- What Is Low Testosterone?
- Testosterone Levels in Men and Women
- Low Testosterone Testing
- Testosterone Deficiency (Low T) in Men
- Testosterone Deficiency (Low T) in Women
- What to Do If “I Have Low Testosterone” ?
- Is Low T a Hereditary Problem?
- Low Testosterone Studies and Research
Testosterone deficiency is a condition under continuous scrutiny and research. Doctors have been prescribing treatment with testosterone therapy to treat low testosterone and even depression for over 70 years. During that time, much has changed regarding the guidelines for treatment.
Until the invention of antidepressants, testosterone was the treatment of choice to treat people with depression. Today, doctors are once again turning to testosterone therapy to help people who get no response from antidepressant therapy. Hormone specialists, on the other hand, immediately check hormone levels when depression is one of the symptoms reported by the patient.is often responsible for changes in mood, emotional state, anxiety, and stress.
In this report, we will discuss the current standard in low testosterone guidelines, including the following:
|Definition of Low Testosterone|
|Testosterone Levels Charts for Men and Women|
|Low Testosterone Testing|
|Causes, Symptoms, and Treatment of Low T for Men|
|Causes, Symptoms, and Treatment of Low T for Women|
|What to Do If You Have Low Testosterone|
|Is Low T a Hereditary Issue?|
|The Latest Research|
|Final Word on Low Testosterone|
Doctors have treated low testosterone for over 70 years!
What Is Low Testosterone?
Low T goes by many names: low testosterone, testosterone deficiency syndrome (TD), andropause, androgen deficiency (AD), or hypogonadism. Essentially, they all mean the same – the body is deficient in the hormone testosterone.
A further explanation of the low testosterone definition is that the word deficiency signifies a shortage in a required substance – in this instance, it is the hormone testosterone. A syndrome groups together symptoms related to a particular health condition. For that reason, testosterone deficiency syndrome signifies a group of symptoms associated with low levels of the hormone testosterone.
As the level of testosterone in the body declines, it can impact other hormones, such as estrogen, dihydrotestosterone (DHT), and human growth hormone (HGH).
Adults with Low T are also at an increased risk of receiving a diagnosis of any of the following health conditions:
- Cardiovascular disease
- Type 2 diabetes
- High blood pressure
- Sleep apnea
- Elevated cholesterol and triglyceride levels
Low testosterone occurs when the body does not produce enough testosterone for its needs, causing the onset of specific symptoms.
Testosterone Levels in Men and Women
Recent guidelines from the American Urology Association list low testosterone levels as being less than 300 ng/dL (nanograms per deciliter). According to the 2018 Endocrine Society Clinical Practice Guideline, the CDC standard for the lower limit of total testosterone is 264 ng/dL, and that should be used to check for low testosterone in CDC certified labs. Non-CDC certified labs have their own reference ranges that may vary. Ultimately, it is up to the doctor to review both the findings from a physical examination along with the blood test results and the symptoms presented by the individual to determine Low T.
There are certain total testosterone levels that present warning flags for possible tumors. For men, having a reading below 150 ng/dL could mean a potential hypothalamic or pituitary tumor. In women, a level greater than 200 ng/dL is the warning sign.
The latest guidelines provided for the treatment of low testosterone in women are from 2014 and do not consider more recent studies. It is up to the hormone specialist to determine if a woman can benefit from treatment for Low T.
The chart below shows the normal range of total and free testosterone levels in males beginning at age 30. We have also included an average range for each age group. Hormone specialists consider 500 to 650 ng/dL to be the ideal range for men of all ages for optimal performance. That is what we strive to reach when prescribing testosterone therapy.
|Age Years||Total Testosterone Normal Range||Average Total Testosterone||Free Testosterone Normal Range|
|30 – 40||219 – 1009 ng/dL||600 – 675 ng/dL||8.7 – 25.1 pg/mL|
|40 – 50||201 – 993 ng/dL||500 – 550 ng/dL||6.8 – 21.5 pg/mL|
|50 – 60||170 – 918 ng/dL||400 – 450 ng/dL||7.2 – 24.0 pg/mL|
|Over 60||156 – 700 ng/dL||300 – 350 ng/dL||6.6 – 18.1 pg/mL|
Women have much lower levels of testosterone in their bloodstream. For that reason, it is not necessary to break down the numbers by age.
