Dr. Ahmed Symptoms Of Low Testosterone Level In Adults, especially women are very subtle. Loss of libido and feeling less energetic are the common complaints. However, getting tired easily is very nonspecific and the diagnosis of hypogonadism is often missed.
In men, low testosterone levels indicate male hypogonadism, which means that the male gonads are not producing enough testosterone to meet the body’s needs. There are various reasons which can result in low testosterone levels in the body.
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What is Testosterone?
Testosterone is a male sex hormone produced by the male reproductive organ, the testicles. There are various functions in the body, performed by testosterone.
Testosterone is also present in females but in less quantity. It has different functions in females. In males, it is involved in sexual character development, muscle mass, sufficient RBCs, and male secondary sexual characteristics.
In females, testosterone and estrogen are associated with the growth, development, and restoration of reproductive organs.
Apart from this, it is involved in bone mass, bone length, hair growth, human behaviors, etc. if there is an abnormal level of testosterone in any gender, it can have serious effects on the body which will be described below.
What are the normal levels of testosterone in men and women?
In women, the normal testosterone level is around 15 to 70 nanograms per deciliter of blood. If it becomes lower than 15, there will be severe effects on the body.
In men, it is difficult to measure the normal testosterone level because, it frequently varies with diet, age, disease, etc. It is maximum in teenagers between 15 to 16 years where it could reach up to 1200 ng/dl.
Prevalence of low testosterone
It is difficult to judge whether a person is low in testosterone but, around 2 % of men are the victims of testosterone deficiency. It means that every 2 people out of 100 may have lower than normal testosterone levels.
It is less common in young individuals ( around 1 %). However, it is more prevalent in old age. Around 50% person of individuals over 80 are low on testosterone.
One of the most important facts is that it is more in overweight individuals than normal weight individuals.
Symptoms of low testosterone in males
There are different symptoms in men, depending upon the age. Mostly it appears when the person becomes old. Some commonly occurring symptoms of hypogonadism are as follows:
Loss of libido or reduced sex drive:
- A person with a low testosterone level has a sex drive lower than normal. It can be understood with the decline of sex drive in old age when it becomes low.
How to treat reduced sex drive?
- In men with a reduced sex drive due to male hypogonadism or low testosterone levels, treatment is directed towards the replacement of testosterone hormone.
- In addition, patients must be advised to lose weight and do aerobic exercises which can boost testosterone levels.
Erection problem:
- Erection is done with the help of testosterone. A compound, nitric oxide is released in response to testosterone by the brain which is a potent vasodilator.
- Due to vasodilation, more blood flow, and in this way erectile tissues become swell. Moreover, to keep the erection for some time, testosterone is needed. otherwise, the erection would not last for some time.
How to treat erectile dysfunction:
- This is sometimes very difficult to treat. The first thing to know is that if your libido has reduced, treatment of erectile dysfunction is not going to work.
- You need to improve your sex drive as mentioned above. Eat foods like salmon, oysters, green vegetables with black pepper, dark chocolates, and fruits rich in zinc like almonds and walnuts.
- Do aerobic exercises. Keep yourself stress-free. You may also try sildenafil (Viagra), Vardenafil (Levitra), and Tadalafil (Cialis) as a temporary measure to improve erection.
- Lastly, you need to replace testosterone as it is the primary cause of your erectile dysfunction.
Hair loss:
- A low level of testosterone in the body may cause the loss of facial and body hair. So low testosterone can lead to balding in men.
- High testosterone levels cause male-pattern balding while low testosterone levels do the opposite.
- It causes thinning of facial, axillary, and pubic hair. Patients may complain of reduced shaving frequency if asked.
How to prevent hair loss?
- Hair loss due to low testosterone is different from balding due to excess testosterone which is the main cause of balding in men.
- Hair loss due to low testosterone levels results in thinning of pubic hair, hair of armpits, and beard.
- Usually, it does not require treatment. Topical Minoxidil spray may be used to improve hair thinning.
- Testosterone replacement may improve hair thinning and growth of hair.
Increased body fat:
- When the levels of testosterone decrease, it results in adipocyte dysfunction which causes the fat mass of the body to increase and reduces the lean mass of the body.
