Causes of Low Testosterone in Men

Home > Low testosterone > Causes of Low Testosterone in Men

 Testosterone deficiency, otherwise known as male hypogonadism is an issue that affects a significant number of men, often leading to various health challenges. Understanding the root causes of this condition is essential for effective diagnosis and treatment. Men of all ages are suffering from symptoms of testosterone deficiency. According to a study on testosterone therapy(TRT) in the UK, over a 10-year period from 2001-2011, testosterone prescriptions increased by 90%!

This article explores 6 primary causes of testosterone deficiency, highlighting the diverse factors that can contribute to low testosterone levels. From environmental toxins to lifestyle choices, and underlying medical conditions, we will delve into the key contributors, symptoms and treatments to this condition.

What is testosterone?

Testosterone is a vital hormone primarily produced in the testes in men and, to a lesser extent, in the ovaries in women and the adrenal glands in both sexes. It is essential for overall health and well-being, with levels typically peaking during adolescence and early adulthood. There are many reasons why a man might have low testosterone levels. This ranges from lifestyle choices to medical conditions and natural ageing. Whatever the cause, this decrease can lead to various health issues. Maintaining balanced testosterone levels is crucial, and understanding the factors that influence its production and regulation can help in managing any related conditions effectively.

The Role of Testosterone in the Body

Testosterone plays a significant role in numerous aspects of our bodies, impacting not only physical development but also essential, life-sustaining processes. It influences various areas of the body, underscoring its importance as one of the most critical hormones for overall health and well-being. Here are some key areas where testosterone exerts its influence.

• Puberty & body development
• Muscle mass & muscle strength
• Bone density & strength
• Libido/sex drive
• Stimulate sperm production
• Hair growth
• Red blood cell production

Hypothalamus, Pituitary, and Testicle Dysfunction & Low Testosterone

Disruption in the functioning of the testicles, hypothalamus, or pituitary gland can lead to low testosterone levels, also known as male hypogonadism. Each of these components plays a critical role in the hormonal pathway that regulates testosterone production.

1. Testicles:

The testicles are directly responsible for producing testosterone. If they are damaged due to injury, infection, or medical treatments like chemotherapy, their ability to produce testosterone can be significantly reduced. Conditions such as testicular torsion, undescended testicles, and mumps orchitis can also impair testicular function.

2. Hypothalamus:

The hypothalamus releases gonadotropin-releasing hormone (GnRH), which is essential for triggering the pituitary gland to produce luteinizing hormone (LH) and follicle-stimulating hormone (FSH). If the hypothalamus is not functioning correctly due to genetic disorders, tumors, or trauma, it may not produce sufficient GnRH, leading to inadequate stimulation of the pituitary gland and, consequently, reduced testosterone production.

3. Pituitary Gland:

The pituitary gland responds to GnRH from the hypothalamus by secreting LH and FSH. LH is crucial for stimulating the testicles to produce testosterone, while FSH supports sperm production. Pituitary disorders such as tumors (adenomas), inflammation, or surgical damage can impair the gland’s ability to release these hormones, resulting in decreased testosterone production.

When any part of this regulatory axis (hypothalamus, pituitary gland, or testicles) is disrupted, the intricate balance required for normal testosterone production is disturbed, leading to male hypogonadism. This condition can cause a range of symptoms, including reduced libido, fatigue, muscle weakness, and mood changes. Proper diagnosis and treatment are essential to address the underlying issues and restore normal hormone levels.

Image source: www.sciencedirect.com

Causes of Low Testosterone

Low testosterone, also known as male hypogonadism, can result from a variety of factors. These causes can be broadly categorised into primary, secondary, and functional hypogonadism.

