Testosterone levels naturally decline as men age. While this decrease is gradual for most men, some experience a more dramatic drop that leads to symptoms of low testosterone, also known as hypogonadism or androgen deficiency. Understanding the signs and symptoms of low testosterone is important for identifying when hormone replacement may be needed.
What causes low testosterone in older men?
Testosterone is the main male sex hormone produced by the testicles. It plays a crucial role in several body functions and processes, including:
- Muscle mass and strength
- Bone density
- Fat distribution
- Sex drive
- Sperm production
- Red blood cell production
- Mood and cognitive function
As men age, the testes gradually produce less testosterone. This natural decline typically begins after age 30 and continues at a rate of about 1% per year. Other potential causes of low testosterone in older men include:
- Injury or infection of the testicles
- Chemotherapy or radiation treatments
- Medications such as corticosteroids or opioids
- Chronic health conditions like diabetes, HIV/AIDS, kidney or liver disease
- Obesity
- Sleep apnea
- Stress
- Excessive alcohol use
- Genetic conditions such as Klinefelter syndrome
What are normal testosterone levels?
Testosterone levels vary significantly between individual men. In general, normal total testosterone levels in adult men are considered to be:
- 240-950 ng/dL (nanograms per deciliter)
- 8.4-32.6 nmol/L (nanomoles per liter)
However, some men can develop symptoms of low testosterone even if their levels are still within the normal range. Doctors may diagnose low testosterone based on symptoms rather than solely relying on blood test results.
At what age does testosterone start to decline?
Testosterone levels begin a gradual decline after age 30, with an average decrease of about 1% per year. The rate of this decline can vary widely between men. Some may experience minimal changes in testosterone over many decades, while others may have a more significant drop around middle age.
On average, men can expect their testosterone levels to decline at these general rates with aging:
- Ages 30-39: 1% decrease per year
- Ages 40-49: 1.6% decrease per year
- Ages 50-59: 2.4% decrease per year
- Ages 60-69: 3.2% decrease per year
- Age 70 and older: 4% decrease per year
However, men over 65 tend to have lower normal ranges for testosterone due to this age-related decline. Maintaining strength training and a healthy lifestyle may help mitigate testosterone loss to some degree.
What are the symptoms of low testosterone in older men?
The symptoms of low testosterone can develop gradually over time. They may be mistaken for normal signs of aging or other health conditions. However, recognizing these symptoms is key to getting proper treatment when low testosterone is impacting quality of life. Common symptoms include:
Decreased sex drive and erectile dysfunction
Testosterone plays a major role in libido and sexual function. Low testosterone is a common cause of reduced interest in sex and difficulty getting or maintaining erections.
Loss of muscle mass and strength
Lower testosterone leads to reductions in muscle mass and strength over time. Men may notice feeling weaker, reduced muscle tone, and decreased ability to engage in physical activity.
Increased body fat and reduced bone density
Low testosterone allows fat to accumulate more easily, particularly around the abdomen. Lean muscle mass that helps burn calories is also reduced. Lower testosterone also contributes to bone loss and increased fracture risk.
Fatigue, low energy and depressed mood
The hormonal effects of low testosterone can sap energy and enthusiasm for daily activities. Irritability, lack of focus and depression are also common symptoms.
Reduced body and facial hair
Since testosterone influences hair growth, men may notice thinning body hair, reduced facial hair, and receding hairlines when testosterone is low.
Gynecomastia
Low testosterone can cause an imbalance with estrogen. This hormonal shift may result in enlarged breast tissue and tenderness, a condition called gynecomastia.
Sleep disturbances
Difficulty falling asleep, frequent nighttime awakenings, and daytime tiredness are common symptoms of low testosterone. Sleep apnea may also occur.
Hot flashes and sweating
Declining testosterone can lead to hot flashes, much like those experienced during menopause. Night sweats are also reported by some men with low testosterone.
Emotional changes
Dramatic shifts in mood, depression, irritability, and difficulty concentrating are possible psychological effects of low testosterone.
How is low testosterone diagnosed?
If symptoms suggest that testosterone deficiency may be present, a doctor will generally order blood work to measure total testosterone levels. This simple blood test is typically done in the morning when testosterone production peaks.