- Increased body fat along with reduced physical activity is the cause of weight gain in patients with low testosterone levels. In men, gynecomastia, a big tummy, and increased fat over the buttocks and thighs are the symptom of low testosterone levels in the body.
How to remove excess body fat?
- Fat burning as a result of low testosterone is difficult to remove because people are tired and fatigued all the time and do not go for a workout.
- However, reducing carbs is an easy way to avoid weight gain.
- One can start with a simple exercise and increase the intensity as the stamina grows. Exercise has been shown to boost testosterone levels as well. In one study, participants in the HPA (high physical activity) group defined as those who walked 3500 to 11000 steps per day had higher serum testosterone levels compared to those in the LPA (low physical activity) group defined as participants who walked less than 3500 steps per day [Ref]
- Medications that are used to lose weight and burn fat may not help because weight gain in these patients is due to low testosterone levels.
- Testosterone replacement may help a person enhance his exercise capacity and help him lose weight.
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Decrease bone mineral density:
- It is observed in men with a low testosterone level that their bone density is lower than a normal person.
- It can be related to older people because their bones are vulnerable to fracture due to low testosterone levels in the body. Generally, it causes osteoporosis in males.
How to improve bone strength and low bone mineral density?
- Increase calcium intake by increasing the intake of dairy products or taking calcium and vitamin D supplements.
- Start weight lifting or go to the GYM and get help from your trainer.
- Testosterone replacement may improve bone mineral density.
Memory loss:
- Testosterone levels may cause the loss of memory as happens in old people. It is believed that testosterone activates the cortical network in the brain during spatial cognition tasks.
- Memory loss is a very non-specific symptom. It can be caused by many medical conditions including aging itself. It is therefore missed.
How to improve memory loss?
- To improve memory loss, you need to increase the intake of certain foods like green vegetables. Chocolates and caffeine may help in improving your focus.
- Reduce the intake of drugs like SSRIs, anxiolytics, sleep medicines, and alcohol.
- You may need testosterone replacement and drugs that improve memory loss such as memantine (Ebixa).
Fatigue and tiredness:
- Low levels also cause the body to get fatigued. The energy levels become less and the person feels incredibly tired.
- Testosterone spike in adolescents is associated with increased energy, strength, and more activity. When the levels drop, the opposite happens.
How to improve fatigue and tiredness?
- You need to cope with stress and anxiety by making healthy choices. Eat healthily, and start exercising although fatigue may hinder your exercise capacity but don’t give up.
- Testosterone replacement might help you increase your exercise capacity or you may need other medicines that boost you such as modafinil.
Mood swings:
- Mood swings are one of the common symptoms in all hypogonadism patients. It can increase the stress level in such patients.
- In these conditions, the cortisol level rises which causes a change in behavior resulting in anger, anxiety, etc.
How to prevent mood swings?
- Eat enough vegetables, fruits, or energy drinks made at home.
- Do yoga, and go for a walk.
- Omega fish oil supplements may help mood swings.
- Replace testosterone but do not overdose as high testosterone levels are associated with aggression.
Testicle and penis size:
- It is noted that the size of the testicles and penis become small when the concentration of testosterone decreases from normal.
- It is because testosterone is required by the testicular tissues to grow. Otherwise, it gets atrophied. The same happens with penile tissues as well.
How to improve your length or testicular volume?
- Testosterone replacement might help to some extent in such cases.
- However, it is important to know the cause of low testosterone in these cases. If hypogonadism is due to a central cause such as hypopituitarism, gonadotropins might be more helpful than replacing testosterone.
- Gonadotropins may increase testicular volume and increase sperm counts.
Insufficient blood count:
- Testosterone is helpful in increasing erythropoiesis. It does this by increasing the release of erythropoietin from the kidney which is a vital hormone involved in the greater production of blood cells, especially red blood cells.
- It also increases bone marrow activity along with increased incorporation of iron in RBCs. When the number of red blood cells increases, hemoglobin, and hematocrit also increase.
- So in case of low testosterone, blood counts fall and result in anemia.
How to treat anemia?
- Anemia due to hypogonadism may respond to testosterone replacement.
