Understanding testosterone deficiency in men

Dr Jireh Serfontein educates us on the causes of testosterone deficiency in men as well as natural and medical interventions to manage it.

You can listen to this article below, or by using your favourite podcast player at pod.link/oncologybuddies

What is testosterone deficiency?

Testosterone deficiency, or hypogonadism, is a common endocrine disorder affecting a significant proportion of men, particularly as they age. It’s characterised by low testosterone levels accompanied by various physical and psychological symptoms.¹ 

The global prevalence of testosterone deficiency is estimated to be around 10% in men, with higher rates noted in older populations.^.1 

As more men become aware of this condition and seek help, it’s important to understand the causes, symptoms, long-term effects, and how to manage it effectively.

Causes of low testosterone

Low testosterone can occur for several reasons, and it typically falls into two categories: primary and secondary hypogonadism.

Primary hypogonadism

This type stems from direct impairment of the testes, the organs responsible for producing testosterone. The causes of primary hypogonadism include:

• Genetic disorders

Klinefelter syndrome is one example of a genetic condition. This is a chromosomal condition where males have an extra X chromosome, leading to testicular dysfunction.²

• Infections

Inflammation of the testes (orchitis) due to viral or bacterial infections can lead to testicular damage and reduced testosterone production. Mumps is a well-known viral cause that can results in primary hypogonadism.³

• Trauma

Physical injury to the testes can impair their ability to produce testosterone.

• Tumours

Testicular tumours can directly damage testicular tissue, leading to low testosterone levels. These could be malignant or benign tumours.

• Medical treatments

Chemotherapy or radiation used for certain cancers can adversely affect testicular function.

Secondary hypogonadism 

Secondary hypogonadism, or hypogonadotropic hypogonadism, results from inadequate stimulation of the testes by gonadotropins (LH and FSH) due to dysfunction in the hypothalamus or pituitary gland. 

The causes include:

• Hypothalamic disorders

Conditions such as Kallmann syndrome, a genetic disorder that impairs the secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus, leading to insufficient LH and FSH levels.⁴

• Pituitary disorders

Tumours or other diseases affecting the pituitary gland can diminish its ability to secrete relevant hormones (LH and FSH), resulting in secondary hypogonadism.⁴

• Chronic diseases

Chronic illnesses, including liver and kidney diseases, can disrupt the hypothalamic-pituitary-gonadal axis.⁶ Hormonal imbalances due to chronic conditions often lead to decreased testosterone production.

• Obesity and metabolic syndrome

Obesity and related metabolic conditions, such as Type 2 diabetes, can lead to hypogonadism by increasing inflammatory mediators and negatively affecting hormone levels, including testosterone.⁴

• High prolactin levels

Conditions that cause hyperprolactinemia (elevated prolactin levels), often due to pituitary adenomas, can inhibit the release of gonadotropins, thus impacting testosterone production.⁵

• Lifestyle factors

Poor lifestyle choices, including chronic stress, lack of sleep, and excessive alcohol consumption, can also contribute to the development of secondary hypogonadism by affecting hormone regulation.⁷

Signs and symptoms of testosterone deficiency

Men with low testosterone may notice a range of symptoms that can affect many aspects of their life. Common symptoms include:

• Physical symptoms: These can include low sex drive, erectile dysfunction, loss of muscle mass, fatigue, and increased body fat.
• Emotional symptoms: Low testosterone can also lead to feelings of sadness, depression, fatigue, and difficulty concentrating.

These symptoms can significantly impact a man’s quality of life and often necessitate further investigation if they are persistent.⁸

Long-term effects of low testosterone

If left untreated, testosterone deficiency can lead to serious long-term health issues. Research indicates that men with low testosterone levels are at higher risk for conditions, such as cardiovascular disease, osteoporosis (weak bones), and Type 2 diabetes.⁹

Managing testosterone deficiency

Managing testosterone deficiency typically involves a combination of lifestyle changes and, if necessary, medical treatment.

