Cause and Effects of Low Testosterone

What is Testosterone?

Testosterone is one of a family of hormones called androgens. Best known for their masculinizing effects, androgens first kick into action during the embryonic stages of life. An embryo is conceived when a female egg is fertilized with a male sperm. Androgens are a naturally occurring sex hormone that is produced by the ovaries, adrenal glands and other tissues. Androgen plays a key role in regulating certain bodily functions, including the growth spurt at puberty. It is believed to regulate the function of many organs, including the reproductive tract, kidneys, liver and muscles. The egg and sperm each donate a single sex chromosome to the embryo, an X chromosome from women, and an X or Y chromosome from men.

If the combination of these sex chromosomes is XX, then the embryo will be female. If it’s XY, the embryo will be male. Though in fact, it’s not until the sixth week of development that XX or XY embryos are anatomically defined. Before this the human fetus is essentially sexless, possessing a set of “indifferent” genitalia. One interpretation of this is that all embryos begin as female. Testosterone makes the difference, influencing the growth of male genitalia, while the female component of the indifferent genitalia degenerates.

Testosterone tends to be identified with masculine stereotype

According to some, the intimate association between testosterone and male identity starts early. This inference that testosterone equals male, while absence of testosterone equals female, is well-entrenched in the layers of our culture.  But, the reality is that testosterone is a girl’s hormone, too.

We have been conditioned to box our hormones into those that belong to men, and those that belong to women. Estrogen and progesterone are the so-called female sex hormones, and testosterone, the so-called primary male sex hormone. With that we assign our hormones impossible gender roles. But of course, gender is not that simple and nor are our hormones.

It turns out men and women produce exactly the same hormones, only in different amounts. Men’s bodies generate more than twenty times more testosterone than women, an average of 7 milligrams per day. Women, via mainly their ovaries and adrenal glands, make a tiny 3/10 of 1 milligram of testosterone per day.

But it may come as a surprise to know that women’s ovaries primarily produce testosterone, from which estrogen is then made. This ovarian production accounts for one-quarter of the total circulating testosterone in a woman’s body. At first glance, this might appear to suggest that women naturally have less estrogen than men.However, with the help of an aromatase enzyme, estrogen is also produced in your fat and muscle cells both before and after menopause. Aromatase is an enzyme found in the liver, responsible for the conversion of the androgens into the estrogens. Inhibiting aromatase can cause the body to produce less estrogen and maintain a higher testosterone state.

Your estrogen levels are not totally dependent on your ovaries, there are a lot of other factors that come into play, like your diet and body composition.

While these numbers may appear to be a bit confusing at first, they basically translate to the fact that women have about 1/10 the amount of testosterone found in men.

Conversely, men’s bodies produce their own estrogen, converted by their tissues from their testosterone. In reality, testosterone is as much a woman’s sex hormone as it is a man’s.

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What Does Testosterone Actually Do?

Testosterone is considered to be the principal male hormone, playing an important role in the development and maintenance of typical masculine characteristics, such as facial hair, muscle mass and a deeper voice. In men, testosterone plays a key role in the development of male reproductive tissues such as the testis and prostate, as well as promoting secondary sexual characteristics such as increased muscle, bone mass and the growth of body hair.

So, why would women want testosterone? The fact is, women produce it too, and it has more positive influences than you might think. Testosterone is essential for health and well-being in women, as well. In women, studies show that it helps maintain muscle and bone and contributes to sex drive or libido and aids in the prevention of osteoporosis.

Is More Testosterone Better?

Not necessarily! In fact, over the past decade researchers have found elevated testosterone levels to influence a person’s tendency towards criminal violence, delinquency, suicide, heroic altruism and aggression, as well as their cognition, sexuality and sex roles, occupation, personality, emotions, competitiveness, childhood behavior, facial expressions, disturbed relationships and more. It’s an extraordinary body of work with powerful implications.

What About Too Little Testosterone in Women?

As with most of our hormones, blood levels of testosterone vary according to our stress levels, or other demands on our bodies. It also declines with age and produces different effects in men and women.

As women age, their levels of circulating testosterone gradually decline. The effect can be especially felt in women around their menopause, when they also experience a precipitous drop in estrogen, or if their ovaries are removed, which prematurely induces a ‘surgical menopause‘. The symptoms of a “deficiency” – or loss of testosterone – can include:

• A loss of vital energy and feeling of “well-being“
• A loss of familiar levels of sexual libido
• Sensitivity of nipples and genitals
• A thinning of pubic hair

Other impacts may include:

• A “flatness” of mood, dry skin
• Brittle scalp hair
• Loss of muscle strength and tone

It’s understood that testosterone also contributes to the health of a woman’s vulva, regrows the vital tissue of the clitoris, and can play a role in curbing osteoporosis by helping maintain the density of our bones. And if that wasn’t enough, it can influence our cognitive function, as well.

How Does Low Testosterone Affect Men?