Results showing testosterone levels below the normal range warrant additional evaluation. The doctor will take a full medical history, perform a physical exam, and check other hormone levels. Further testing may include:
- Repeat testosterone blood tests to confirm low hormone levels
- Tests for luteinizing hormone (LH) and follicle stimulating hormone (FSH) to assess pituitary gland function
- Blood tests to check for underlying health issues impacting testosterone
- Semen analysis to evaluate fertility
- Bone density scans to assess fracture risk
- Sleep studies if sleep apnea is suspected
If no other underlying cause is found, the diagnosis is testosterone deficiency or hypogonadism. Treatment can then be considered based on the severity of symptoms and the degree of testosterone decline.
What are the treatment options for low testosterone?
Increasing low testosterone levels through hormone replacement therapy often relieves associated symptoms. Treatment options may include:
Testosterone injections
Testosterone injections every few weeks are an effective means of hormone replacement. Various doses and formulas are available to best meet individual needs.
Testosterone gels
Daily topical testosterone gels provide continuous hormone delivery through the skin. Gels must be carefully applied to avoid transference to others.
Testosterone patches
Skin patches deliver testosterone gradually when changed daily. Patches may cause skin reactions in some men.
Testosterone pellets
Implanted testosterone pellets release hormones over several months. Minor surgery is required for pellet placement under the skin.
Testosterone pills
Oral forms of testosterone are available but may have greater side effects. Testosterone pills are typically reserved for treating infertility.
Lifestyle changes
Improving diet, increasing exercise, reducing stress, and treating underlying health issues may help boost testosterone. But moderate lifestyle changes are unlikely to fully correct a hormone deficiency.
Men considering hormone replacement should discuss all treatment options thoroughly with their doctor. Therapy is adjusted based on effectiveness and side effects for the individual.
What are the risks and side effects of testosterone therapy?
Testosterone replacement is generally safe when prescribed and monitored appropriately. However, potential side effects can include:
- Acne or oily skin
- Breast enlargement and tenderness
- Increased red blood cell production
- Infertility and testicle shrinkage
- Sleep apnea exacerbation
- Prostate enlargement
- Elevated prostate-specific antigen (PSA) levels
More serious risks that require medical attention include:
- Blood clots
- Heart attack or stroke
- Urinary tract infections
- Allergic skin reactions
Close monitoring and dosage adjustment can help minimize adverse effects. Testosterone therapy is not advisable for men with breast or prostate cancer.
Can low testosterone be prevented with age?
The natural decline in testosterone levels with age cannot be completely prevented. But certain healthy lifestyle measures may help sustain hormone levels, including:
- Maintaining a healthy body weight
- Engaging in regular exercise and strength training
- Minimizing stress
- Getting adequate sleep
- Following a nutritious, balanced diet
- Avoiding excessive alcohol intake
- Quitting smoking
- Taking vitamin D and zinc supplements
Seeking treatment for chronic illnesses, depression, obesity and lack of sleep may also promote healthier testosterone function. While these steps cannot halt the aging process, they can help reduce the rate of testosterone decline in some men.
When to see a doctor
Consult a doctor if symptoms of low testosterone develop. Sudden or unexplained testosterone deficiency warrants medical assessment. Diagnosis and treatment guided by a specialist can help men regain strength, energy and vitality when hormone imbalance occurs.
Key takeaways
- Testosterone decreases slowly with age, beginning around age 30.
- Common symptoms of low testosterone include low libido, erectile dysfunction, depleted muscle mass and strength, increased body fat, low energy, and depression.
- Blood tests along with a medical history confirm low testosterone. Additional hormone and health evaluations may be recommended.
- Testosterone injections, gels, patches and pellets can effectively treat low levels.
- Lifestyle improvements to diet, exercise, weight, sleep and stress management may support healthier testosterone function.
- Monitor for potential side effects of testosterone therapy and consult a doctor with any concerns.
Conclusion
Testosterone is essential for men’s health. When testosterone production declines with age, bothersome symptoms can develop that disrupt vitality and wellbeing. Understanding the signs of low testosterone enables men to seek medical assistance when needed. Under proper supervision, testosterone replacement therapy can safely and effectively restore hormone levels, alleviating concerns like low libido, muscle loss, fatigue and other issues. Along with treatment when warranted, engaging in healthy lifestyle behaviors may help aging men preserve testosterone levels and function.
