Medical Conditions That May Cause Low Testosterone

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Testosterone is a primary male sex hormone that fuels sex drive, regulates sperm production, and increases muscle mass in men. Its production increases during puberty and begins to drop when you hit 30.

The decline in testosterone production is a part of the natural ageing process, but sometimes you may experience it due to a medical condition. Low T can cause numerous symptoms, including erectile dysfunction, fatigue, depression, and loss of muscle mass.

Let’s see what medical conditions can contribute to low T and how you can fight it.

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Health conditions that cause low T

Type 2 diabetes

Type 2 diabetes is the most common form of diabetes in which your body fails to properly use the insulin hormone that regulates blood sugar levels. Diabetic people have insulin resistance, meaning their body makes enough insulin, but their cells do not respond to it.

Experts believe that men with type 2 diabetes are more likely to have low T. In a study of 580 type 2 diabetic men, researchers found that 43% of all men had low total testosterone levels, and 57% had low free testosterone levels.

Obesity

It is a complex disease that develops due to excessive accumulation of body fats. People suffering from this condition have a 30 or more BMI.

Obese men are at a higher risk of low T than men without this disease. A study indicates that the BMI of healthy men is inversely proportional to free testosterone levels. It means the higher your BMI, the lower your testosterone.

It is believed that it might be due to two reasons. First, fat tissue may start expressing more aromatase enzymes that convert testosterone into androgen. The second reason might be the reduced production of SHBG protein, a carrier protein that transports testosterone in the blood.

Reducing body fat can help obese men restore their testosterone levels.

Non-alcoholic fatty liver disease (NAFLD)

NAFLD is the build-up of fats in the liver even when you drink little to no alcohol. It is usually seen in obese or overweight people. People with early-stage NAFLD have a healthy liver, but they can experience severe liver damage if the condition gets worse.

Some studies suggest an association between liver damage and testosterone. NAFLD contributes to low insulin sensitivity and visceral adipose tissue (VAT) accumulation, both of which are linked to low T.

Head injury

Traumatic brain injuries can affect testosterone production if the pituitary or hypothalamus is damaged in any way.

The Hypothalamus is part of the brain, and the pituitary gland is attached to it. Hypothalamus secretes gonadotropin-releasing hormone (GnRH), which stimulates the pituitary to secrete luteinising hormone (LH). LH makes testicular Leydig cells produce and release testosterone.

Diminished pituitary or hypothalamus function means reduced production of LH or GnRH. As a result, testosterone production declines.

Sleep apnea

It is a sleep-related breathing disorder in which your breathing stops and starts while you sleep. If it is left untreated, it can lead to serious problems like high blood pressure.

Sleep apnea in men is associated with low testosterone. Men with this condition have reduced pituitary-gonadal function and deep sleep time, both of which affect testosterone levels.

Kidney failure

Kidney failure means your kidney can no longer filter blood and remove waste products. It can be temporary or permanent.

Studies show that more than half of male kidney failure patients have low testosterone levels. Its possible reason might be the reduced LH production in them.

Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a general term used for several lung-related diseases, such as chronic bronchitis. It can cause airflow blockage, fatigue, and weakness.

Men with COPD are seen to have low testosterone levels. Scientists have not yet found the exact reason behind this correlation, but they suspect that low oxygen levels in COPD men may affect testosterone production.

COPD treatment (steroid-based medications) may further reduce the testosterone level.

Alcohol use disorder

Alcohol use disorder (AUD) is a medical condition which involves frequent alcohol drinking despite its negative health and social effects. It is also known as alcoholism, alcohol abuse, or alcohol addiction.

Excessive alcohol consumption is known to affect reproductive health and testosterone levels in men. A study has found that testosterone levels start declining in men in just 30 minutes after alcohol consumption.

Alcohol damages testicular Leydig cells, impairing their ability to produce testosterone. It may also reduce LH or GnRH synthesis by disturbing pituitary or hypothalamus functions.

Injury to testicles

Since testosterone is produced and released by the testicles, any injury to the testicles can have a direct effect on your testosterone levels.

AIDS

Acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV) that damages the immune system and makes the person susceptible to diseases and infections. Once this virus enters your body, you cannot remove it fully and have to live the rest of your life with it.

