Testosterone is produced in your testes. In puberty, it helps you develop male characteristics, from facial and body hair to a deeper voice and muscle strength. It’s crucial for sperm production and sex drive, and low levels can affect these – and more.
Some men are born with low testosterone, or develop it through injury to the testes, autoimmune disease or cancer. Most men experience a gradual decrease in testosterone as they age. The level peaks in your teens to early 20s, when you develop secondary sexual characteristics such as body hair, and may also experience changes in behaviour, such as increased assertiveness, irritation and aggression.
Testosterone typically starts to decline after age 30 to 40, at a rate of around one percent a year. This may be accompanied by a loss of libido, muscle mass and energy, and mood changes.
In your 50s and beyond, as the decline continues, you can develop increased body fat around your midsection, grow less hair on your head and more in your nose and ears, and have trouble maintaining erections. If your physical or mental wellbeing or your relationship is affected, it’s vital to see your healthcare provider.
Getting your testosterone levels tested
A physical exam is important to rule out other possible health problems (erectile dysfunction can be first a sign of cardiovascular problems). You may then be given blood tests to establish your total testosterone blood level, as well as your luteinizing hormone blood level and prolactin level. The last two levels can establish if low testosterone is linked to a problem with your pituitary gland or your hypothalamus, which controls testosterone production in the testes.
In South Africa, testosterone levels are interpreted according to the reference ranges and units of measurement used by the specific laboratory, says Durban-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, and a low level needs to be confirmed with a second test.”
What is a normal testosterone level?
There’s a wide variation in normal testosterone levels in healthy young men of normal weight, she adds. According to the International Society of Andrology, a testosterone level of less than 8 nmol/L (nanomoles per litre) is regarded as testosterone deficiency, 8-12 nmol/L is borderline, which can be treated if you have symptoms, and above 12 nmol/L is considered sufficient. “However, we should avoid just focusing on the numbers – assessing symptoms of testosterone deficiency influences our decision to start treatment,” she says.
What are the symptoms of low testosterone?
Whatever your age, go for a check-up if you have low sex drive, difficulty achieving and maintaining an erection, loss of body and facial hair, loss of lean muscle mass or bone density, increased body fat, shrinking testicles, hot flashes, low or no sperm count (infertility), loss of energy, loss of physical strength and endurance, constant fatigue, obesity, enlarged breasts, irritability, poor memory, poor concentration and depression, says Cape Town-based endocrinologist Dr Wayne May.
You are more likely to have low testosterone if you are older, obese, have poorly managed diabetes, obstructive sleep apnoea, or a chronic medical condition such as kidney dysfunction, cirrhosis of the liver or HIV/AIDS. “Taking opioids, glucocorticoids (such as cortisone) or anabolic steroids can also raise your risk,” he says.
What is the treatment for low testosterone?
Low testosterone can often be treated with testosterone replacement therapy, improving your sex drive and energy and relieving symptoms of depression. Today, options range from skin gels applied daily, to intramuscular injections – every two to three weekly for short-acting formulations, and every three months for long-acting ones, says Dr May.
“We prefer to use only pharmacological grade testosterone, available as injections and gels,” says Dr Naidoo. “Over-the-counter preparations and supplements may be contaminated with other substances and the testosterone concentrations are not carefully regulated.”
Not everyone is a suitable candidate for testosterone replacement treatment, and it can have side effects such as acne, oily skin, fluid retention, difficulty peeing, breast tenderness or enlargement, worsening of sleep apnoea, smaller testicles, and raised risk of clots.
Prevention is best, and managing weight with a healthy diet and regular exercise may be enough to keep testosterone levels normal. “It can depend on weight, as people who weigh more will need to lose more to see benefits,” says Dr May.
Some studies suggest zinc is especially important, particularly in those with low baseline zinc levels. Good sources are red meat, shellfish, nuts, seeds, whole grains, fortified breakfast cereal and dark chocolate, says Johannesburg-based dietitian Lila Bruk. “Just don’t self-medicate, and don’t exceed the recommended intake for men of 11 mg. Too much can interfere with iron absorption and cause nausea.”
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