Lifestyle changes

Adopting a healthy lifestyle can help improve testosterone levels and overall well-being.

• Exercise regularly: Engaging in regular physical activity, particularly strength training, can boost testosterone levels.
• Healthy diet: Adopting a balanced diet rich in healthy fats, proteins, and vitamins can support hormone production.
• Weight management: Maintaining a healthy weight is critical since obesity has been linked to lower testosterone levels.

Medical treatment

For those with significant deficiencies, testosterone replacement therapy (TRT) may be prescribed. This treatment can be administered through injections, patches, or gels. 

TRT aims to restore testosterone levels to normal and alleviate the symptoms associated with low testosterone. However, it’s essential to work closely with a healthcare provider to monitor for potential side effects and ensure the treatment is effective.¹⁰

Conclusion

Testosterone deficiency is more common than many might think, particularly among older men. Understanding this condition is crucial for anyone experiencing symptoms. 

With appropriate management, through lifestyle modifications and medical interventions men can regain balance and improve their overall quality of life. 

If you suspect you may have low testosterone levels, it’s essential to consult a healthcare professional for proper evaluation and treatment options.

References

1. Campbell K. , Muthigi A. , Ghomeshi A. , Schuppe K. , Sandler M. , & Ramasamy R. Safety aspects and rational use of testosterone undecanoate in the treatment of testosterone deficiency: clinical insights. Drug, Healthcare and Patient Safety 2023;Volume 15:73-84. https://doi.org/10.2147/dhps.s383130
2. Alharbi M. , Alelyani M. , & Walidadham M. Updated review on surgical management of male hypogonadism. The Egyptian Journal of Hospital Medicine 2018;70(8):1356-1361. https://doi.org/10.12816/0044648
3. Gomes A. , Aragüés J. , Guerra S. , Fernandes J. , & Mascarenhas M.. Hypogonadotropic hypogonadism in human immunodeficiency virus-infected men: uncommonly low testosterone levels. Endocrinology, Diabetes &Amp; Metabolism Case Reports 2017;2017. https://doi.org/10.1530/edm-17-0104
4. Kadiwala R. and Dhadwad J.. Andropause in diabetic and non-diabetic males: a cross-sectional observational study in western India. Cureus 2024. https://doi.org/10.7759/cureus.65152
5. Mohammed A. , Mansour A. , & Ahmed J.. Effect of exogenous glucocorticoids on male hypogonadism. Biomedical Reports 2020. https://doi.org/10.3892/br.2020.1319
6. Kalra S. , Jacob J. , Unnikrishnan A. , Bantwal G. , Sahoo A. , Sahay R. et al.. Expert opinion on the diagnosis and management of male hypogonadism in india. International Journal of Endocrinology 2023;2023:1-10. https://doi.org/10.1155/2023/4408697
7. Fraietta R. , Zylberstejn D. , & Esteves S.. Hypogonadotropic hypogonadism revisited. Clinics 2013;68:81-88. https://doi.org/10.6061/clinics/2013(sup01)09
8. Lunenfeld B. , Mskhalaya G. , Zitzmann M. , Arver S. , Kalinchenko S. , Tishova Y. et al.. Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men. The Aging Male 2015;18(1):5-15. https://doi.org/10.3109/13685538.2015.1004049
9. Yadav G. , Pahwa M. , Singh M. , Tyagi V. , & Chadha S.. Prevalence of age-associated testosterone deficiency syndrome in indian population. Advances in Urology 2019;2019:1-4. https://doi.org/10.1155/2019/2468926
10. Lodovico E. , Facondo P. , Delbarba A. , Pezzaioli L. , Maffezzoni F. , Cappelli C. et al.. Testosterone, hypogonadism, and heart failure. Circulation: Heart Failure 2022;15(7). https://doi.org/10.1161/circheartfailure.121.008755