Low Testosterone in Men: Signs, Causes, Consequences

When a man has low levels of testosterone in his bloodstream, his androgen receptors sit idle, unable to perform their functions. The resulting changes can alter his motivation, drive, appearance, health, brain functions, sexual performance, and emotional state. In this review of low testosterone in men, we look at the signs and possible causes of Low T, as well as what consequences can occur at different ages and stages of life.

Low T is not pleasant. A man who suffers from this condition may not even know why he feels depressed, has no sexual appetite, or cannot seem to focus. His body may be turning flabby due to muscle loss and weight gain. Achy joints and a lack of interest in activities he once enjoyed may alter his social life, causing him to retreat into himself and his home. His relationships with those he loves, as well as his friends and colleagues, may suffer.

As we look at the reasons for male testosterone decline, we also focus on what changes may occur at each stage of life. The goal of this review is to help you understand low testosterone in men, and what you can do to improve your testosterone levels.

Male Adolescents and Low Testosterone

Puberty is a time when hormonal changes go into full drive, helping young men develop both physically and sexually. Testosterone and growth hormone levels increase significantly. It is also no surprise that these two hormones help influence one another, as well as stimulate the process known as spermatogenesis (sperm cell maturation).

Long before a diagnosis of low testosterone in men, young boys may discover their testes are not producing enough testosterone to fuel this growth and development. Signs of prepubescent hypogonadism include:

• High pitched voice
• Minimal body hair
• Underdeveloped muscles
• Slow or impaired sexual development (testes, phallus, prostate gland)
• Gynecomastia (excess breast tissue)
• Slower height growth

Some boys may exhibit elongated legs and arms due to their growth plate not closing. Many young males will receive their diagnosis before turning 13, as doctors can detect these signs during a physical examination between the ages of 10 and 12.

Causes of low testosterone during childhood and adolescence include:

• Klinefelter syndrome – a genetic condition causing an extra X chromosome
• Noonan syndrome – a genetic disorder that affects many areas of the body
• Kallmann syndrome – abnormal hypothalamus development
• Head or genital injuries
• A tumor in the hypothalamus, pituitary gland, or testes
• Certain types of infections

An absence of these causes may just mean that a boy is developing slower than his peers. A “wait and see” approach may result in a normal catching up over time. Some males may benefit from small doses of testosterone cypionate, injected for 6 to 12 months to help jumpstart their development. Doctors tend to proceed with caution to protect growth from cessation as too much testosterone can lead to growth plate fusion.

Young Males Under 20: Low T Causes and Effects

In the previous section, we looked at what causes low testosterone in adolescent boys. The signs of Low T at that age are often easy to overlook. However, when a young man enters his teenage years, it becomes apparent to both him and others that his development is delayed.

At this time, it is imperative to test blood levels of not only testosterone but other hormones, as well, to try and locate the source of the developmental delay. The doctor may also order a CT or MRI scan of the brain to check for tumors. A check for testicular tumors is also essential, as that can hinder testosterone production.

Some young men participate in sports, and over-training or certain illegal medications used to increase performance may also hinder testosterone secretion. Obesity is another cause of low testosterone in men of all ages, including the teenage years.

Teenagers with Low T will develop slower than their peers. Body and facial hair may not grow in until closer to their twenties. Low testosterone levels can lead to depression in young men who may find themselves subject to ridicule or feelings of inadequacy. It is essential to contact an endocrinologist for young males who may have low testosterone levels.

Older Men and Low Testosterone Levels

For most males, testosterone levels peak during the teenage years, leveling off in the early twenties, and then starting a slow decrease of about one percent each year by the mid to late-twenties. Some men may experience as much as a two percent reduction each year. While that may not seem like much, after ten years, a man could have twenty percent less testosterone in his bloodstream.

Low testosterone in men can have many symptoms, causes, and consequences – some of which are age-influenced, as shown below:

Over 20 Under 30

• Symptoms – the most common symptoms of Low T in men in their twenties are enlarged breasts, decreased libido, fewer spontaneous erections, infertility, rapid hair loss, trouble sleeping, fatigue, depression, brain fog, weight gain, and muscle loss.
• Causes – other than previously mentioned reasons for Low T, males in their twenties may experience these symptoms due to obesity, high blood pressure or cholesterol levels, diabetes, HIV/AIDS, liver or kidney disease, excessive alcohol consumption, illegal drug or anabolic steroid use, or opiate addiction. Radiation or chemotherapy for cancer treatment can also impact testosterone production.
• Consequences – erectile dysfunction, low libido, and infertility are some of the biggest concerns for men in this age group. Impaired brain functions resulting in lack of drive, poor focus, forgetfulness, and decreased productivity can hinder a man’s climb up the corporate ladder. Even worse, ignoring the signs of Low T at such a young age can cause significant health problems in the future.

