Low testosterone, or low T, is a condition in which men have testosterone levels lower than normal for their age. All men experience a natural decline in testosterone that begins around the age of 30, declining about 1 percent each year. However, sometimes young men can develop this condition.
Low testosterone is sometimes called "male menopause," but it's not always a sign of normal aging. Unlike menopause in women, in which estrogen levels reach zero, testosterone levels in men never completely decline, but they can get quite low. The signs of low testosterone can include everything from depression and fatigue to decreased libido and reduced muscle mass. Research even suggests men who have low testosterone levels are at a higher risk of conditions like diabetes and heart disease.
Common Signs of Low Testosterone
Symptoms of low testosterone can be subtle and easy to disregard or attribute to another cause. Many men are under the mistaken belief that erectile dysfunction and decreased libido are the primary signs of low T, but the hormone problem can cause widespread symptoms. Not all men with low T develop sexual side effects.
The most common symptoms of low testosterone include:
- Hair loss, which tends to be rapid
- Decreased libido
- Erectile dysfunction, which may include difficulty maintaining or developing an erection or fewer spontaneous erections
- Enlarged breasts or gynecomastia
- Increased body fat with no apparent cause. This weight usually accumulates around the belly and breasts.
- Reduced lean muscle mass. Some men report a visible reduction in muscles of the chest, arms and legs, but others find they simply aren't as strong as they were. Building more muscle mass can also be challenging.
- Chronic fatigue. This fatigue is more than just being tired; it can make it hard to stay awake or feel motivated to do anything.
- Sleep problems
- Irritability. Some men feel down with low T, but others become irritable.
- Brain fog or difficulty concentrating.
- Low ejaculate volume. Normal ejaculatory volume is 1.5-5 cubic centimeters. The prostate, testicles and seminal vesicles all require a sufficient supply of testosterone to produce semen.
- Testicle shrinkage. Testicles may shrink slightly and feel softer.
These symptoms can quickly affect relationships and quality of life, especially among younger men.
What Causes Low T in Men Under 30?
Low testosterone among young men is not as common as among older men. The causes also tend to be different. Rather than normal aging, low T among men under 30 may be related to high blood pressure or high cholesterol, excessive use of alcohol, illegal drugs, anabolic steroids and some prescription drugs like steroids.
Causes of low T can be categorized as primary or secondary. Primary low T refers to an issue with the testicles, such as an injury, chemotherapy or a developmental problem. Secondary low testosterone occurs when the testicles are normal but the function is compromised due to a problem with the pituitary gland or hypothalamus. This interference can come in many forms, such as obesity, Type 2 diabetes or high blood pressure.
One of the most common causes of low testosterone is obesity. This link between low testosterone and obesity can be found in men of all ages, but it's perhaps most commonly responsible for younger men. One study found that 40 percent of obese study participants had low testosterone. Fifty percent of obese men with diabetes had low T. Seventy-five percent of men who are considered very obese had low testosterone.
Unfortunately, as low T can increase fat accumulation and reduce lean muscle mass, these two factors often create a cycle. Lowering body weight can improve testosterone levels, but low T can make it difficult to shed weight. One study found that obese men who lost weight reported better sexual function, which may indicate improved testosterone levels.
Diabetes and low testosterone are also closely related. The Endocrine Society even recommends that men diagnosed with Type 2 diabetes have their testosterone levels checked. According to the study, diabetes appears to lower testosterone levels in a similar way to gaining about 20 pounds. The study found men with diabetes, regardless of weight, had lower testosterone levels than non-diabetic men in all weight categories.
Some injuries and medical conditions are also linked to low T, including pituitary disease, cancer treatment, inherited diseases like Prader-Willi syndrome in which the testicles do not fully descend and injuries or conditions affecting the testicles.
Even when no obvious cause is determined, low testosterone is still possible. Sometimes T levels decline for no obvious reason in young men.
Treating Low Testosterone
Low testosterone is usually not treated unless there are noticeable symptoms like low libido, erectile dysfunction or mood problems. The only option for men who do not produce testosterone in their testes is testosterone replacement, a form of hormone therapy. When this is not the case, other treatment options may help. Increasing exercise, eating a healthier diet, getting enough sleep and losing weight can all contribute to healthier testosterone levels.
While testosterone replacement therapy can be a suitable option, it can come with risks and downsides. For example, fertility is a concern among young men as providing testosterone therapy to men who want to be fertile can cause an important side effect: turning off sperm production.