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Low Testosterone: Causes, Symptoms, Diagnosis, Treatment, and Prevention

When the primary male sex hormone, testosterone, is present at a level below normal, it is referred to as low testosterone. The testicles generate testosterone, which is in charge of the growth and maintenance of masculine traits including muscular mass, facial hair, sex desire, and sperm production. Many symptoms and problems, including decreased libido, erectile dysfunction, exhaustion, melancholy, and osteoporosis, can be brought on by low testosterone. Many conditions and disorders, including age, obesity, drugs, and traumas, can result in low testosterone levels. Medication, lifestyle modifications, or testosterone replacement treatment may be used to treat low testosterone, depending on the underlying cause and severity of the condition.

Causes

There are two categories of low testosterone: main and secondary. A issue affecting the testicles' capacity to make testosterone is the cause of primary low testosterone. A brain or pituitary gland issue that impairs their capacity to stimulate the testicles to make testosterone is the cause of secondary low testosterone. The following are a few typical reasons of low testosterone:

• Aging, which naturally reduces the production and secretion of testosterone over time. Testosterone levels peak in early adulthood and decline gradually after age 30.

• Obesity, which increases the conversion of testosterone to estrogen, the female sex hormone, by an enzyme called aromatase. Obesity also reduces the secretion of luteinizing hormone (LH), which stimulates the testicles to produce testosterone.

• Medications, such as opioids, steroids, antidepressants, or antifungals, that can interfere with the production or action of testosterone or LH.

• Diseases, such as diabetes, thyroid disorders, liver disease, kidney disease, or HIV, that can affect the metabolism or function of testosterone or LH.

• Injuries, such as trauma, infection, or surgery, that can damage the testicles, the brain, or the pituitary gland and impair their ability to produce or stimulate testosterone.

• Genetic conditions, such as Klinefelter syndrome, Kallmann syndrome, or hemochromatosis, that can affect the development or function of the testicles, the brain, or the pituitary gland and cause low testosterone.

Symptoms

The symptoms of low testosterone can vary depending on the individual, the cause, and the duration of the condition. Some common symptoms include:

• Reduced libido, or sexual desire

• Erectile dysfunction, or difficulty getting or maintaining an erection

• Decreased semen volume or quality

• Reduced muscle mass or strength

• Increased body fat or weight gain

• Loss of bone density or osteoporosis

• Reduced energy or stamina

• Mood changes, such as depression, irritability, or anxiety

• Cognitive changes, such as memory loss, poor concentration, or difficulty learning

• Sleep problems, such as insomnia, sleep apnea, or snoring

• Hair loss or thinning

• Reduced testicle size or gynecomastia, which is the enlargement of breast tissue in males

Diagnosis

A physician will inquire about the patient's symptoms, medical history, and lifestyle choices in order to make the diagnosis of low testosterone. In addition, the physician will do a physical examination to look for physical indicators of low testosterone, such as decreased muscle mass, testicle size, or body hair. A blood test that determines the amount of testosterone in the blood is the primary diagnostic tool for low testosterone. For adult males, the typical range of testosterone is 300–1000 nanograms per deciliter (ng/dL). Nevertheless, the age, time of day, and laboratory technique may all affect this range. Two blood tests conducted at various times, ideally in the morning when testosterone levels are greatest, are often used to confirm a low testosterone level. To determine the source and effects of low testosterone, the doctor may also prescribe other tests, such as a genetic test, a bone density scan, or a semen analysis.

Treatment

The treatment of low testosterone depends on the cause, the symptoms, and the goals of the patient. The main goal of the treatment is to restore the testosterone level to within the normal range and improve the quality of life of the patient. The treatment options may include:

• The most popular and successful treatment for low testosterone is testosterone replacement therapy. Synthetic testosterone can be introduced into the body by injections, patches, gels, pellets, or tablets as part of testosterone replacement treatment. The symptoms and consequences of low testosterone, including libido, erectile dysfunction, muscle mass, bone density, mood, and cognitive abilities, can be ameliorated by testosterone replacement treatment. However, there are some dangers and adverse consequences associated with testosterone replacement medication, including increased risk of heart disease or stroke, liver damage, fluid retention, acne, and prostate enlargement. As a result, testosterone replacement treatment needs to be administered carefully and with frequent follow-up, under the supervision of a physician.

• Medications that can induce the testicles or pituitary gland to produce or release more testosterone or LH, such as clomiphene citrate, human chorionic gonadotropin (hCG), or aromatase inhibitors. For individuals who wish to maintain their fertility or who have secondary low testosterone, these drugs can be used as adjuncts or alternatives to testosterone replacement treatment. These drugs can cause gynecomastia, ovarian hyperstimulation syndrome, headaches, nausea, and eyesight issues, among other dangers and adverse effects. As a result, a doctor should also prescribe and oversee the administration of these drugs, and they should also be used carefully and often monitored.

• A patient's overall health and well-being can be enhanced by lifestyle modifications such as weight loss, regular exercise, eating a balanced diet, quitting smoking, consuming less alcohol, managing stress, and getting enough sleep. These changes may also enhance the body's natural production or function of testosterone. A change in lifestyle can also help prevent or treat conditions including obesity, diabetes, cardiovascular disease, and osteoporosis, which are some of the causes or repercussions of low testosterone.

Prevention

Some cases of low testosterone may not be preventable, especially if they are caused by genetic or congenital factors. However, some cases of low testosterone may be prevented or delayed by taking some preventive measures, such as:

• Maintaining a healthy weight and avoiding obesity, which can reduce the conversion of testosterone to estrogen and increase the secretion of LH

• Practicing good hygiene and avoiding infections or injuries that can damage the testicles, the brain, or the pituitary gland

• Avoiding or limiting the use of medications that can lower the testosterone level or interfere with its action, such as opioids, steroids, antidepressants, or antifungals

• Treating or controlling any underlying conditions that can affect the metabolism or function of testosterone or LH, such as diabetes, thyroid disorders, liver disease, kidney disease, or HIV

• Getting regular check-ups and screenings to detect and treat any problems that can affect the testosterone level, such as prostate cancer, testicular cancer, or pituitary tumors