Low Testosterone

Figure 1: Symptoms of Low Testosterone.

What is hypogonadism (low testosterone)?

Large proportion of testosterone in the male is produced in the testicles. Testosterone is responsible for male reproductive and sexual functions including puberty, fertility, muscle mass, body composition, bone strength, fat metabolism, sex drive, mood and mental processes.

Low testosterone, also known as male hypogonadism, means the testicles do not produce enough of the male sex hormone testosterone. When levels are low this can present with many symptoms as shown in Figure 1. This can have a negative effect on quality of life.

Production of androgens decreases slightly with age. Low levels are more common in men who are obese and have multiple health conditions.

Diagnosis of hypogonadism

Male hypogonadism is diagnosed based on:

• Long-term discomfort from symptoms

• Low testosterone levels in the blood measured mid-morning on at least two separate occasions

Your doctor may conduct further tests, including checking other hormone levels such as prolactin and those produced by the pituitary gland, thyroid hormones and iron levels. Sometimes CT/MRI scans and testing for rarer genetic conditions may be required.

How do you treat hypogonadism

If hypogonadism is from a secondary cause such as a pituitary tumour, then that will need to be treated. If the cause is testicular, the treatment is a combination of lifestyle changes and testosterone replacement.  

Lifestyle changes include losing weight, adjusting your diet, stopping smoking, and increasing exercise can improve your muscle strength, diabetes, sexuality and overall quality of life. 

Testosterone replacement can be via oral tablets, injections or topical skin application. There are advantages and disadvantages of each route and your doctor will discuss these with you to find the agent most suitable for your circumstances.

You should not take testosterone supplements if you have certain untreated medical conditions like heart disease, prostate cancer, an enlarged prostate that causes problems urinating, male breast cancer, a high red blood cell count, severe sleep apnoea and infertility but wanting to have children.