Let’s Talk About “T”

Low testosterone, or low T (also known as andropause or hypogonadism), has been a topic of increasing interest in recent years. Maybe that’s because approximately 39% of men aged 45 years and older may have low T.

That is not to say men of any age can’t experience low T as well. Men who have high blood pressure, diabetes, obesity, and high cholesterol are more likely to experience low testosterone levels and the symptoms that accompany them. Young, healthy men can have low testosterone as well. It is important for all men to be aware of the symptoms of low testosterone instead of shrugging them off as a side effect of aging.

Symptoms to Look For

Male hypogonadism is often characterized by reduced libido, erectile dysfunction, thinning of facial and body hair, loss of lean muscle with increased body fat, and a shrinking stature. This condition can also lead to extreme fatigue, depressed mood, and a change in sleeping patterns. While many of these symptoms can be attributed to other conditions, it is important to seek a doctor’s advice to rule out other causes and run laboratory testing.

Lab Tests

Before doctors determine if treatment is necessary, it is important they consider lab values and the presence of symptoms that might correlate with those lab values. A few key laboratory values to assess include total testosterone, free testosterone, and estradiol, a predominate form of estrogen that also plays a critical role in male sexual function, including modulating libido, erectile function and spermatogenesis.

According to professional compounding pharmacist Bruce Biundo, the normal range for total testosterone in men is 300-1000 ng/dL. The optimal range is 600-750 ng/dL. The normal range for free testosterone in men is 47-244 pg/mL, and the normal range of estradiol in men is 0-50 pg/mL, with the optimal range being 20-30 pg/mL.

Luteinizing hormone (LH) is another important value that can help differentiate between primary and secondary hypogonadism. An elevated LH level can indicate primary hypogonadism, which is a dysfunction of the testes, while a relatively low LH level can indicate secondary hypogonadism, which results from improper signaling from the brain. The normal range for LH is 1.3-13 IU/L.

Traditionally, primary hypogonadism has been treated with testosterone supplementation and secondary hypogonadism has been treated with medications and lifestyle modifications.

While there is no widely accepted testosterone-to-estrogen ratio, changes in this ratio can result in symptoms of hypogonadism. For some individuals, the exact cause can be challenging to identify. Lifestyle modifications, such as increasing exercise, eating a wide variety of healthy foods, and reducing alcohol consumption, can help boost testosterone levels, but many individuals will require treatment.

If you are a man who thinks he may have low T, it is important to mention your symptoms to your doctor and get your testosterone, estrogen, and LH levels checked. Proper treatment can be extremely effective and can lead to a happier, healthier life.

Estrogen is Not Just for Women

Estrogen is also present in men. Too much estrogen in males has been linked to swelling or enlargement of breast tissue (also known as gynecomastia), erectile dysfunction, infertility, depression, delayed puberty in boys, and short stature.

Many of these symptoms are not too surprising, but why would estrogen render a male short? Scientists say that estrogen both promotes the lengthening of bones and decreases cartilage growth. The problem is that a decrease in cartilage growth can lead to fusion of the growth plates, which could possibly stunt a male’s height.

Just as too much estrogen can be problematic for males, too little of it can also adversely affect them.

In a 2013 Massachusetts General Hospital study, men who were blocked from producing estrogen had increases in body fat. The study also found that adverse effects on this group’s sexual function became more obvious.

Due to their findings, the researchers suggested that estrogen deficiency could also be responsible for some symptoms often associated with low T in men. They recommended that estrogen be measured when assessing sexual dysfunction, loss of sex drive, bone loss, or fat accumulation in men with hypogonadism.