A small number of aging men (over 40) develop a condition called Late-Onset Hypogonadism (LOH). Also known as testosterone deficiency, LOH signals a failure of the body to produce testosterone, sperm, or both. The condition is associated with several sexual, physical and psychological symptoms including “male menopause” as described by Time magazine here.
What is Late-Onset Hypogonadism?
LOH is, surprisingly, not easy to diagnose. Symptoms occur in only 20–40% of men (this number does not take into account men who exhibit symptoms but do not seek medical attention); and most importantly, low circulating testosterone and LOH symptoms seldom occur together.
The strict diagnostic criteria for LOH actually eliminates most of the men who exhibit symptoms. These diagnostic criteria include reproducibly low serum testosterone levels as well as sexual symptoms that include erectile dysfunction, reduced morning erections, and reduced frequency of sexual thoughts and urges.
Symptoms of late-onset hypogonadism include:
- Erectile dysfunction
- Low libido
- Low sperm count/infertility
- Depressed mood
- Hot flashes and night sweats
- Excessive sweating
- Sleep disturbances
- Poor concentration and mental fogginess
- Diminished muscle mass and strength
- Increased body fat, particularly around the belly
- Loss of body hair (pubic, axillary, facial)
- Breast enlargement and tenderness
- Osteoporosis and decreased bone mineral density
Late-onset hypogonadism occurs after puberty and within a few weeks of the onset of a testosterone deficiency.
The condition can be caused by a number of factors depending on the type of hypogonadism. Obesity, diabetes, COPD and cardiovascular disease are most strongly associated with LOH, even more so than advanced age.
- Primary hypogonadism: the testicles are non-responsive to hormone stimulation due to congenital disorders, or acquired due to chemotherapy, radiation, tumors, testicular trauma, or diseases such as mumps.
- Secondary hypogonadism: the functioning of the hypothalamus or the pituitary gland is interrupted by disease. The hypothalamus and pituitary gland release hormones that stimulate the testes to produce testosterone and sperm. The contributing conditions can include:
- Systemic illness
- Side effects from medications
- Cirrhosis of the liver due to heavy alcohol consumption
- Toxins such as heavy metals and alcohol
- Morbid obesity
Erectile dysfunction is the most common reason adult men seek treatment for late-onset hypogonadism.
While testosterone levels naturally decrease over time as part of the aging process, this process should be gradual. Testosterone increases in males until around the age of 17 and holds steady until the mid-30s. After 40, testosterone levels begin a gradual decline of 1.2-2% per year. This normal decline is called Andropause. If testosterone levels drop faster than 2% per year, it could signal the onset of hypogonadism.
Due to the correlation between “lifestyle” diseases such as obesity, diabetes, and cardiovascular disease, it would seem logical to begin by treating these conditions first, and then initiating testosterone replacement therapy only if testosterone levels do not return to normal levels before testosterone replacement therapy is initiated. Testosterone replacement should only be used if there are no contraindications including cardiac disease, prostate cancer, male breast cancer, high hemoglobin levels or serious prostate symptoms.
The long-term benefits of testosterone replacement are uncertain. Due to the risks associated with testosterone replacement, the treatment is not to be taken lightly. Many patients respond very well to testosterone replacement and report better sex, better moods, and more energy shortly after starting the therapy. Some, however, report a higher red blood cell count, breast enlargement and tenderness, accelerated prostate growth.
A holistic approach can yield the best results. A combination of testosterone replacement therapy and lifestyle changes can stimulate the body’s own healing mechanisms and help restore natural hormonal balance. It is also recommended to begin adding a testosterone boosting supplement (we review many here on this page).
Natural Testosterone Boosters
- Exercise. Obese men, in particular, show a marked increase in testosterone as a result of frequent physical activity; and exercise increases fitness, reaction times, and testosterone in the elderly.
- Resistance training such as weight lifting or bodyweight exercises
- High-intensity interval training
- Caffeine (when combined with an exercise program)
- Creatine monohydrate supplements (when combined with an exercise program)
- Increased protein, fat, and carbohydrates within a whole food diet that includes daily vegetable and fruit intake. Constant dieting or overeating negatively impacts testosterone and other hormonal levels. Eating more protein helps maintain healthy testosterone levels; it also aids in fat loss, which further elevates testosterone levels. Fat is the most effective fuel source and helps balance hormonal levels. Carbohydrates help optimize testosterone levels during resistance training.
- Reduce stress. Chronic stress increases cortisol levels, which quickly reduce testosterone levels. If testosterone goes up, cortisol goes down and vice-versa. Stress and cortisol also tend to stimulate the appetite leading to overeating, weight gain, and the storage of unhealthy visceral fat around the organs. Decrease stress through meditation, exercise, laughter, and a healthy social life.
- Go outside. Vitamin D may work as a natural testosterone booster. Many people are Vitamin D-deficient because of a largely indoor existence. 3,000 IU of vitamin D3 per day has been shown to increased testosterone levels by about 25%.
- Take vitamin/mineral supplements. Although some researchers say that vitamin supplements only result in very expensive urine, specific minerals and vitamins do play a role in low testosterone. Zinc and vitamin B supplements can increase sperm quality and testosterone. Vitamin D and Zinc show the greatest promise as over-the-counter treatments for low testosterone. However, “everything in moderation” is wise counsel, as it is possible to overdose on vitamins! Testosterone supplements are rich in these vitamins and minerals, as we detail in our TestoGen review here and our Prime Male review here.
- Herbal supplements. While more studies are needed, two herbs stand out as having beneficial qualities for men suffering from low testosterone:
- Ashwagandha root has the most research-backed testosterone-boosting qualities as well as for its ability to reduce the concentration of the stress hormone cortisol.
- Ginger root can increase the levels of sex hormones.
- Sleep more. Insomniacs who sleep 5 hours per night exhibit a 15% reduction in testosterone levels. Other studies show that every additional hour of good quality sleep can raise your testosterone by 15%. 7–10 hours of sleep each night supports long-term health and helps maintain healthy testosterone levels.
- Avoid estrogen-like compounds (including soy), BPA plastics, excess alcohol.
- Laugh more! Laughter, happiness and success boost testosterone levels. Laughter is the best medicine!
Having LOH doesn’t mean the end of your sex life or wellbeing. There are steps you can take including taking better care of yourself and minimizing exposure to substances that lower testosterone; and if those measures fail, consult with your doctor about testosterone replacement therapy.