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How is “Low T” diagnosed and what's the treatment?

Updated: Aug 5, 2023

Hypogonadism is the medical definition of low testosterone or “low T.” It is estimated that 4.5 million American men are affected. Testosterone is an androgen (sex hormone) that plays a significant role in several bodily functions, such as:

  • Sexual development

  • The appearance of facial and pubic hair

  • Muscle and bone strength and growth

  • Sex drive (libido)

  • Sperm Production

How Is Testosterone Regulated In The Body?

The pituitary gland controls the production of testosterone in men. This gland will send signals to the testicles to produce testosterone. A “feedback loop tightly regulates testosterone levels in the blood”; when testosterone levels rise too high, the brain signals the pituitary gland to reduce testosterone production.

What Causes Low Testosterone?

Hypogonadism is the result of the testicles failing to produce adequate testosterone levels. There are two forms of hypogonadism:

  • Primary­– originates from a problem in the testicles and is often referred to as primary testicular failure.

  • Secondary– indicates a problem in the hypothalamus or the pituitary gland — parts of the brain that signal the testicles to produce testosterone.

It’s essential to remember that testosterone levels will naturally decrease with age. Still, certain medical conditions HIV, obesity, history of chemotherapy, etc., can also increase the risk for lower testosterone levels.

What Are the Symptoms Of Low Testosterone?

Symptoms of low testosterone can be nonspecific and can worsen over time. Here are a few common symptoms reported by men:

  • Decreased libido

  • Erectile dysfunction or inability to maintain an erection

  • Reduced muscle mass and strength

  • Changes in mood and depression

  • Fatigue

How Is Hypogonadism Diagnosed?

Low testosterone is diagnosed by measuring the amount of testosterone in the blood with a blood test. Testosterone levels tend to change throughout the day. Testosterone levels are highest before 10 a.m., so it remains controversial when the best time to test men for hypogonadism is. In addition, to a testosterone level, your healthcare provider may want to order the following labs to rule out other chronic conditions that could be contributing factors based on your physical exam and past medical history:

What Is the Treatment For Low Testosterone?

Low testosterone is treated with replacement therapy and may be required as a long-term treatment. Testosterone replacement is available in various forms:

  • Intramuscular injections (into a muscle) on a weekly or bi-weekly schedule.

  • Testosterone patches are used daily and applied to different body parts, including the buttocks, arms, back, and abdomen.

  • Testosterone gels are applied every day to the clean, dry skin of the upper back and arms.

  • Pellets are implanted under the skin every two to six months.

Learn more about the advantages and disadvantages of the various treatment forms here:

Common Side Effects of Testosterone Replacement

Before deciding to start testosterone replacement therapy, it is essential to understand the risks and consider alternative treatments first. First and foremost, know that you can always leave your testosterone levels alone if you are asymptomatic (not experiencing symptoms) and have noticed no changes to your quality of life. Here are a few common side effects of testosterone replacement:

  • Worsening sleep apnea — a potentially serious sleep disorder in which breathing repeatedly stops and starts. Patients must be willing to comply with sleep apnea treatment as well.

  • Acne – testosterone itself does not directly cause acne. However, testosterone stimulates the production of sebum which can lead to acne.

  • Gynecomastia (enlarging breasts) ­­– this can be avoided with proper monitoring of estrogen levels.

  • Reduction of sperm count – testosterone replacement will decrease follicle-stimulating hormone, thus reducing sperm count.

  • Polycythemia – testosterone stimulates the bone marrow to increase the production of red blood cells. When not adequately monitored, overproduction of red blood cells can increase the risk of blood clots, and subsequently, heart attacks and strokes can occur.

When Is Testosterone Replacement Therapy Inappropriate?

Although testosterone replacement is a safe and effective treatment when adequately supervised, therapy is not recommended for men who have:

  • History of Prostate Cancer or Breast Cancer

  • Elevated PSA levels without further evaluation

  • Untreated Obstructive Sleep Apnea

  • Elevated hematocrit levels

  • Certain levels of heart failure

If you are experiencing signs or symptoms of low testosterone or have been diagnosed with low testosterone, contact our office for a consultation.

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