Worn out? Irritable? Gaining weight? Low libido? Memory problems? You and your doctor might not think about low testosterone, when you think about your symptoms, but you will after reading this.
Many symptoms of low testosterone are similar to those of other conditions. Before you self-diagnose with Dr. Google, or get a prescription based only on how you feel, see if low testosterone might be the issue.
How Common is Low Testosterone
Some experts believe a quarter of 30-year-old men have low testosterone.
A 2006 study found 39% of U.S. men, age 45 and older, were testosterone-deficient.[i] With about 40% deficient, most men are below optimal levels.
The situation is slightly better for women. Daniel Amen, in his book Unleash the Power of the Female Brain, points out that 20% of women have low testosterone. He also suggests another 20% of women have polycystic ovary syndrome (PCOS), which is caused by testosterone levels that are too high.
Unfortunately, these numbers are based on people who have gone to the doctor, and are experiencing symptoms. Chances are, many more men and women have testosterone levels out of balance. If you haven't had your testosterone levels checked, you could be among them.
Why Are So Few Aware of the Low Testosterone Problem
Most people don’t know how important testosterone is. They just see it as a hormone for making muscles and boosting libido.
They don't relate testosterone to heart disease, insulin resistance, degenerative brain disease, or depression. As you'll see, low testosterone plays a role in these conditions, and many more.
It's for this reason I recommend adults, beginning at age 30, get a complete lab panel each year. If everyone did this, they'd likely identify trends leading to health problems, long before they became actual “health problems.”
These trends include changes in hormones, like testosterone. Fortunatley, you don't have to wait for your doctor to order such a lab panel (most doctors won't). You can order your own, like the Premium Panel from WellnessFX.
Just as Jim LaValle's book title suggests, Your Blood Never Lies.
Signs and Symptoms of Low Testosterone
Healthcare practitioners diagnose men as “low” in testosterone when it's measured below 300 ng/dL. However, signs and symptoms of low testosterone often occur at levels much higher.
The “normal” range for men is 300 ng/dL to 1100 ng/dL. That’s an enormous range!
It would be like saying someone from Dallas lives near the Mexican border. They might live in the state next to Mexico, but it's still 878 miles to the border. It's far from Mexico.
And a testosterone level of 400 ng/dL is far from optimal, even though it's in the “state” of normal.
In Improving Male Sexuality, Fertility and Testosterone, Dr. Dan Purser says:
As far back as the 1970s, some endocrinologist actually knew the proper optimized range of total testosterone (800-1200 ng/dL).
Here we are, decades later, and the optimal range is rarely discussed. Many doctors don't know of this “optimal” range. As a result, a doctor tells a guy he's normal as long as his levels are above 300 ng/dl.
In women, the “normal” range for testosterone is 15-70 ng/dL.[ii] Because testosterone levels are so much lower in women, doctors often dismiss the importance of measuring it.
Though their total levels are much lower, they still have a large range in what's considered “normal.” A woman can feel quite different at a level of 15 ng/dL, versus 65 ng/dL, even though she’d be considered normal in both circumstances.
The following two tables outline common signs and symptoms of low testosterone.
|Signs and Symptoms of Low Testosterone in Men[iii],[iv]|
|Increased “central” body fat (“pot” belly)||Irritability and anxiety||Hot flashes|
|Gynecomastia||Sleep disturbances||Difficulty concentrating|
|Testicular atrophy||Reduced libido||Poor memory|
|Osteoporotic fracture||Decreased energy / fatigue||Lack of morning erections|
|Loss of height||Muscle Aches||Decreased ejaculate volume|
|Loss of facial, axillary and pubic hair||Decreased strength||Infertility|
Signs and Symptoms of Low Testosterone in Women[v]
Gain in body fat
Reduced sex drive or sexual function
Loss of muscle or muscle weakness
Menstrual irregularity or absence
Diminished exercise performance
Decreased energy / fatigue
Loss of height
Low testosterone can cause cardiovascular disease, type 2 diabetes, loss of muscle, low bone density, reduced physical performance, decreased libido, depression, and cognitive decline.[vi],[vii],[viii]
In a study of almost 400 men, under 50 years old, with low testosterone, one-third had low bone density![ix] That's a lot of men with a condition historically seen in women!