By the time men are between the ages of 40 and 55, they can experience a phenomenon similar to the female menopause, called andropause. Unlike women, men do not have a clear-cut signpost such as the cessation of menstruation to mark this transition. Both, however, are distinguished by a drop in hormone levels, estrogen in the female, testosterone in the male. The bodily changes occur very gradually in men and may be accompanied by changes in attitudes and moods, fatigue, a loss of energy, sex drive and physical agility.

Studies show that this decline in testosterone can actually put men at risk for other health problems like heart disease and weak bones. This usually happens at a time in life when many men begin to question their values, accomplishments and direction. It’s often difficult to realize that the changes occurring are related to more than just external conditions and is frequently associated with what is called a “Mid-Life Crises.”

A gradual hormonal decline

While menopause generally occurs in women during their mid-forties to mid-fifties, the same transition in men may be much more gradual and develop over many decades. Attitude, psychological stress, alcohol, injuries or surgery, medications, weight gain and frequent infections can contribute to its onset.

To compound this frustration, none of these transitional changes are predictable, aside from the fact that there will be a drop in testosterone. Neither is there a way of predicting who will experience andropausal symptoms of sufficient severity to seek medical help.

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What causes andropause?

Just as in the female, it revolves around a change in the production and relationship of certain hormones. Starting at about age 30, testosterone levels drop by about 10 percent every decade in both males and females. At the same time, another factor in the body called Sex Binding Hormone Globulin, or SHBG, is increasing. SHBG traps much of the testosterone that is still circulating and makes it unavailable to exert its effects in the body’s tissues. What’s left over does the beneficial work and is known as “bioavailable” testosterone.

Andropause is associated with low (bioavailable) testosterone levels. Every man experiences a decline of bioavailable testosterone but some men’s levels dip lower than others. And when this happens these men can experience andropausal symptoms. In addition to the generalized impact of andropause listed below, it is quite common for men to experience a wide variety of related symptoms, such as:

• Muscle Loss
• Low Libido or Sex Drive
• Depression
• Weight Gain
• Urinary Problems
• Hot Flashes in Men
• Hair Loss
• Sleep Apnea
• Fatigue
• Irritability
• Night Sweats in Men

It is estimated that 30% of men in their 50s will have testosterone levels low enough to be causing symptoms or putting them at risk.

Testosterone Testing

I want to make several important points about male testosterone levels and lab readings.

First of all, you should keep in mind that it’s unwise to go by one reading. Testosterone fluctuates considerably from week to week and even from day to day. Stress, lack of sleep and many other things that are a normal part of life for us males can whack testosterone levels.

It is entirely possible, for example, for your testosterone to be 4000 one week and 525 the next. Lifestyle issues can whack even normal testosterone 20-30% or more, see my link Common Things That Lower Testosterone.

Second, if at all possible, you should also try to get your testosterone levels read in the morning. Male testosterone levels peak in the morning and then steadily decline until late evening. This decline from am to pm is about 35% for most younger guys and about 10% for seniors, on average. (See my link on Daily Testosterone for more information.)

In addition, it’s worth pointing out that labs aren’t perfect either. I had one testosterone reading that was three times any previous reading! Of course, there is no reasonable explanation for that reading and it was surely an outlier from normal as they say in the stats world.

All cautions aside, you can assess your testosterone levels against the average for males.

• For example, there was a 1999 study that examined 4,393 men between the ages of 32 and 44 and found that their average testosterone level (at 8 a.m.) was 679 ng/dl.
• It should be noted that in this study the men with testosterone levels slightly above 800 were 42% and 72% less likely to have high blood pressure and a heart attack, respectively, than those with testosterone a little less than 400. Again, solid testosterone is good for you!

So, you may be wondering what exactly are normal male testosterone levels?

Let’s look at another study the NERI (New England Research Institute) that examined men between 65-69 years of age.

• Their average testosterone levels in 1998 were 503 hg/dl.
• But, fifteen laters in 2003, their average testosterone levels were 423.

This corresponds to what other studies have found:  testosterone levels are falling steadily with age.

I speculate that the leading factors for such a decline are diet, mitochondrial damage, excitotoxins and pesticides. So, if you put these studies together, you can start to get a good picture of reasonable values by age.

• Studies have found that total testosterone levels decrease by about 1.0-1.2% per year and free testosterone by about 1.2-1.3% per year in the average male.

This decline, by the way, is normal and a part of aging.  What you don’t want is to venture significantly below these normal numbers – low testosterone is “nothing’ but trouble” for us males.

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What Is the Impact of Low Testosterone?

When there is less testosterone available, the testosterone target-organ response decreases, bringing about a variety of unpredictable changes. Most usually these appear as conditions expressed as Erectile Dysfunction, Gynecomastia (male breasts) and low sperm counts. Even though sperm make up a rather small portion of the semen that is released during ejaculation. Semen is made from the secretions of several glands and each of these glands requires testosterone support for its function.

Due to the great variability in testosterone levels among healthy men not all will experience the same changes to the same extent. Some typical responses to low bioavailable testosterone levels include:

• Low sex drive
• Emotional, psychological and behavioral changes
• Decreased muscle mass
• Loss of muscle strength
• Increased upper and central body fat
• Osteoporosis or weak bones and back pain
• Cardiovascular risk

Are There Any Risks Associated With Low Testosterone?