- Total testosterone levels: 15 – 70 ng/dL (over 60 the average is 35 ng/dL)
- Free testosterone levels: 0.3 – 1.9 ng/dL
An average total testosterone level of 500 to 650 ng/dL is ideal for males.
Low Testosterone Testing
Guidelines for the diagnosis of low testosterone are just that – merely guidelines. It is up to the individual health care provider to use independent judgment for each patient’s circumstances.
Our well-established guidelines for the diagnosis of testosterone deficiency include a low testosterone test that consists of checking a minimum of the following blood panels in males:
- Total Testosterone
- Free T4 (Direct)
Optional panels depending on symptoms may also include:
- Free Testosterone
We recommend the full, comprehensive lab work-up to ensure the most accurate assessment of hormone levels.
For women, the low testosterone blood test includes:
- Total Testosterone
- Free Testosterone
- Free T4 (Direct)
Optional panels for women include:
These blood tests allow the hormone specialist the ability to check blood count, cholesterol levels, thyroid hormone production, and a variety of hormone levels for an accurate diagnosis. Together with the physical examination and review of the patient’s health history, the doctor can determine the appropriate treatment.
The testosterone deficiency diagnosis requires blood testing, examination, and a review of the patient’s medical history and symptoms.
Testosterone Deficiency (Low T) in Men
Male testosterone levels decline with age. By the time most men reach age thirty, they are already losing one to two percent of their testosterone production each year. That number may seem low, but it adds up as the years’ pass. The signs of low testosterone in men over 30 are often age-specific. We do not expect to see the severe symptoms of the decline until ten or twenty years down the road. It is more common to see the signs of low testosterone over 40, and more likely when men reach their fifties and sixties.
Of course, there are also those who will never experience low testosterone symptoms in men for the same reason that not all women get hot flashes or night sweats. The body can adjust to changes in hormone levels without any problems. Luckily, for those who do face these changing signs, treatment is available.
Hypogonadism has. Some are unavoidable – such as an unexpected injury to the brain or testicles. Others, such as type 2 diabetes, steroid abuse, or opioid use are avoidable by leading a healthy lifestyle.
- Testicular injury
- Other hormonal disorders
- Testicular tumor or cancer
- for testicular cancer or tumor
- Tumor of the hypothalamus or pituitary gland
- Traumatic brain injury
- Certain infections, such as mumps orchitis
- Type 2 diabetes
- Liver disease
- Kidney disease
- Natural aging
- Elevated blood levels of iron
- Klinefelter’s syndrome
- Certain inflammatory diseases such as sarcoidosis, tuberculosis, or histiocytosis
- Kallmann syndrome
- Opioids or steroids
Because testosterone influences a varied array of functions in the human body, the low testosterone symptoms may differ from one person to the next. Although your symptoms of Low T may be different from someone else, it does not mean the condition is different. Do not think you do not have TD just because someone you know was diagnosed with different symptoms. Only a qualified hormone specialist can know for sure if you have Low T.