Several studies have shown that a majority of HIV-infected men have low T. It can be due to multiple reasons, such as chronic inflammation or some other disease that the person may develop due to poor immunity.

Iron overload

Haemochromatosis, or iron overload, is a condition in which your body starts storing excess iron in different organs, mainly in pancreas, heart, and liver. It leads to several problems, including diabetes, low sex drive, and hyperpigmentation.

Men with iron overload tend to have low T. It might be because high iron levels induce testicular shrinkage and make existing testosterone not function correctly.

Infections

Some bacterial and viral infections, such as coronavirus infection, can also reduce serum testosterone levels. It is a temporary problem; your testosterone level will restore when the infection is gone.

Testicular cancer

Testicular cancer is the uncontrolled division of cells in the testicles. It results in the formation of painful lumps in one or both testes. Men with this problem have low T. Surgery, or chemotherapy further reduces their testosterone levels.

Cushing’s syndrome

It is a condition in which your adrenal gland starts producing too much cortisol (also called the stress hormone because of its role in stress regulation). It can produce severe effects if it is left untreated.

Elevated cortisol levels block the production of testosterone. The stress hormone keeps your body in fight or flight mode, during which it pushes its need to produce a healthy amount of testosterone away to survive a difficult situation.

Kallmann syndrome

It is a hormonal disorder that causes delayed or absent puberty. It occurs when the body fails to produce enough GnRH required to stimulate testosterone production; as a result, the affected person has low testosterone levels. It is a genetic problem; hence it cannot be cured.

Klinefelter’s syndrome

It is another genetic disorder in which a boy is born with an extra X chromosome. A normal boy is XY; however, a boy with Klinefelter’s syndrome is XXY.

XXY men have small testicles that produce no or very little testosterone. They are unable to produce sperm and are mostly infertile.

Other causes of low T

Low T can occur due to many other reasons such as:

• Medications: Certain medications, such as psychoactive drugs or corticosteroids, can block testosterone production. However, this issue is temporary. In most cases, testosterone levels are restored once you stop taking the medication.
• Sleep deprivation: A study shows 1 week of sleep restriction can affect a man’s testosterone levels prominently. When your testosterone goes down, cortisol production rises. You feel low and exhausted most of the time.
• Stress: As mentioned earlier, the cortisol hormone is released during stress to help the body cope with difficult situations. It blocks testosterone production.
• Certain foods: Your diet can increase or decrease your testosterone levels. Soy or soy-based products, processed foods, flaxseeds, and vegetable oil negatively influence testosterone production. You should avoid taking these foods if you have trouble maintaining your testosterone levels.

Can you restore your testosterone levels?

All the medical conditions mentioned earlier can dampen your testosterone levels. Some of them can be cured, while others cannot. When a disease is cured, your body will most probably start making testosterone again.

However, in certain cases, such as Klinefelter’s syndrome, head injury, testicular injury, etc., you may never be able to produce normal amounts of testosterone. In such cases, doctors often recommend testosterone replacement therapy (TRT).

Let TRT help

In this treatment method, man-made testosterone is administered in the body through different methods such as injections, creams, skin patches, etc. Your doctor adjusts your dose based on your current testosterone levels.

It is a lifelong treatment that has helped millions of men enhance their sexual performance, be more energetic, or increase muscle mass by restoring their testosterone levels.

The treatment may worsen symptoms of certain diseases. That is why your doctor will most likely first conduct different tests to evaluate whether or not you are the right candidate for TRT. Discuss all aspects of TRT with your doctor to understand it better and find how it can help you improve your life.

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References/Further reading/Bibliography/Scientific studies

• Duca, Y., Aversa, A., Condorelli, R.A., Calogero, A.E. and La Vignera, S., 2019. Substance abuse and male hypogonadism. Journal of clinical medicine, 8(5), p.732.
• Snyder, G. and Shoskes, D.A., 2016. Hypogonadism and testosterone replacement therapy in end-stage renal disease (ESRD) and transplant patients. Translational andrology and urology, 5(6), p.885.
• Mody, A., White, D., Kanwal, F. and Garcia, J.M., 2015. Relevance of low testosterone to non-alcoholic fatty liver disease. Cardiovascular endocrinology, 4(3), p.83.

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