Apart from the impact that low testosterone may have on your quality of life. there are other longer-term and silent effects that are harder to track, such as increased cardiovascular risk and osteoporosis.

Low testosterone & osteoporosis

In a healthy individual, bone tissue is constantly being broken down and rebuilt. In an individual with osteoporosis, more bone tissue is lost than is regenerated. We’ve all heard of women suffering from weaker bones, or osteoporosis, after menopause. In men, testosterone is thought to play a role in helping to maintain this balance. Between the ages of 40 and 70 years, male bone density falls by up to 15%.

Unfortunately, with advancing age and declining testosterone levels, men, like women, seem to demonstrate a similar pattern of risk for osteoporosis. What’s more, approximately 1 in 8 men over age 50 actually have osteoporosis.

Two important consequences of osteoporosis are often seen as a slow but progressive rounding of the shoulders as well as a loss of height and back pain. Particularly devastating seem to be hip fractures; up to 1/3 of patients never seem to regain full mobility.

Cardiovascular risk

It is now well accepted that women’s risk of atherosclerosis (hardening of the arteries) increases after menopause. Estrogen replacement therapy seems to reverse this trend.

New evidence suggests that a similar phenomenon occurs in men as their testosterone levels diminish with age. While research is not as complete as for women, the clinical findings point to an association between low testosterone levels and an increase in cardiovascular risk factors in men.

In andropausal men, night sweats and palpitations occur because of an overactive autonomic system in response to falling testosterone levels. To assess for hypogonadism, which is in part the clinical basis of the andropause, the doctor will check for physical signs in men including hair loss particularly in the armpit and genitalia. Psychological tests may be carried out to rule out depression and other mood and cognitive changes.

Psychological challenges with low testosterone

Throughout the life of a male or female there are several psychological issues that they may struggle with, and these challenges are often amplified during the time of the diminishing testosterone. These changes can be reflected in any or all of the following:

• Sexuality
• Emotions
• Mind
• Courage
• Productivity
• Personality
• Character
• Boyish behaviors

Low Testosterone Treatment Options

Low testosterone treatment may include lifestyle and dietary changes, herbal supplements or hormone replacement therapy. Men choose different treatments than women depending on the severity of their symptoms, their overall health and the advice of their doctor. What follows is a brief description of treatment options.

Testosterone replacement therapy is an option that must be closely monitored by a physician. Blood tests determine the current testosterone levels and those are compared to “normal” levels.

The physician must then ensure that the patient only receives enough of the hormone to bring his levels back up to “normal”.

Too much testosterone can actually affect the body’s natural ability to produce the hormone on its own. Men selecting testosterone replacement therapy as an andropause treatment have reported positive results in as little as three weeks.

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Testosterone can be administered in several ways.

• Oral testosterone capsules and lozenges are synthetic testosterone and appear to be the least effective.
• Testosterone injections, also synthetic, appear to be more effective, but may be painful, because the hormone must be injected directly into a muscle.
• Transdermal patches are worn on the skin and many people find them uncomfortable.
• A natural testosterone gel which is applied directly to the skin was approved for use by the FDA in 2000 and appears to be very effective as treatment for low testosterone. Men using the gel report increased energy levels, sex drive, endurance and overall muscle strength.

What are the side-effects of testosterone replacement?

When given in appropriate doses, there are no negative side-effects. Today we can measure blood levels, so it’s easier to monitor the dose. Excessive testosterone can cause acne, body hair growth and scalp hair loss in women. Excessive testosterone supplementation, such as you’ll find with anabolic steroids used by athletes, also tends to drop high-density lipoprotein (HDL) cholesterol levels. That’s the “good” cholesterol. Lower HDL levels increase the risk of heart disease.

Lifestyle changes can alleviate some of the symptoms associated with low testosterone. One study of women who had been previously sedentary and began a regular exercise program reported increased energy levels, sex drive and an overall sense of well-being.

On a personal note, I first had my testosterone levels check when I was 55, having decided that I was becoming a bit frumpy and grumpy. To my surprise, my levels were at 50% of normal for my age. At that point, I was 230 pounds with a 25% body fat at 5’11” tall. I started immediately on a testosterone treatment program and 12 weeks later I was still 5’11” tall but I weighed 190 pounds with an 18% body fat.

What is the Bottom Line for Testosterone?

A good basic treatment program for low testosterone will include regular exercise and a healthy diet that is comprised of foods that can naturally help boost testosterone levels. And boosting is a good thing when you consider, according to the men’s hormonal health website, the average man makes approximately 100 mg of testosterone each week, but high testosterone levels are associated with health benefits.

Men with high testosterone are more likely to experience positive well-being with less depression and mild euphoria. High testosterone levels may contribute to lower social anxiety and greater self-confidence. High testosterone can provide more energy that fuels greater ambition than men with lower testosterone levels. High testosterone levels also enhance a man’s libido and may shorten his refractory period, or the amount of time it takes for him to become aroused.

My advice? If you are experiencing any of these common symptoms and suspect the culprit is testosterone, at least get tested. It can’t hurt and you may end up being pleasantly surprised.