Primary Hypogonadism (Testicular Causes)

Primary hypogonadism originates from problems within the testicles themselves:

1. Genetic Disorders: Conditions such as Klinefelter syndrome, where there is an extra X chromosome, can impair testicular function.
2. Injury or Trauma: Physical damage to the testicles from sports, accidents, or surgery can affect testosterone production.
3. Infection: Infections like mumps orchitis can damage the testicular tissue responsible for testosterone production.
4. Medical Treatments: Chemotherapy and radiation (cancer treatment) can impair the testicles’ ability to produce testosterone.
5. Undescended Testicles: If one or both testicles fail to descend into the scrotum at birth, it can affect hormone production later in life.

Secondary Hypogonadism (Hypothalamic or Pituitary Causes)

Secondary hypogonadism stems from problems with the hypothalamus or pituitary gland, which regulates testosterone production:

1. Pituitary Disorders: A pituitary tumour (adenomas) or pituitary gland problem can impair its ability to produce LH and FSH, which are critical for stimulating testosterone production.

2. Hypothalamic Disorders: Conditions affecting the hypothalamus, such as Kallmann syndrome, can result in insufficient production of GnRH, leading to low levels of LH and FSH.

3. Trauma: Head injuries that affect the pituitary gland or hypothalamus can lead to secondary hypogonadism.

4. Genetic Conditions: Certain genetic mutations can impact the functioning of the hypothalamus or pituitary gland.

Functional Hypogonadism

Functional hypogonadism is often associated with broader health and lifestyle issues:

1. Obesity: Excess body fat can lead to increased conversion of testosterone to estrogen and decreased production of testosterone.

2. Metabolic Syndrome: Conditions such as diabetes, high blood pressure, and high cholesterol can disrupt hormone production.

3. Chronic Illness: Long-term illnesses like HIV/AIDS, kidney disease, liver disease and prostate cancer can affect testosterone levels.

4. Medications: Certain drugs, including opioids, steroids, and antidepressants, can lower testosterone levels.

5. Stress and Psychological Factors: Chronic stress and depression can negatively impact hormone production.

6. Alcohol and Substance Abuse: Excessive alcohol consumption and the use of recreational drugs can impair testosterone production.

Normal Aging

Testosterone levels naturally decline with age, typically starting around age 30 and continuing to decrease by about 1% per year. This gradual decline can lead to symptoms of low testosterone in older men, otherwise known as late onset hypogonadism, andropause or male menopause.

Lifestyle Factors

1. Poor Diet: Nutrient deficiencies, especially in zinc and vitamin D, can impair testosterone production.

2. Lack of Exercise: Sedentary lifestyles are associated with lower testosterone levels, while regular physical activity, particularly strength training, can boost hormone production.

3. Sleep Deprivation: Inadequate sleep and poor sleep quality can lower testosterone levels.

Poor general health: Poor general health can cause chronic illness like obesity, and metabolic disorders. These health conditions can disrupt hormone production and balance, leading to decreased testosterone levels.

Symptoms of Low Testosterone

Men with low testosterone levels can experience a range of symptoms. Many of these symptoms can also present themselves alongside other conditions such as diabetes, high blood pressure, and coronary disease. Some of the most common low T signs are listed below:  

• Low sex drive/libido
• Erectile dysfunction
• Decreased muscle mass
• Increased weight gain
• Fatigue
• Frequent urination at night
• Body and facial hair loss
• Pelvic floor pain
• Depression
• Poor memory or concentration

If you have two or more of the symptoms listed above, we would advise you to book a free consultation. Our doctors are specialised professionals where you can discuss your health and available treatments further.   

Normal Testosterone Levels

Testosterone is measured in nanograms per decilitre of blood (ng/dl) and the following table illustrates healthy levels for different adult age groups. It’s important to note that healthy levels can vary from person to person.

Source: J Urol. 2022 ‘What Is a Normal Testosterone Level for Young Men?‘

Testosterone Replacement Therapy (TRT)

TRT is a hormone replacement therapy that aims to restore testosterone levels to optimal physiological range. Itinvolves providing the body with bioidentical testosterone to help relieve low testosterone symptoms.

