When most of us hear the word “testosterone,” we instantly associate it with manliness, strength, and sexual prowess. However, in reality, testosterone is nothing more than a hormone found in both men and women. In men, it plays a larger role, aiding in the development during puberty of facial hair, a deeper voice, and larger muscles. “In adult men, testosterone is critical in regulating sex drive and sperm production. So, when a man’s testosterone levels begin to drop below what they should be, the symptoms often include low sex drive, fatigue, fertility problems, weight gain around the midsection and irritability, to name just a few,” explains S. Adam Ramin, MD, urologist and medical director of Urology Cancer Specialists in Los Angeles.
But, what exactly causes low testosterone, a common condition that affects approximately four out of ten men over the age of 45. The most common misconception, according to Dr. Ramin, is that low testosterone causes erectile dysfunction. “Low testosterone doesn’t necessarily have anything to do with the physical ability to get, or maintain, an erection, and has more to do with low desire and libido.”
If your doctor suspects low testosterone levels, he’ll administer a blood test to determine whether you fall under the range of “normal,” which is anywhere between 300 to 1,000 ng/dL. The good news is that this condition should not be anything that a man feels ashamed of, and it is very treatable, according to Dr. Ramin. If you do have low testosterone, here are some potential ways that it could affect you.
Physical Changes
It is true that a decrease in testosterone can affect how an individual looks physically. “Low testosterone can cause an increase in body fat, a decrease in muscle mass, weak bones, hair loss, increased fatigue, and tiredness,” says Jamin Brahmbhatt, M.D., a urologist at Orlando Health and co-director of The PUR Clinic in Clermont, Florida. If you notice incessant weight gain, despite attempts to eat healthy and exercise, low testosterone may be the cause.
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Sexual Function
Because the hormone testosterone is important for sexual drive and libido, a low amount can certainly have an impact on sexual function. However, it is good to note that shifts in testosterone does not affect erectile function, but mostly sexual drive, according to Dr. Brahmbhatt. “A lot of men think getting their testosterone replaced is going to improve the quality of their erections, but, unfortunately, this is not always the case,” he says. “When men have low testosterone, they can get a decline in sexual desire.”
Sleep
Low testosterone can also cause issues with energy and difficulty sleeping. “When it comes to sleep, it’s important to differentiate whether the patient truly has symptoms from low testosterone or may also be suffering from sleep apnea, which is known to cause a decline in testosterone,” says Dr. Brahmbhatt. “This is why it’s important when patients have some of these general vague complaints that the entire body is looked into as a whole and all other causes for their symptoms are worked up, as well.”
Mood
There are some reports that link low testosterone with emotional instability with feelings of sadness or depressive symptoms being the most common, according to Dr. Brahmbhatt. He also notes that there are some suggestions that low testosterone can affect memory and concentration, as well.
Heart
Additional physical manifestations of low testosterone also include cardiovascular disease, which may lead to heart attacks and strokes. “In terms of cardiovascular effects, it’s important to note that men with very low testosterone or those with testosterone levels significantly higher than the normal range (ie. those on aggressive TRT), are both at risk of heart attacks and strokes,” says Dr. Ramin. In other words, both ends of the spectrum are not favorable, rather mid-level testosterone levels appear to be cardioprotective.
The only way to truly know if you have low testosterone is with a blood test performed by a highly-trained, male-specialized physician. This way, he or she can determine whether the factors at play are related to normal aging or if the disease hypogonadism is indeed to blame, explains Dr. Ramin. “The physician may also want to run a prostate cancer screening test (PSA) and a test to measure the red blood cell count in the body (hematocrit) to rule out any other conditions that can cause these symptoms,” he adds.
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