Low testosterone might also cause cognitive dysfunction, including development of Alzheimer’s disease.[x]
What Does Testosterone Do
What doesn't testosterone do? The following are some of the highlights.
Testosterone plays an important role, in men and women, in maintaining muscle mass. When you have more muscle, you not only move better, you also maintain healthier blood sugar levels. Oh, and it helps you look better too.
As testosterone rises, so do levels of hemoglobin. Increasing testosterone can improve your ability to circulate oxygen throughout your body. Increasing testosterone levels may also resolve cases of anemia.[xi]
Insulin resistance and diabetes
If you have low testosterone, you are much more likely to develop type 2 diabetes in the next five years, even if you have no signs of diabetes today.
Testosterone is necessary for proper bone metabolism. Ten to 20% of men have osteoporosis, and low testosterone may be the leading cause.[xvii]
Confidence and mood
Low testosterone is clearly associated with symptoms of depression.[xiii] Sometimes people describe themselves as lacking ambition, drive, or passion.
At the other end of the extreme in testosterone levels, you find people with a desire to dominate others, like the 14-year old bearded bully.
While extreme levels of testosterone can make someone into a jerk, optimal levels help you keep your head up, and confidently ask for what you want in life.
The confidence-boosting effect is seen in women as well as in men.
A single dose of testosterone was given to women with Social Anxiety Disorder (SAD). A hallmark sign of SAD is “gaze avoidance.” They have trouble looking others in the eye.
Following the testosterone treatment, the women with SAD had no trouble holding the gaze of someone else, suggesting their confidence went up and anxiety went down. [xiv]
Cognitive function and emotional control
Women treated with testosterone also experience improvements in memory and spatial awareness.
If you're a guy, and you cry more than you used to, or you tend to overreact to situations, your testosterone and estrogen might be out of balance.
Libido and sexual function
I can't talk about the importance of testosterone and not talk about libido and sexual function. Higher testosterone levels almost always equal greater desire, interest and pleasure in sex for both men and women.
For women, low libido is more often tied to depression or her emotional state.
However, women with low testosterone often have low libido and rarely think about sex. They also deal with sexual dysfunction, such as dryness and discomfort during intercourse.
With about one in five married couples in a “sexless marriage,” low testosterone might be one of the many causes.
What Lowers Testosterone
The following are some of the major causes of low testosterone.
Overweight and obesity
Low testosterone can increase body fat levels, and increased body fat can lower testosterone. Together, they can create a vicious cycle of continued body fat gain and lowered testosterone. Testosterone therapy decreases body fat and increases lean mass (muscle tissue).[xviii]
Women are the most susceptible to stress-related drops in testosterone. In women, the adrenal glands contribute directly to testosterone production, by producing testosterone itself, or by producing hormone precursors, like DHEA.
Since the adrenal glands also produce the stress hormone cortisol, excessive physical or psychological stress in women can limit their ability to make testosterone.[xix] Chronic stress can also reduce testosterone levels in men, but if often requires a lot more stress, or a longer period of enduring it.
Sleep debt, or interrupted sleep, has been shown to lower testosterone and elevate cortisol levels.
A staggering 26% of middle-aged men have obstructive sleep apnea (OSA), which drastically limits testosterone production.[xx]
Testosterone is secreted in pulses during the 24-hour cycle. Your greatest production takes place in the morning, so disrupted or insufficient sleep limits it.
Moderate-to-heavy alcohol consumption decreases testosterone .[xxi] If you self-medicate with alcohol because of your excessive stress, and then sacrifice sleep because of your drinking, you create a triple-whammy on your testosterone production.