- Loss of body hair
- Testicular shrinkage
- Decreased erection frequency
- Erectile dysfunction
- Low libido
- Reduced sperm count
- Breast tenderness
- Gynecomastia – breast enlargement
- Loss of height
- Decreased bone mineral density
- Bone fractures
- Night sweats
- Hot flushes
- Reduced or lack of energy
- Poor sleep
- No motivation
- Decreased productivity
- Changes in mood
- Increased anxiety or stress
- Trouble concentrating
- Memory lapses
- Impaired cognitive functions
- Loss of muscle mass
- Reduced strength
- Weight gain
- Hair loss or thinning from scalp
Receiving a diagnosis of Low T is not the end of the world. TD is relatively easy and affordable to treat. A variety of treatment options exist for men with hypogonadism, including:
- Testosterone cypionate injections
- Testosterone enanthate injections
- Transdermal skin patches
- Testosterone gel
- Testosterone cream
- Implantable pellets
- Nasal gel
Low T testosterone injections are the most recommended form of testosterone therapy for the following reasons:
- Long-lasting effects – most males inject testosterone cypionate once every two weeks
- Best absorption into the bloodstream
- Quickest-acting effects
- Lowest cost
- Least risk of cross-contamination to others
Testosterone deficiency symptoms may vary from one man to another; however, Low T is easy to treat with numerous options.
Testosterone Deficiency (Low T) in Women
Unlike men who begin to reduce testosterone production before age thirty, women experience a change on a regular basis. Female testosterone levels fluctuate throughout the monthly menstrual cycle, as well as at various times of the day. Pregnancy and menopause are also two significant influencers of testosterone production in women.
Aside from the ovaries, women also produce some testosterone in their adrenal glands. After menopause, only the adrenals continue to provide testosterone. Low testosterone in women can be as troublesome as with men.
As previously discussed in the section “What Is Low Testosterone,” testosterone deficiency is often associated with many other health conditions. Medical issues such as, type 2 diabetes, cardiovascular disease, atherosclerosis, and dementia can greatly impact quality of life and morbidity.
In women, the primary causes of low testosterone over 50 include:
- Ovarian tumor
- Tumor of the pituitary gland, hypothalamus, or adrenal glands
- Oral estrogen
- Ovary removal (oophorectomy)
Symptoms of low testosterone can be especially bothersome for women. Decreased bone density puts them at risk for potentially life-threatening fractures.
- Hot flashes
- Mood swings
- Night sweats
- Muscle weakness
- Decreased sex drive
- Vaginal dryness
- Reduced sexual satisfaction
- Weight gain, especially abdominal fat
- Height shrinkage
- Loss of bone density
- Thinning hair
- Irregular menstrual cycles
- Increased stress and anxiety
- Memory loss
- Poor concentration
- Impaired cognitive functions
- Reduced drive
- Lack of productivity
Women who cannot take estrogen during menopause due to breast cancer risks can often receive low testosterone treatment without any concern. To reduce the risk of testosterone conversion into estradiol, the hormone doctor will prescribe an aromatase blocker.
- Pharmacy-compounded testosterone cream
The female testosterone patch is not yet approved for use. Other options used for males have too high a testosterone dosage to be safe for female use. The hormone specialist will carefully calculate the appropriate dosage of testosterone, and that is what the compounding pharmacy will use to provide the medication.
What to Do If “I Have Low Testosterone” ?
Looking over the lists of symptoms listed above, it is certainly easy to “self-diagnose” Low T. However, just because you might think you have low testosterone problems, it does not mean that you do. Without proper testing and diagnosis, it is impossible to determine if testosterone deficiency is your problem. The symptoms of TD are similar to those of growth hormone deficiency – another issue affecting many males and females as they age. The wrong diagnosis and treatment will not provide the results you desire.
The best thing to do is contact a low testosterone clinic to speak with a hormone specialist. At a hormone clinic, you will receive the highest level of care for hormonal imbalances. Along with a consultation, you will have physical exam and visit a local lab for your blood test. Only after completing all the diagnostic steps, including a health history questionnaire, can you know for sure if treatment for Low T is right for you.
Hormonal balancing is a medical specialty that requires the services of a highly trained physician. Always contact a hormone specialist for diagnosis of Low T and the appropriate, customized treatment.
Is Low T a Hereditary Problem?
