"After age 30, most men begin to experience a gradual decline in testosterone," says David Samadi, MD, chairman of the urology department at Lenox Hill Hospital in New York City.
Although testosterone levels never reach zero (as estrogen levels do in women during menopause), low testosterone levels men to experience symptoms such as fatigue, low libido, and loss of muscle mass.
While low testosterone is more common in older men, it may occur in younger guys also. Fortunately, all the causes of low testosterone in young guys are curable, so if you encounter such symptoms at any given age, there is no reason to dismiss it.
For younger men, a fall in testosterone levels may be brought on by some illnesses, including type 2 diabetes, chronic liver or liver disease, COPD or other lung disorder, or adrenal gland problems, based on Dr. Samadi.
Genetic causes of low testosterone in men include the diseases Klinefelter syndrome, Kallmann syndrome, Prader-Willi syndrome, and Myotonic dystrophy. Another disorder which could result in low testosterone is hemochromatosis, which makes the body shop too much iron.
"Low testosterone can also result when something happens, like trauma or steroid use, that prevents the testes from making the hormone," states Bruce Gilbert, MD, PhD, an adjunct clinical professor of urology and reproductive medicine at Weill Cornell Medical College and director of reproductive and reproductive medicine at the Smith Institute for Urology of the North Shore-LIJ Health System.
Other causes of low testosterone in males younger than 50 include pituitary gland tumors, HIV infection, and radiation therapy or chemotherapy for cancer.
Doctors categorize causes of low testosterone as primary or secondary.
"Primary hypogonadism stems from a problem in the testicles," Samadi says.
Is It Low Testosterone?
Irrespective of the cause, low testosterone symptoms are the same.
"Symptoms include low libido, erectile dysfunction, fatigue, decreased mental acuity, and moodiness," Dr. Gilbert says.
"Younger men with low testosterone usually come to me and say, ‘I can't work out like I used to, and I've lost interest in sex.' â€
If you suspect low testosterone, the first step is to see your primary care physician. Your doctor can diagnose low testosterone with a blood test.
If your blood test reveals low testosterone (usually defined as a level lower than 300 ng/dL), the doctor may treat you or refer you to a specialist, such as a urologist or endocrinologist.
Treatments for Low Testosterone in Younger Men
Not everyone with low testosterone needs treatment. "When it comes to treating low testosterone in younger guys, we usually reserve treatment for people who have symptoms, such as fatigue and reduced libido," Gilbert says.
In these circumstances,"treatments are often used just in the brief term, and if a physician has close observation and knowledge of the individual," Gilbert says.
An important consideration for younger men before getting treatment is fertility. "You don't want to give supplemental testosterone to men who are interested in being fertile because it can turn off sperm production," Gilbert says.
Once a young man goes off testosterone supplementation, there's a chance his sperm count will never return to what it was before he started. "Therefore, men of reproductive age should consider alternatives that might increase their testosterone as well as preserve their sperm production," he says. One such choice is a class of drugs called selective estrogen receptor modulators (SERMs).
Other treatments for low testosterone include weight loss and other lifestyle changes, like eating healthier and raising exercise.
The bottom line, though, is that in the event that you have low testosterone symptoms, then it's important to see your doctor. Then, your doctor can rule out potentially more significant causes of your symptoms, including hypertension or a thyroid problem, and give treatment that could enhance your energy and quality of life.