"After age 30, most men begin to experience a gradual decline in testosterone," says David Samadi, MD, chairman of the urology department at Lenox Hill Hospital in New York City.
Although testosterone levels never reach zero (as estrogen levels do in women during menopause), low testosterone levels men to experience symptoms like fatigue, low sex drive, and reduction of muscle mass.
While reduced testosterone is more prevalent in older men, it can occur in younger guys also. Fortunately, all the causes of low testosterone in young men are treatable, so if you experience these symptoms at any age, there's no reason to ignore it.
Causes of Low Testosterone in Younger Men
For younger men, a drop in testosterone levels can be caused by some illnesses, including type 2 diabetes, diabetes, chronic liver or liver disease, COPD or other lung disease, or pituitary gland issues, based on Dr. Samadi.
Genetic causes of low testosterone in men include the diseases Klinefelter syndrome, Kallmann syndrome, Prader-Willi syndrome, and Myotonic dystrophy. Another disorder which can result in low testosterone is hemochromatosis, which makes the body store too much iron.
"Low testosterone can also result when something happens, like trauma or steroid use, that prevents the testes from making the hormone," states Bruce Gilbert, MD, PhD, an adjunct clinical professor of urology and reproductive medicine at Weill Cornell Medical College and director of reproductive and reproductive medicine in the Smith Institute for Urology of their North Shore-LIJ Health System.
Additional causes of low testosterone in men younger than 50 include pituitary gland tumors, HIV infection, and radiation therapy or chemotherapy for cancer.
Doctors categorize causes of low testosterone as secondary or primary.
"Primary hypogonadism stems from a problem in the testicles," Samadi says.
Is It Low Testosterone?
Regardless of the reason, low testosterone symptoms would be the same.
"Symptoms include low libido, erectile dysfunction, fatigue, decreased mental acuity and moodiness," Dr. Gilbert says.
If your blood test reveals low testosterone (usually defined as a level lower than 300 ng/dL), the doctor may treat you or refer you to a specialist, such as a urologist or endocrinologist.
Not everyone with low testosterone needs treatment. "When it comes to treating low testosterone in older guys, we usually reserve treatment for those who have symptoms, such as fatigue and low libido," Gilbert says.
Such testosterone supplements come in the form of a gel, injections, patches, long-acting pellets, or oral inserts.
In these circumstances,"treatments are usually used just in the short term, and when a doctor has close monitoring and understanding of the individual," Gilbert says.
An important consideration for younger men before getting treatment is fertility. "You don't wish to give supplemental testosterone to men who are interested in being fertile since it can turn off sperm production," Gilbert says.
Once a young man goes off testosterone supplementation, there's a chance his sperm count will never return to what it was before he started. "Therefore, men of reproductive age should think about alternatives that might increase their testosterone in addition to preserve their sperm production," he says. One such choice is a category of drugs known as selective estrogen receptor modulators (SERMs).
Other treatments for low testosterone include weight loss and other lifestyle modifications, like eating healthy and raising exercise.
The bottom line, however, is that if you've got low testosterone symptoms, then it's important to see your doctor. Then, your doctor can rule out potentially more serious causes of your symptoms, including high blood pressure or a thyroid problem, and offer treatment that can enhance your power and high quality of life.