Is It Low Testosterone or Normal Aging?
As men get older, testosterone levels decline naturally and almost imperceptibly. But for some men, a significant decline can impact their quality of life. So how can you tell the difference between normal aging and low testosterone?
When testosterone levels are too low, men may experience less interest in sex, fewer spontaneous erections, and a reduced intensity of orgasm and sensation. It may also cause loss of pubic hair, decrease in energy, increase in fatigue, depression, poor concentration and memory, disrupted sleep, and reduced strength.
What’s a “Normal” Level of Testosterone?
Testosterone is the most important male sex hormone. It’s produced primarily in the testes adrenal glands. Testosterone regulates sex drive, bone mass, fat distribution, muscle mass and strength, and sperm production. In puberty, it makes the penis and testes grow larger, causes facial and pubic hair to grow, and deepens the voice. Normal levels of testosterone are considered to be anywhere from 300 to 1,200 nanograms per deciliter (ng/dl).
About 5 million American men have testosterone deficiency, but because testosterone levels vary widely, it’s difficult to determine a specific level that indicates a medical problem. Plus, low testosterone symptoms can be mistaken for natural signs of aging. The prevalence of low testosterone increases with age, affecting about 20 percent of men between ages 60 and 70, 30 percent after age 70 and up to age 80, and about half of all men older than 80.
A study published in September 2013 in theNew England Journal of Medicineestablishes testosterone levels at which various physiological functions begin to be affected. While this may help determine when to seek treatment for low testosterone, the study also found that some symptoms normally associated with testosterone deficiency are partially or even totally caused by the decline in estrogen that also results in lower testosterone levels.
Shalender Bhasin, MD, an endocrinologist and director of the research program on men's health, aging, and metabolism at Brigham and Women’s Hospital in Boston, says the field of treatment for testosterone deficiency is still evolving. “Most of the clinical trials in this area are inconsistent,” he says. “No testosterone study has involved more than 300 men, giving us very limited information.”
Should You Be Treated for Low Testosterone?
If you believe you’re experiencing low testosterone symptoms, see a doctor, preferably a urologist specializing in endocrinology. The urologist may be able to determine if and why your testosterone level is too low. A blood test will tell you what your testosterone level is at a particular time. The best time to have your testosterone level measured is in the early morning, when levels are at their highest. If your level is low, your doctor should measure it at least two more times before making a diagnosis. Less than 200 or 300 ng/dl of total testosterone is considered to be a low testosterone level.
“There are many potential causes for the symptoms of low testosterone — it’s not always clear why a man feels the way he does,” says Joseph Alukal, MD, director of reproductive health and benign diseases of the prostate and an assistant professor in the departments of obstetrics and gynecology and urology at NYU Langone Medical Center in New York City. Although a diagnosis of low testosterone is based on symptoms and repeated blood tests, other tests are needed. "When other hormones are checked, other underlying medical conditions may be found,” he says.
Your doctor should take into account your medical history, including past and present illnesses, any genetic history, and current prescriptions and over-the-counter medications you’re taking before making a diagnosis of low testosterone. Be sure to mention any sexual problems or issues that may be causing you stress.
A physical examination should include checking your penis, testes, and breasts for any lumps. Bone density testing may be ordered because low testosterone can cause bones to become brittle, and a scan of the brain may be needed to rule out a tumor in the pituitary gland or hypothalamus. Your prostate-specific antigen (PSA) level should also be checked to make sure there are no prostate problems or cancer.
Hypogonadism: When Testosterone Levels Are Very Low
When testosterone levels are seriously low, a clinical condition called hypogonadism may be the cause. Hypogonadism occurs when the body doesn’t produce enough testosterone either because of a problem in the testicles, the hypothalamus, or the pituitary gland. Chris Saigal, MD, a professor and vice chairman of urology at UCLA, says that men with hypogonadism can benefit from testosterone therapy, but he stresses that only a small percentage of men have this condition. “Low testosterone by itself does not constitute hypogonadism,” he says.
“Testosterone can be difficult to measure,” Dr. Bhasin says, “because the measurement system can be problematic and often inaccurate.” Only 10 labs are certified by the Centers for Disease Control and Prevention to test testosterone levels. To get the most accurate measurement, Bhasin recommends that you ask that your blood sample be sent to one of these labs.
And Robert Brannigan, MD, an associate professor of urology at the Northwestern University's Feinberg School of Medicine in Chicago, says that when considering testosterone treatment, ask your doctor to explain the known risks and benefits. “Men need to know about potential downsides and adverse effects to treatment," he says. A November 2013 article in theJournal of the American Medical Associationsuggests, for example, that testosterone therapy increased the risk for cardiovascular incidents in men who had previously undergone cardiac catheterization and were subsequently started on testosterone therapy.
“The pros and cons for treatment of each individual must be weighed,” Dr. Brannigan says, “and unless an individual meets specific diagnostic criteria, there’s no reason to be given testosterone therapy."
Experts agree that while testosterone can help men with hypogonadism resulting from low testosterone, it isn’t for men with normal testosterone levels. “Some men may just need to be reminded that decreased testosterone is a normal part of aging,” Dr. Saigal says.
Video: Treating Low Testosterone in Men
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