- However, it is better to find and treat other concomitant diseases like iron deficiency anemia, folate deficiency, and Vitamin B 12 deficiency anemia.
- Sometimes, erythropoietin replacement might help improve your blood counts.
Infertility:
- As the concentration of testosterone becomes lower than normal, the number of sperm cells decreases drastically.
- It also decreases the libido and reduces erectile functioning, both of these are crucial for fertility.
How to treat infertility?
- Infertility caused by testosterone deficiency needs to be investigated.
- Infertility caused by primary hypogonadism (Low testosterone as a result of a problem in the testes) is usually not treatable.
- However, if low testosterone is caused by a deficiency in the pituitary hormones (gonadotropins), it is treatable by replacing those hormones.
Hot flashes:
- Hot flashes are common in women with menopause. However, men can also have andropause. Male menopause is a decline in the male sex hormone, testosterone.
- There are no clear cut-offs when a patient is labeled as having male menopause but it affects men after the age of 50.
How to treat hot flashes?
- This is primarily due to low testosterone levels in men. In women, hot flashes occur in menopause due to disturbed female hormones.
- One can get relief from hot flashes by taking cold baths, avoiding caffeine and coffee, and avoiding strenuous exercises.
- Vitamins and supplements such as evening primrose oil may help some patients.
- SSRIs like citalopram or sertraline may help those with severe symptoms.
- Hormonal replacement helps most patients
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What are the symptoms of low testosterone in women
Although most of the symptoms of low testosterone in females are the same as in males, some are different which are mentioned below:
Loss of sexual drive:
- Sexual desire is not completely dependent on testosterone levels, although libido (sexual desire) is affected to some extent.
- It is due to mood swings such as anxiety, denial, etc. The amygdala moderates these in the hypothalamus.
How to treat reduced sexual drive in women:
- Like men, women are asked to lose weight, perform aerobics, and treat associated mental or medical conditions.
- Testosterone replacement is rarely used in women because of the side effects of testosterone in women.
- Flibanserin (Addyi) is a drug that has been approved by the FDA in 2015 for the treatment of premenopausal women with a hypoactive sexual disorder [Ref]
Menstrual Irregularities:
- Bizarre menstrual bleeding is also one of the common symptoms of low testosterone levels. It is also observed that the quality of eggs is reduced in case of low testosterone levels. It is responsible for fertility issues as well.
How to treat menstrual irregularities:
- The hormonal replacement may be required for most patients.
- However, it is also important to consider weight reduction and treat concomitant medical conditions.
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Vaginal Dryness:
- Low testosterone levels also cause the vagina to get dry. When this happens, the female experiences painful intercourse. Tearing and micro abrasions can also occur in such conditions.
How to treat vaginal dryness:
- Vaginal dryness may need to be treated to avoid pain and discomfort during intercourse.
- Lubricants and moisturizers may help.
- Increase the intake of foods with high amounts of plant estrogens such as soy, nuts, and seeds.
- Treat concomitant vaginal yeast infections
- Hormonal replacement help most patients. Flibanserin (Addyi) can be taken and is approved by the FDA for the treatment of hypoactive sexual disorder in premenopausal women.
Osteoporosis:
- Bone density, muscle mass, sexual desire, etc are also reduced in the same way it reduces in men.
How to treat osteoporosis:
- Try weight lifting and do some sort of physical activity.
- Take enough calcium and vitamin D supplements. Simultaneously increase the intake of dairy products.
- Sometimes, you may need hormonal replacement or drugs used to treat bisphosphonates like alendronate (Fosamax), Ibandronic acid (Bone viva), Pamidronate (Aredia), or Zoledronic acid (Zometa or Aclasta).
Disturbed sleep:
- The sleep cycle is also disturbed if the individual has abnormal levels of testosterone.
How to treat disturbed sleep:
- Try simple things first. Get up early in the morning, go for a walk and avoid mid-day naps.
- Get into a comfortable bed. Keep light dim and sleep in a quiet room with optimal temperature.
- You can try simple OTC pills like melatonin. However, if no improvement is noted, you can try Zolpidem (Siesta), Clonazepam (Clonexa), or benzodiazepines (Xanax, Bromazepam, etc)