Although beer drinking seems to be a “manly” pastime, if you keep it up long enough, you might end up watching more Nicholas Sparks movies than football or UFC with your buddies.
Rosuvastatin, which is sold under the label Crestor, was shown to suppress testosterone levels during a six-month study. Fortunately, testosterone levels climbed back up after discontinuing use.[xxii]
Atorvastain (Lipitor) is also known to lower testosterone levels. The findings of one study recommended combining Lipitor and testosterone therapy, as patients had better outcomes than when using Lipitor alone.[xxiii]
I must admit, though, that the better question is whether the Lipitor is appropriate for men in the first place. After all, elevated cholesterol is not necessarily a problem of its own, but rather a symptom of something else.
Head trauma (men)
Head trauma can damage the pituitary, which is what tells the testes to produce testosterone. (pituitary damage in women affects estrogen production).
In some, the effects are short-term, lasting days to weeks. Others don't experience effects until years later. And still in others, head trauma causes an immediate effect that never goes away. The pituitary is often overlooked as the cause of low testosterone in men.
Oral contraceptives (women)
Ironic, isn't it? The contraceptive that’s used to prevent pregnancy, can lead to low testosterone's lack of libido, making sex less likely anyway.
Long-term calorie restriction
Calorie-restriction is a significant stress on the body. When you don’t provide enough nutrition, testosterone production declines.[xxv] Excessive exercise, without sufficient nutrition does the same thing.
You don't have to be on a 500-calorie diet to see your testosterone plummet. You just have to constantly under-nourish your body compared to the energy you expend.
Corticosteroids such as prednisone and cortisone can lower testosterone levels.[xxvi] If you use these medications on a daily basis, get your testosterone levels checked!
How Can You Increase Testosterone
In men, the testes produce testosterone directly. The pituitary gland stimulates the hypothalamus, which stimulates the testes.
In women, it's more complicated. For pre-menopausal women, a quarter of testosterone is produced by the ovaries, and another quarter is produced by the adrenal glands. The other half of testosterone is produced from hormone precursors, including androstenedione (the prohormone Mark McGwire allegedly used), and dehydroepiandrosterone (DHEA).[xxvii]
Androstenedione is banned, and no longer available as a dietary supplement. DHEA is available as a dietary supplement, and is often recommended for women, to support optimal testosterone production.*
In my opinion, it’s best to do everything you can, with your lifestyle, exercise, nutrition, and supplementation. Then, if you still need help, hormone therapy can be an appropriate and safe way to optimize levels.
In many studies, higher vitamin D is significantly associated with higher testosterone,[xxviii] although other smaller studies did not find this association.[xxix] Vitamin D plays a role in many areas of metabolism, so supplementing with Vitamin D is a must even if you have optimal testosterone levels already.
On evenings when couples had sex, their testosterone levels increased. On evenings when they didn’t, testosterone levels fell.[xxx] If you need another good reason to make love to your spouse, there you go.
Another study found that women who were not on hormonal contraceptives, just thinking sexual thoughts increased testosterone. Those on contraceptives did not experience the testosterone boost.[xxxi]
It’s also believed that a woman’s psychological state can affect testosterone. When she feels sexy, her testosterone levels go up.
One study showed resistance training increased testosterone levels by 30%. Another study showed hypertrophy-style training increased levels 136%, and strongman-style training increased testosterone 74%.
Resistance training increases testosterone for a short period of time, during and after exercise. But by exercising five to six days a week, week-after-week, the long-term effects can be significant over time.
Sufficient, quality sleep is one of the most powerful ways to maximize hormone production. Most hormones rely on a healthy circadian rhythm. If you don’t get enough sleep, or you go to sleep at inconsistent times, you’ll disrupt your circadian rhythm, and sabotage your body’s hormone production.
Supplements, HCG and Hormone Therapy
This was a pretty heavy article of its own, and addressing supplements, HCG and hormone therapy turned out to be as well. So, I wrote a separate article on those topics. Check it out: What You Need to Know About Supplements & Testosterone.
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