Testosterone is the primary sex hormone in men. It is responsible for the secondary sexual characteristics we see develop in boys during puberty, and has profound physical and psychological effects on our bodies throughout our lives. Testosterone stimulates sperm production as well as sex drive. It also helps build muscle, minimise body fat, makes us hairy, (as well as lose hair on our heads), changes the way we think, and is involved in mood and cognitive function. Testosterone affects all aspects of the male body both physically and mentally, and is crucial in helping us maintain a good quality of life.
So why might my testosterone levels have changed?
Testosterone production typically starts to decrease by about 1% per year from the age of 30. However, the rate and severity with which testosterone levels drop in practice, is highly individual and can be affected by a range of external factors. Low testosterone is relatively common in the over 40 age group, affecting up to 12% of men aged 50 and over, and with prevalence increasing each year. Those more likely to suffer from testosterone deficiency are men with pre-existing health problems such as diabetes (up to 50% of men with type 2 diabetes have low testosterone levels), obesity, high blood pressure, raised cholesterol levels, heart disease, and chronic inflammatory conditions (such as asthma or arthritis). Some prescription medications will also lower testosterone production.
Symptoms of testosterone deficiency may include a decrease in libido, difficulty in achieving and maintaining an erection, tiredness, reduced muscle mass, increased body fat, mood swings, or just feeling like everything is that bit harder. Importantly, testosterone deficiency is not just a physical disorder; it can have a significant impact on mental and emotional wellbeing.
The key factor is to decipher why the levels are low and then in some cases, testosterone levels can be restored by making lifestyle changes, for instance changing the way we exercise, improving diet, avoiding consuming large amounts of alcohol, and even reducing stress levels. Sleep is another important factor in testosterone production; although the ideal amount of sleep varies from person to person, one study found that sleeping only 5 hours per night was linked to a reduction in testosterone levels. We should all be aiming for adequate, good-quality sleep.
What should I do if lifestyle changes alone don’t seem to be making a difference?
In patients where making lifestyle changes are not enough to restore normal testosterone function, testosterone replacement therapy (TRT) may be considered where testosterone deficiency has been properly diagnosed and treatment is clinically appropriate.
There are several ways to administer TRT: topical gels, creams, and short, medium, or long-acting injections. The most appropriate option depends on the individual, and treatment requires appropriate assessment and ongoing monitoring.
TRT has potential benefits and risks, and these should be discussed before treatment is started. Current evidence does not support the idea that appropriately prescribed TRT automatically causes prostate cancer or cardiovascular events, but individual risk factors still need to be assessed and monitored.
Some clinics will advocate that one type of TRT is the “gold standard” and that method, preparation, or therapy should always be used. However, in reality this is not the case.
The best form of TRT is one that works for you. It needs to be a combination of a treatment that is safe, based on individual risk, easy to administer, and provides appropriate clinical benefit.
So what should you do if you think you’re suffering with low testosterone?
If you suspect you might be suffering with low testosterone, it is important to get it checked. By seeing a Men’s Health specialist, you can have your symptoms and blood results properly assessed and discuss whether lifestyle changes, further investigation or treatment may be appropriate.