Over 30 Under 40

• Symptoms – at this stage of life, a man is busy building his career and family. Cognitive impairments that occur because the androgen receptors in the brain do not receive enough testosterone can lead to workplace mistakes. Loss of work and income is a concern that increases stress for many males with Low T. A decline in libido and erectile functions can put pressure on a relationship. Because testosterone influences sperm cell maturation, many males with Low T will find themselves dealing with infertility. Lack of sleep and fatigue impact all areas of a man’s life.
• Causes – the causes of Low T at this stage include all those we have already discussed. However, now is also the time that the natural aging process can hinder testosterone levels. If a man does not get at least seven hours of sleep and proper physical activity (exercise) at least three times a week, his testosterone levels may decline at a faster rate. Abdominal obesity further lowers testosterone levels as belly fat increases the enzyme aromatase, which converts testosterone into estradiol (estrogen).
• Consequences – infertility is a significant issue for men with low testosterone in their thirties. Fertility treatments can cost tens of thousands of dollars for a couple trying to conceive. Problems on the job due to mistakes caused by poor focus, forgetfulness, or cognitive impairment may impact employment and home life. Because testosterone helps to maintain proper metabolic functions, as well as bone and muscle mass, the body may undergo changes that can lead to osteoporosis, obesity, type 2 diabetes, cardiovascular disease, and other health concerns.

Over 40 Under 50

• Symptoms – the forties are a time when some males are starting to notice physical changes associated with low testosterone, such as muscle loss, thinning hair, loss of the morning erection, fewer spontaneous erections, and weight gain. Depression is common as a male begins to lament the passing of his youth.
• Causes – increased stress, reduced sleep, poor dietary choices, and lack of exercise all contribute to declining testosterone levels at this stage of life. Of course, all the issues previously mentioned are also possible, making it imperative for a man to seek professional help if he notices the signs of Low T.
• Consequences – since many males are still building their families and furthering their careers at this time, both areas can suffer if low testosterone in men is ignored or undiagnosed.

Over 50 Under 60

• Symptoms – at this stage of life, men start to experience changes in libido and sexual performance. Erectile dysfunction, urinary tract issues, and prostate growth are possible. Many males experience changes in mood, anxiety, stress, and depression. Fatigue, insomnia, weight gain, and joint pains make it difficult to engage in physical activities.
• Causes – although all previously mentioned causes are still possible, aging is a primary reason why many men in their fifties experience Low T. Because of these changes, many males also turn to substance abuse, such as consuming too much alcohol, that can hinder testosterone production.
• Consequences – ignoring the signs of Low T at this time can lead to loss of employment, relationships, and severe depression. The risk of developing cardiovascular disease, high blood pressure, atherosclerosis, type 2 diabetes, and dementia increases exponentially.

Over 60

• Symptoms – in addition to the previously mentioned symptoms, elderly men over sixty years of age may find themselves at an increased risk of developing potentially life-threatening bone fractures. Dementia risk also increases, and forgetfulness must be addressed with blood testing for low testosterone levels.
• Causes – brain or testicular tumors, aging, weight gain, lack of exercise, stress, not enough sleep, and poor lifestyle habits are the leading causes of Low T in men over sixty.
• Consequences – the most significant issues at this stage of life are those that can take away a man’s independence and well-being. Osteoporosis, cardiovascular disease, and dementia are serious concerns.

Concerns Over the Effects of Low T in Men

Why does low testosterone in men result in decreased sperm count?

An absence of mature sperm cells, also called azoospermia, is because testosterone is necessary for spermatogenesis. Although it is follicle-stimulating hormone (FSH) that promotes sperm cell development, it is testosterone that plays a leading role in the maturation process. Low levels of testicular testosterone will inhibit sperm cell maturation, decreasing a man’s overall sperm count and often resulting in infertility.