TRT administration

The most common way for testosterone to be administered is through topical methods like testosterone gel or cream but it can also be administered by:

• Cream
• Gel
• Patch
• Pill
• Implant.
• Injection

How To Get Testosterone Treatment (TRT)

1. Recognise the Signs and Symptoms

The first step in pursuing TRT is recognising the signs and symptoms of low testosterone, the most common symptoms include:

Decreased sex drive

Erectile dysfunction

Fatigue and low energy levels

2. Consult a Healthcare Provider

If you are experiencing symptoms associated with low testosterone, schedule a consultation with a healthcare provider. During the consultation, your doctor will take a detailed medical history and perform a physical examination to evaluate your symptoms and overall health.

3. Blood Tests

To diagnose low testosterone, your healthcare provider will order blood work. These tests typically measure the total testosterone level in your blood. It is important to have these blood serum tests done in the morning when testosterone levels are naturally highest.

4. Blood Test Results

Once your blood test results are available, your doctor will review them with you. If your serum testosterone levels are below the normal range, and you are experiencing related symptoms, your doctor may diagnose you with hypogonadism.

5. Discuss Treatment Options

If you are diagnosed with low testosterone, your healthcare provider will discuss treatment options with you. TRT can be administered in various forms (see above). Your doctor will help you choose the best form of TRT based on your preferences, lifestyle, and medical condition.

6. Start Treatment

After deciding on a treatment plan, your healthcare provider will prescribe testosterone replacement. You will receive instructions on how to use the medication and monitor your response to the treatment.

7. Monitor and Adjust

Regular follow-up appointments are essential to monitor your progress and adjust the treatment as needed. Your healthcare provider will periodically check your testosterone levels through blood tests to ensure they are within the desired range. Additionally, they will monitor for any side effects or complications.

Testosterone Replacement Therapy Side Effects

Testosterone Replacement Therapy (TRT) can offer significant benefits, but it’s important to be aware of potential side effects. These may include:

Blood Clots: Elevated testosterone levels can increase the risk of blood clot formation, which may lead to deep vein thrombosis or pulmonary embolism.

Sleep Apnea: TRT may exacerbate sleep apnea, a condition where breathing repeatedly stops and starts during sleep.

Cardiovascular Disease: There is a potential for increased risk of cardiovascular issues, such as heart attacks or strokes, particularly in those with pre-existing conditions.

Fat Cells: Increased testosterone can sometimes lead to changes in fat distribution, affecting body composition.

Despite these potential side effects, TRT is considered safe when administered under medical supervision, and side effects are relatively rare. Proper management and regular monitoring can help minimise risks and ensure the therapy’s effectiveness.

Final Thought

Understanding the various causes of low testosterone is crucial for accurate diagnosis and effective treatment. If you suspect you have low testosterone, you should consult a healthcare provider for proper evaluation and management.

TRT can be an effective treatment for men with low testosterone, helping to improve various aspects of health and quality of life. If you suspect you have low testosterone, get in contact with us and our specialist doctors can determine if TRT is right for you.

Bibliography/References/Further reading/Scientific studies

Gan EH, Pattman S, H S Pearce S, Quinton R. A UK epidemic of testosterone prescribing, 2001-2010. Clin Endocrinol (Oxf). 2013 Oct;79(4):564-70. doi: 10.1111/cen.12178. Epub 2013 Apr 5. PMID: 23480258.

https://onlinelibrary.wiley.com/doi/10.1111/cen.12178

Evidence Based Research

This article has been researched and written based on scientific evidence and fact sheets that have then been crossed checked by our team of doctors and subject matter experts.

References, sources and studies used alongside our own in-house research have been cited below, most of which contain external clickable links to reviewed scientific paper that contain date stamped evidence.

Our team of healthcare experts and GMC registered doctors are licensed to UK GMC standards. We strive to provide you with the latest evidence based, researched articles that are unbiased, honest and provide you with accurate insights, statistics and helpful information on the discussed topic to ensure you gain a better understanding of the subject. You can read more about our Editorial Process by clicking here.

We value your feedback on our articles, if you have a well-researched paper you would like to share with us please contact us.