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Do you have low testosterone levels?

The male sex hormone is responsible for everything from facial and body hair to muscle strength and sex drive, and lower levels can affect these and more. But there are ways to treat it.

10 July 2023 | By Glynis Horning

Testosterone is made in the testes. You need testosterone to make sperm and for your sex drive. But some men are born with or develop lower levels of the hormone for a range of reasons, including injury to the testes, autoimmune disease and cancer – and most men experience a decrease with age.

Studies suggest 2% of men may have low testosterone, ranging from 1% of young men to 8% of those aged 50 to 80. The Mayo Clinic reports that testosterone level gradually declines, “typically about 1% a year after age 30 or 40”.

In South Africa, testosterone levels are interpreted according to the reference ranges and units of measurement used by the specific laboratory, says KwaZulu-Natal-based endocrinologist Dr Kumari Naidoo. “It’s very important that a reputable laboratory is used. Testosterone should be measured in the morning after an overnight fast (it’s influenced by daily variation and food intake) and a low level needs to be confirmed with a second test.” 

She adds that there’s a wide variation in normal testosterone levels in healthy young men of normal weight: between 9.2 – 31.8 nmol/L (nanomoles/litre). “According to the International Society of Andrology, a testosterone level of less than 8 nmol/L is regarded as testosterone deficiency; between 8-12 nmol/l represents borderline testosterone levels which can be treated if a person has symptoms; and levels above 12 nmol/L are considered sufficient. We should avoid just focusing on the numbers – assessing symptoms of testosterone deficiency influences our decision to start treatment.”

Know the signs

Common symptoms of low testosterone are:

  • Low sex drive
  • Erectile dysfunction
  • Loss of body and facial hair 
  • Loss of lean muscle mass
  • Loss of bone density
  • Shrinking testicles
  • Hot flashes
  • Low or no sperm count (infertility)
  • Loss of energy, physical strength, endurance
  • Constant fatigue
  • Obesity
  • Enlarged male breasts
  • Irritability
  • Depression
  • Poor memory
  • Poor concentration

If you experience these, it’s important to get checked out. You are more likely to have low testosterone if you are older, obese, and have poorly managed diabetes, obstructive sleep apnoea, or a chronic medical condition such as cirrhosis of the liver, kidney dysfunction, or HIV/aids. Using opioids, glucocorticoids (such as cortisone) and anabolic steroids can also raise your risk.

Take action

Your health provider will do a physical exam, ask about your medical history, and then may order blood tests to establish your total testosterone blood level, and your luteinizing hormone blood level and prolactin level. These last two can help establish if low testosterone is linked to a problem with your pituitary gland or hypothalamus, which control testosterone production in the testes, says Dr Kumari. 

Low testosterone can usually be treated with testosterone replacement therapy (TRT), which for many men can help to improve their sex drive and energy, and relieve symptoms of depression. Options have never been wider, from pills to skin gels you apply daily, intramuscular injections (weekly, or every 10 weeks for longer-acting types), patches and pellets (implanted every three to six months).

“We prefer to use only pharmacological grade testosterone, which is available as injections and gels,” says Dr Kumari. “Although over-the-counter preparations and supplements are easily available, the danger is that these products may often be contaminated with other substances, and the testosterone concentrations are not carefully regulated.” 

But not everyone is a candidate for TRT, she adds – a history of prostate cancer, breast cancer, uncontrolled heart failure or obstructive sleep apnoea is likely to rule you out.

Men have been drawn down the ages to enhancing their virility, and a growing number are now reported to be requesting TRT, but it can have unpleasant side effects – from acne and oily skin to fluid retention (swollen ankles), difficulty peeing, breast enlargement or tenderness, worsening of sleep apnoea, smaller testicles, and blood thickening that may cause clots.

As always, prevention is best, and in many cases managing weight with a healthy diet and regular exercise may help keep testosterone levels normal. “Levels can be ‘functionally’ reduced by many factors, like being overweight, having uncontrolled diabetes, depression and using substances like opioids and marijuana,” says Dr Kumari. “Addressing these factors can improve testosterone levels.”

Some studies suggest zinc can be helpful, and good sources are beef, chicken, oysters, legumes, nuts, seeds, whole grains and fortified breakfast cereals, says Joburg dietitian Ria Catsicas. If you can’t consume enough in your diet, ask about a supplement, but don’t exceed the recommended daily intake for men of 11mg.

IMAGE: 123rf.com