Is low testosterone the cause of erectile dysfunction?

No, low testosterone is not a direct cause of ED for most men. Erectile dysfunction has many reasons, including poor blood circulation to the genitals and hardening of the arteries (atherosclerosis). However, low testosterone indirectly may contribute to ED because testosterone stimulates red blood cell production necessary for healthy circulation. Testosterone also helps keep cholesterol levels in balance to reduce plaque build-up in the arteries. That is why some men do experience relief from ED with testosterone therapy.

Does low testosterone or testosterone therapy cause prostate cancer?

Research has shown no connection between low testosterone or testosterone therapy and prostate cancer. However, prostate enlargement does increase as testosterone levels decrease, so testosterone may have protective benefits over prostate size. Many males have experienced PSA improvement from testosterone therapy.

Will a vasectomy cause low testosterone?

No, having a vasectomy has no impact on testosterone production. The only thing the vasectomy does is inhibit the movement of mature spermatozoa into the vas deferens.

Does low testosterone affect ejaculation (premature and delayed)?

Low testosterone levels can influence a man’s ejaculation. Premature ejaculation causes include psychological issues, serotonin levels, penile sensitivity, erectile dysfunction, prostate problems, low testosterone, or elevated thyroid hormone levels. Delayed ejaculation may be due to nerve damage, hormonal imbalance (testosterone, prolactin, or serotonin), or antidepressant use.

Is it true that low testosterone can result in baldness?

Male pattern baldness is often influenced by high levels of dihydrotestosterone (DHT). The enzyme 5-alpha reductase converts some of the body’s free testosterone into DHT. If DHT levels get too high, they can affect the hair follicles. If the follicles are sensitive to DHT, it can trigger hair loss.

Is there a connection between low testosterone and impotence?

Impotence, or erectile dysfunction, has many causes. Testosterone is necessary for the stimulation of sexual desire in the brain. Because testosterone also helps increase red blood cell levels, it can help improve circulation to the penis for better erectile functions.

Does low testosterone cause testicular pain?

Most males experience some form of testicular pain at some time in their lives. Even kidney stones can cause pain in the testes as the stones pass on their way out of the body. Low testosterone is not a typical cause of testicular pain. If pain is ongoing, it is essential to see a doctor for a thorough examination to rule out testicular tumors, torsion, hernias, cysts, infections, and inflammation that could be causing the pain.

Does low testosterone affect testicular size?

Yes, men with low testosterone may notice testicular shrinkage or atrophy. It is also essential to note that using testosterone in high doses can interfere with natural testosterone production, which can also lead to smaller testicles.

Does low testosterone cause frequent urination?

Nocturia, the frequent waking at night to urinate, is often associated with low testosterone in men. Prostate enlargement, which occurs at the same time as testosterone levels decline, is one cause of frequent urinary need. Decreased bladder capacity, metabolic syndrome, diabetes, weight gain, sleep disorders, cardiovascular problems, and hypertension, all associated with Low T, can increase urinary frequency.

Doctors and Treatment of Low Testosterone in Men

Treatment of low testosterone in men is crucial to ensuring the best chance at a healthy and active future. Men with Low T have an increased risk of developing potentially debilitating medical conditions such as cardiovascular disease, osteoporosis, type 2 diabetes, dementia, and obesity. By getting a diagnosis and learning how to treat low testosterone, a man can improve his quality of life and well-being.

For younger men dealing with the early stages of low testosterone, it is best to act naturally, focusing on lifestyle changes that can improve testosterone production. These strategies include:

• Getting between seven and nine hours of sleep each night for optimum testosterone production
• Decreasing stress to lower cortisol levels which inhibit sleep and testosterone release
• Losing weight if one is overweight
• Eating testosterone-boosting foods such as oysters, grassfed red meat, spinach, garlic, eggs, tuna, and beans
• Engaging in the right types of exercise, such as high-intensity interval training (30 minutes maximum) and resistance training – avoid long periods of cardio exercise as that can lower testosterone levels

For those diagnosed with low testosterone in men, testosterone replacement therapy is the best option. The doctors here at our hormone clinic recommend testosterone cypionate injections for the following reasons:

• Best absorption into the bloodstream
• Fastest results
• Lowest cost
• Least risk of side effects
• Decreased cross-contamination risk to others

For additional information about low testosterone in men, please contact our clinic for a free consultation.