What Men Should Know about Low Testosterone

By Dr. Cameron Wilson

“Male menopause” is sometime used to describe the natural decline in testosterone levels among men as they age. However, the term can be misleading, because female menopause is significantly different in comparison. Whereas women experience a dramatic decline in production of the hormone estrogen over a short period of time during female menopause, men undergo a gradual decrease in testosterone over a period of many years. As such, many doctors prefer to use the term andropause, or more accurately, Androgen Decline in the Aging Male (ADAM), to describe age-related low testosterone in men. ADAM is often responsible for changes in sexual function, energy level or mood, which can be subtle and go on unnoticed for years.

Testosterone is the primary male hormone responsible for keeping a man’s muscles and bones strong, and maintaining his interest in sex. In the normal developing male, testosterone peaks during early adulthood, and once he reaches age 30, it is common for testosterone levels to slowly decline by approximately one percent a year. While testosterone levels vary greatly among men, older men generally have lower testosterone levels than younger men. In fact, low testosterone affects roughly 39 percent of all men over the age of 45.

A gradual decline in testosterone is a normal part of aging among men, however, a higher-than-normal drop in testosterone levels may be related to certain medical conditions or other various underlying factors, including medication side effects, pituitary or thyroid problems, depression, and excessive alcohol use. Abnormally low levels can cause symptoms that include:

•Change in sleep patterns or insomnia

•Physical changes such as increased body fat and reduced muscle bulk

•Reduced sexual desire, sexual dysfunction or infertility

•Emotional changes that can include depression or confusion

•Decrease in energy or bone density

The only way for low testosterone to be diagnosed is through a blood test. It is important for a man to talk to his doctor if he suspects that he has low testosterone. The physician can help identify and treat any health issues that might be causing or contributing to signs or symptoms.

Testosterone therapy is something that can be considered for men experiencing symptoms of low testosterone, but it’s important that he discusses options with his doctor. The use of replacement therapy is controversial among otherwise healthy men experiencing age-related decline in testosterone. For some men, therapy relieves bothersome symptoms associated with lower testosterone, but for other men, the benefits are unclear and may expose them to certain risks, including increased risk of prostate cancer, fluid retention or a possible worsening of sleep apnea.

Overall, men should remember that while declining testosterone is a normal part of aging, it’s important that he is open with his doctor about any symptoms or health concerns he may have.

Cameron Wilson, MD, is a board-certified urologist affiliated with Sharp Grossmont Hospital.