Testosterone deficiency syndrome, also known as late-onset hypogonadism, can occur in middle-aged men and older. While the condition is typically associated with aging, one’s calendar age is almost never the real culprit.
What is Testosterone Deficiency Syndrome?
Testosterone deficiency occurs when the testicles fail to produce adequate testosterone for normal sexual and physical functioning. This imbalance can affect multiple organs and cause serious long-term health issues.
The term “andropause” is sometimes used for this condition; however, “male menopause” (the more common name) is not an inevitable result of aging.
The most common symptoms that are associated with a deficiency in testosterone in adult men include:
- Low libido
- Difficulty achieving or maintaining an erection (erectile dysfunction)
- Increase in body fat, especially around the belly
- Loss of lean muscle mass and strength
- Loss of bone density
- Low energy
- Difficulty concentrating or making decisions
Beyond these symptoms, testosterone deficiency syndrome can be a contributing factor to the onset or worsening of:
- Cardiovascular disease including hypertension
- Elevated insulin levels/diabetes
- Abnormal cholesterol levels
- Incidence of prostate cancer
It’s important to note that many of the symptoms of low testosterone can also be caused by conditions unrelated to hormones. This is why a thorough physical exam is necessary in addition to a blood test.
In some cases, your doctor can pinpoint a specific cause for testosterone deficiency, for example, hypothyroidism or pituitary gland issues that interfere with testosterone production or availability.
In many men, while there is often no one specific cause for testosterone deficiency, much of the problem can be attributed to lifestyle-related ailments including obesity, diabetes, and heart disease. If these conditions are addressed first, there is a high likelihood that one of the symptoms – abnormally low testosterone – will diminish.
As far as aging goes, men can expect a gradual decline in testosterone production as they get older. In healthy men whose testosterone is not affected by disease, obesity or other factors, this natural decrease amounts to only 1-2% per year. If you consider that a healthy 30-year old man may have testosterone levels measuring around 1000 nanograms per deciliter (ng/dL) and the normal natural decline is on the high side at 2%, that same man (assuming he stays healthy) can expect a testosterone level of around 300 ng/dL at age 65. That is still within the normal range; therefore, any declines into the sub-normal levels must be attributed to factors other than age.
Testosterone deficiency is diagnosed with a blood test. This blood test is typically combined with a comprehensive physical exam in order to identify any underlying conditions that cause or contribute to low testosterone.
If the doctor finds a specific cause for your testosterone deficiency, the treatment will focus on that cause first. You may begin taking a testosterone boosting supplement like those we list here. In many, if not most, cases lifestyle changes will also be recommended. These include resistance training (weights), high-intensity training (intervals), a better diet rich in leafy greens and protein, stress management, and healthy ways to achieve weight loss. This approach yields positive results in the improvement of overall health – and gives the body the opportunity to recalibrate and rebalance itself.
If testosterone levels remain low after treatment (and if they are not significantly affected by positive lifestyle changes) then testosterone replacement therapy yields excellent results for most patients.
Testosterone replacement therapy elevates the body’s testosterone levels through regularly adding testosterone to the body. There are several ways to accomplish this, and the treatment protocol depends on the severity of the deficiency:
- Intramuscular testosterone injections are administered once every week to four weeks.
- Testosterone patches deliver a specific amount of testosterone daily. They must be replaced every day.
- Testosterone gels are applied daily in measured amounts.
- Testosterone “pellets” are implanted beneath the skin (usually under the buttocks), providing stable levels of testosterone delivery that lasts 4-6 months.
Risks of Testosterone Replacement Therapy
Don’t rush into getting testosterone replacement therapy to treat Testosterone Deficiency Syndrome. While it can reverse or at mitigate age-related decline, many men who are prescribed testosterone replacement don’t have levels low enough to warrant the treatment, which does come with side effects that can include:
- Breast enlargement and tenderness
- Sleep apnea
- Elevated red blood counts
- Higher risk of cardiovascular problems (from long-term use)
- Growth of prostate cancer cells
- Fluid retention
- Decreased testicle size
- Decreased sperm count
While testosterone replacement is generally safe for most men, there are instances in which it cannot be used, such as if you are receiving any kind of treatment for cancer or if you have prostate problems.
Testosterone replacement is a lifelong commitment. You may be able to reduce the amount of supplementation, but you will likely have to maintain the therapy for the rest of your life. This is because:
- Testosterone levels fluctuate normally
- Testosterone levels are easily influenced by lifestyle choices (for better or for worse)
- Testosterone replacement therapy usually results in a reduction of naturally produced testosterone by the body.
Because of these fluctuations, your doctor will need to closely monitor not only your hormone levels but your hematocrit (red blood cell mass) levels since testosterone replacement often results in elevated red blood cells.
If you don’t want to go through testosterone replacement therapy, you can try supplementing with a testosterone booster. We review many on this site, but rank the following two as the best on the market: