ranges for total testosterone based on four cohort studies in the US and Europe, as reported in January 10, 2017, Journal of Clinical Endocrinology & Metabolism. These charts also show how levels are lower when obese men are added to the study.
Total Testosterone Levels and Percentile in Non-Obese Men by Age
|19 to 39||40 to 49||50 to 59||60 to 69||70 to 79||
80 to 89
Total Testosterone Levels and Percentile in All Men by Age
|19 to 39||40 to 49||50 to 59||60 to 69||70 to 79||
80 to 89
While the Mayo Clinic recommends female testosterone levels in the normal range of 20 to 75 ng/dL, the National Institutes of Health suggest 30 to 95 ng/dL. Low testosterone levels in females typically fall under 25/ng/dL for those under fifty, and less than 20 ng/dL for those women over fifty years of age.
The optimum total testosterone range for men is between 550 and 650 ng/dL.
It takes more than blood tests to diagnose low testosterone – symptoms play a significant role in determining who can benefit from testosterone therapy.
Common Symptoms of Low Testosterone
We have already addressed some of the most common symptoms of low testosterone, such as fatigue, weight gain, muscle and bone loss, and low libido. Infertility, depression, thinning hair, brain fog, and lack of motivation are likely.
How does low testosterone cause so many different symptoms?
Androgen receptors that require testosterone for their activation can be found on tissues throughout the brain and body. Depending on which receptor cells receive the least testosterone, those are the areas that will be hit the hardest by any decline.
That is also why two people can have the same low testosterone levels yet very different symptoms. It all depends on where any current supply of testosterone goes. If the androgen receptors do not receive testosterone, they sit inactivated – unable to perform their functions.
HGH replacement therapy is contraindicated in only a few instances but provides many benefits at reducing other, more severe health issues.
FAQ About Concerns Related to Low T in Adults
Can low testosterone cause problems with health in adults? Are there conditions or situations that can impact your testosterone levels? We answer common questions below:
Can low testosterone cause dizziness?
Because testosterone plays a vital role in red blood cell production, some people with Low T become anemic. Anemia can cause dizziness, as well as sleep issues, leg cramps, poor focus, and abnormal and rapid heart rate.
Does low testosterone cause tiredness?
Fatigue is a common issue for many people with low testosterone. As testosterone levels decline, the body begins to experience internal stress, which increases the release of cortisol into the bloodstream. Cortisol opposes testosterone, keeping its levels low while making it hard to fall asleep at night. Lack of sleep decreases the amount of testosterone reduced into the bloodstream. That can lead to increased tiredness and lack of energy during the day. Since testosterone also helps regulate metabolism and insulin sensitivity, weight gain and poor glucose uptake by the cells further reduce energy levels.
Could my brain fog be due to low testosterone?
The brain contains an abundant supply of androgen receptors that require adequate levels of testosterone during the day. Without enough testosterone, these receptor cells sit unengaged. The corresponding brain functions, including learning, processing, and memory recall, suffer. That is why many people with low testosterone complain about brain fog and forgetfulness.
Is my irritability due to low testosterone?
Testosterone plays a crucial role in balancing emotional well-being. Many people with low testosterone report feelings of irritability, sadness, and dissatisfaction in their lives.
Could my depression be linked to low testosterone levels?
Low testosterone has long been associated with depression, anxiety, mood swings, and irritability. Receptor cells in the brain that are responsible for regulating mood and emotional well-being do not receive enough of a supply of testosterone, causing them to decrease their feel-good functions. Long before the invention of antidepressants, testosterone therapy was the primary treatment for depression. Today, many hormone doctors are looking at hormone deficiency as a cause of depression.
Does low testosterone increase anxiety and stress, and does stress lower testosterone levels?
Low testosterone and stress tend to feed off one another – causing a vicious cycle that goes round and round until one or both are appropriately dealt with to end the chain reaction. As testosterone levels decline, cortisol (stress hormone) levels rise. The more cortisol that is in the bloodstream, the more agitated and stressed a person would likely feel. Since cortisol inhibits testosterone levels, that further causes a decrease in testosterone production.
Does low testosterone have anything to do with anger or hostility?
Some people, men especially, may feel anger or hostility when they have low testosterone levels. Mood changes often occur when a person suffers from hormonal imbalance.
Can low T cause mental confusion and forgetfulness?
Mental confusion and experiencing bouts of forgetfulness can be scary. Trying to remember why you entered a room, where your phone or keys are, or if you have taken your daily medicine can all be signs of having too much on your mind or be due to low testosterone. The brain requires a plentiful supply of testosterone each day to ensure sharp memory and focus.
Is shortness of breath linked to low testosterone levels?
In studies of men with low testosterone and sleep apnea, it is possible to stop breathing during sleep. Another issue involving shortness of breath in conjunction with Low T is COPD. People with COPD often require steroid medications, which can lower testosterone levels.
Are sleep disorders such as sleep apnea linked to low testosterone?
