Understanding Low Testosterone

Testosterone is the male sex hormone and is literally responsible for what makes us men (including genital development, height, muscle mass and facial hair during puberty), but it also does much more.

Testosterone acts on our muscles, fat cells, affects our cholesterol, blood pressure, bone density and even the way our brain works.   It affects the way we think and provides us with drive, motivation, energy and influences our personality.

In fact, testosterone has some impact on almost every aspect of our body.  It is no wonder, therefore that men feel rubbish when their levels drop.

Surely if we feel terrible when our testosterone levels plummet, the answer is to just get some testosterone replacement therapy (TRT), and everything will be great?  Well, yes and no.  And not always.

We commonly have contacts and emails from many men who have independently taken a blood test (finger prick or from a vein), which comes back with an uncertain testosterone level, and whose first question is: “Am I eligible for TRT?”   This should be a difficult question for any doctor to answer because TRT is the final part of an investigatory pathway and not the first.

If your doctor looks at your initial numbers and his first response is “ Yes of course, let’s get you a prescription”, alarm bells should be ringing.

For most men with a confirmed low testosterone, TRT is a prolonged treatment and is designed to simply put testosterone levels back to a normal or even optimal level.   However, the question should always be “Why has my testosterone dropped in the first place?”

We know that age is a key factor in the decline in testosterone production.  After the age of 30 men tend to lose about 1% of their testosterone production per year, (although this can be sped up or slowed down based on lifestyle and medical factors).   If this is the case, and other factors have been considered, then starting TRT is a more straightforward process.

Another important contributor to low testosterone in men is obesity, which acts as a direct antagonist to testosterone.  But in practice the list of factors than impact on testosterone production is vast, and a small sample includes:

• Type 2 diabetes
• High Blood Pressure
• Liver, Kidney problems
• Cancer and cancer treatments
• Lung disease (including asthma)
• Thyroid disease
• Sleep patterns
• Alcohol
• Exercise (too little or too much)
• Many prescription and non-prescription drugs

One of the main reasons we have doctors with a specialist interest in Men’s Health is because if you can find out why your testosterone is low, you may be able to improve this by changing a medication, getting a different treatment, or altering your lifestyle.  If you are really lucky, it may mean you do not need TRT at all.

Going straight to TRT without looking at why your testosterone is low, is a bit like stitching up a wound without knowing why you were bleeding in the first place.

A bit like HRT for menopause in women, testosterone replacement therapy for men can be life changing.  It can make you feel better both mentally and physically and reduce the risks of various medical conditions.  But it is still a medicine, and requires blood monitoring, review with a doctor, and you may end up on treatment for many years.

Therefore, when considering clinics or treatment options, I would always ask the doctor “ I have done a blood test and I have low testosterone, can you help me work out why it is low, and what we can do together to put it right?”.

If you’d like to talk to one of our men’s health specialists about low testosterone or any of the topics we’ve touched on you can make a booking here – to make it easy we offer consultations online or face to face, whichever you prefer.