In certain cases, the answer could be yes, Low T may be hereditary. If you are first diagnosed with low testosterone over 30 and have no underlying medical conditions, chances are it is the natural aging process causing your concerns. However, with low testosterone, hereditary or genetic concerns like the ones below may be connected:
- Kallmann Syndrome – this X-linked chromosome disorder impacts luteinizing hormone (LH) and follicle-stimulating hormone (FSH) causing a decrease in both testosterone and sperm count. Although men and women can have the disorder, it is more common in males. Kallmann syndrome is typically diagnosed by puberty as there is a failure to start to complete the pubertal process. Men with this disorder often have decreased testicular size. Fertility treatment can help improve sperm count.
- Klinefelter Syndrome – instead of having one X and one Y chromosome, men with this disorder have an addition X chromosome (or more). Rather than being hereditary, this condition is often due to a problem during conception. Abnormally developed testicles cause a decline in testosterone production. Men may also have a lower body mass, decreased body hair, and enlarged breasts. Some men do not know they have this condition until they receive testing for infertility. Treatments can help improve fertility.
- Myotonic Dystrophy – a male form of muscular dystrophy associated with the Y chromosome. Testicular failure typically occurs between the ages of thirty and forty. The condition may be passed from father to son.
- Prader-Willi Syndrome – in this disorder, chromosome 15 has some form of problem. There may be a defect in the paternal genes, or they may, in part, be missing. The mother could have provided two copies of the chromosome. Prader-Willi syndrome can affect males and females, causing a significant reduction in the production of sex hormones. Diagnosis typically occurs during puberty due to slow development. Some women who do not receive treatment may not get a period until their thirties, if ever. Men may retain a higher-pitched voice and not develop much in the way of facial hair. Hunger is an issue for some people with Prader-Willi.
Certain genetic or hereditary conditions may contribute to Low T.
Low Testosterone Studies and Research
Low testosterone research is an ongoing field, as testosterone is such a vital hormone to the body. Below, we highlight some of the latest 2018 research regarding the hormone testosterone:
- Endurance training can lower testosterone – males involved with chronic endurance exercise training more often display clinically low-normal levels of testosterone. For some, the levels reach sub-clinical status, meaning Low T. Infertility problems, decreased bone mineral content, and other symptoms associated with testosterone deficiency are possible.
Lessons learned from the Testosterone Trials – the results of seven double-blind, placebo-controlled trials featuring 788 men showed the following benefits:
- Increased sexual desire, activity, and function
- Distance walked
- Improved mood and symptoms of depression
- Increased hemoglobin levels in men with anemia
- Improved volumetric bone mineral density and hip and spine strength
- Testosterone and Prostate Cancer – men with low testosterone and normal PSA levels did not have an increase in the risk of prostate cancer following testosterone therapy.
- Testosterone and Cardiovascular Health – although still not a definitive answer on the subject, numerous studies demonstrate no increased risk of cardiovascular incidents in men who receive testosterone therapy for Low T. Benefits of testosterone may include direct vasodilatory effects on the coronary vasculature as well as peripheral system vascular resistance.
As new low testosterone study reports come out, we will continue to bring the results to you.
Studies continue to support the many health benefits of testosterone therapy.
Testosterone deficiency can be bothersome with minor symptoms, or potentially debilitating if long-term effects lead to serious health conditions. Treatment with testosterone therapy is generally considered safe for most adults.
A hormone specialist is the best person to assess hormone deficiency in adults. Our hormone clinic is here to provide free consultations (confidential) by phone. We offer convenient diagnostic testing facilities throughout the US and affordable treatment options for men and women.
- Abram McBride, MD, Culley C. Carson III, MD, Robert M Coward, MD
- Nasimeh Yazdani, MD, Stacy Matthews Branch, DVM, PhD
- Bruno Lunenfeld, MD, PhD, G. Mskhalaya, MD, Dr. Michael Zitzmann, MD, PhD, FRSM, FECSM, Stefan Arver, Dr. Abraham Morgentaler, MD, Svetlana Kalinchenko, MD, PhD, Yuliya Tishova, MD, PhD
- Joshua A. Halpern, MD, MS; Robert E. Brannigan, MD
Testosterone deficiency in the aging male
Daily subcutaneous testosterone for management of testosterone deficiency
Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men