Sleep problems such as sleep apnea tend to increase in people who are overweight. Low testosterone is often linked to weight gain and obesity. Although some people may exhibit a worsening of their sleep apnea at the start of testosterone therapy, the weight loss that occurs with testosterone treatment often helps reduce these issues.
Does low testosterone cause my nightly insomnia?
Many people with low testosterone have insomnia due to the increase in cortisol levels. Cortisol keeps the body and the mind in a state of high alert – fight or flight mode – making it hard to unwind, relax, and drift off to sleep. Increasing testosterone levels helps reduce cortisol and improves sleep quality and duration.
Can low testosterone cause changes in eyesight?
Hormonal changes, such as low testosterone, can lead to changes in eyesight. It is natural for vision to change with age. However, if the change is rapid or drastic, it is imperative to see an eye doctor. Getting a comprehensive hormone blood test is also recommended for people who notice changes in their eyesight as they age.
Does low testosterone cause excessive sweating?
Men with low testosterone are just as likely to experience night sweats and hot flashes, just like menopausal women. Excessive alcohol consumption can also lead to night sweats.
How does low T affect my cholesterol levels?
Although there are contradictory studies, it does appear that low testosterone influences cholesterol and triglyceride levels. Elevated LDL and total cholesterol are associated with an increased risk of cardiovascular incidents. Adults with cardiovascular disease also have a higher risk of receiving a low testosterone diagnosis.
Does low testosterone cause high blood pressure?
Both high and low testosterone can influence blood pressure levels. Because low testosterone is also linked to high cholesterol, atherosclerosis (hardening of the arteries), anemia, and cardiovascular risks, it can also cause an increase in blood pressure levels.
Is there a connection between low testosterone and high blood sugar?
Testosterone helps increase insulin sensitivity in the body’s tissues. That allows the cells to take in more of the circulating glucose. When a person has low testosterone, they may become insulin resistant, causing a spike in blood sugar levels that can lead to type 2 diabetes.
Does low testosterone increase belly fat?
Weight gain is a well-known effect of low testosterone. Not only does testosterone help influence how well the body metabolizes the food it takes in for energy, but it also promotes the use of that converted glucose by the cells and tissues. The other aspect of this question has to do with how belly fat produces an enzyme called aromatase the has the function of converting free testosterone into estradiol (estrogen). Estrogens force the body to retain fat, further worsening weight gain and decreasing testosterone levels.
Does low testosterone affect the immune system?
Testosterone’s role for immunity is more indirect as it helps boost growth hormone production. Growth hormone stimulates both the thymus and cellular regeneration, crucial to providing the body with the white blood cells that fight infection. In that way, low testosterone can hinder growth hormone’s effects on the immune system. On the other side, high testosterone levels have been shown to inhibit and weaken immunity, making it imperative to keep hormone levels in proper balance.
What role does testosterone play in metabolism?
Testosterone is crucial for the proper metabolism of fat, protein, and carbohydrates. At the molecular levels, testosterone helps control the expression of regulatory proteins necessary for glycogen synthesis, glycolysis, and cholesterol and lipid metabolism.
Conditions & Deseases
How is low testosterone linked to diabetes?
Low testosterone interferes with insulin sensitivity, often causing the cells to become resistant to the effects of insulin. That inhibits their ability to take in the circulating glucose molecules. The result is a build-up of blood sugar that can lead to metabolic syndrome and type 2 diabetes.
Can low testosterone cause diarrhea?
Although low testosterone causes many symptoms in adults, diarrhea is not one we often hear. Some people may experience a problem of that nature as a rare side effect of treatment, but even that is extremely infrequent.
Is there a link between low testosterone and cancer?
There are no direct links between high or low testosterone and cancer. However, it is well-known that prostate size and prostate cancer risk increase with age – the same time that testosterone levels decline. Some researchers believe that testosterone may have beneficial and protective effects for the prostate.
Is it true that low testosterone increases cardiovascular disease risk?
Low testosterone has frequently been reported as an increased risk factor for cardiovascular disease. Testosterone helps to improve red blood cell production, resulting in better circulation. Other CVD risk factors such as metabolic syndrome, high blood pressure, diabetes, and high cholesterol are often associated with low testosterone.
Does low testosterone increase the risk of having a heart attack?
The connection between heart attacks and low testosterone exists, in part, because of the cholesterol build-up that can occur in the arteries due to elevated LDL cholesterol. As plaque adheres to the arterial walls, it can inhibit proper circulation. If a piece of plaque breaks free, it can move through the body and reach the heart, causing a blockage that can result in a heart attack. If the plaque moves to the brain and blocks blood flow there, it can cause a stroke.
Is it true that low testosterone can affect my fertility?
Infertility is a problem for many people with low testosterone. Men need testicular testosterone (not supplemental) to promote sperm cell maturation. Women need testosterone to make the ovarian follicles more sensitive to stimulating hormones.
Do low testosterone levels always lead to low libido?
Low testosterone does not always influence sexual desire and functions. Some people do not realize they have Low T because their bedroom performance has not changed. However, since testosterone is the primary sex hormone (also for women), its decline often does result in decreased libido.