Testosterone is often called a “male” sex hormone, but it plays a critical role in both male and female sexual and physical development. It affects sexual development and reproduction in both men and women, but especially more so in men, due to its androgenic and anabolic effect that defines “male” characteristics.
The body produces higher amounts of testosterone during puberty, causing the following changes in adolescents and teenagers:
- Penile and testicular growth
- Enhanced muscle and bone growth
- The development of facial hair and deepening of voice
- Improvement in bone density
- Height increase
- Increase in libido and aggressive behaviors
Testosterone levels begin a gradual, slow decline at age 30, declining by 1%-2% every year from that point onwards. Low T can also be caused by diseases or medical conditions.
If you suspect that you might have low testosterone, you’ll need a full evaluation from your trusted healthcare provider to determine the underlying causes for your underperforming hormonal production. Often, treating the causes can help normalize deficient testosterone levels.
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The Testosterone Production Process
Leydig cells are cells responsible for producing testosterone. They are located in the testicles, and they initiate the production of testosterone through the following process:
- Once puberty ends, the hypothalamus secretes gonadotropin-releasing hormone (GnRH) in bursts.
- GnRH promotes the release of luteinizing hormone (LH) within the pituitary gland, a gland in the brain responsible for promoting growth.
- LH is carried into the testicles through the bloodstream, where it induces the Leydig cells to produce testosterone from cholesterol.
- High testosterone levels indicate the pituitary gland and hypothalamus to stop secreting testosterone-producing GnRH and LH, respectively, to maintain a tight rein on the process.
Men have 25 times more testosterone than women. Females produce testosterone through the ovary, although the majority of it is converted to estrogen by aromatase. Nevertheless, women need testosterone for optimal sexual function. In both sexes, a fraction of testosterone is produced by the adrenal glands, which belong to the endocrine system.
Testosterone and Its Effects
While testosterone plays its most prominent role in men during puberty, keeping testosterone levels within normal levels is important to men and women and their overall health. Testosterone plays an integral role in the following physical processes in men:
- Sex drive
- Sexual function
- Erectile health
- Sperm quality and motility
- Sperm production
- Muscle and bone development
- Facial and body hair growth
- Management of emotions and moods
In women, testosterone affects the following factors:
- Libido
- Muscle and bone mass
- Mood regulation
- Fertility
Therefore, abnormally low testosterone levels can cause a variety of diverse symptoms. Abnormally low or high testosterone levels may cause side effects in both men and women.
Low Testosterone: A Primer
Testosterone levels begin their gradual decline when men hit their 30s. Testosterone concentrations fluctuate throughout the day, and tend to be at their highest during the mornings.
When diagnosing low testosterone, most healthcare providers often take two testosterone level tests during the early morning (particularly between 8 to 10 AM) before conclusively diagnosing low T. Consistently recording low testosterone levels during the early mornings over a prolonged period of time may indicate a chronic hormonal imbalance.
Anything below 300 ng/dL of testosterone at any given time is considered low. Moreover, certain underlying medical conditions may cause low T, such as:
- Being overweight or obese
- Sleep apnea and other analogous sleep disorders
- Genetic diseases
- Certain illnesses like HIV
- Certain medicines such as glucocorticoids
- Radiation/chemotherapy
- Trauma
Your healthcare provider will determine your medical history and run you through some specifical physical and blood tests to determine any potential underlying medical conditions causing your hypogonadism (low T).
Low Testosterone in Men: Common Signs and Symptoms
Low testosterone levels can cause a diverse array of supposedly unassociated symptoms like:
- A low sex drive
- Erectile dysfunction
- Excessive tiredness or fatigue
- Diminished muscle strength and mass
- Low bone density (osteoporosis)
- Development of male breasts (gynecomastia)
- Higher body fat percentage
- Infertility
- Anxiety/depression
High Testosterone in Men
Too much of anything isn’t good for anyone – and the same is true for testosterone. Men and women may sometimes experience hormonal imbalances in the form of having excessive testosterone due to anabolic steroid use or excessively high doses of testosterone.
Anabolic steroids are synthetic versions of testosterone developed to influence muscle growth rather than androgenic functions that support sexual health and fertility. However, taking anabolic steroids may result in the body becoming incapable of producing its own testosterone.
High Testosterone in Men: Signs and Symptoms
Excessive testosterone levels may cause the following symptoms:
- Facial/back acne breakouts
- Prostate enlargement
- Gynecomastia in men
- Higher cholesterol levels
- Increased heart disease risk
- Unexplained weight gain
- Testicular shrinkage
- ED
Individuals with the aforementioned symptoms should consult their doctors to determine what is causing the excessive testosterone in the bloodstream in order to work out an appropriate treatment plan.
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How To Treat Low Testosterone
Once your healthcare provider determines what’s causing your low testosterone levels, they will help devise a plan to address the underlying cause, such as weight loss for obese or overweight individuals.
For cases of low T of indeterminate causes, drugs such as clomiphene citrate and human chorionic gonadotropin (hCG). The latter is a hormone found in high levels during female pregnancy that may increase testosterone in people with low T, while the former is a drug that induces the pituitary gland to produce more luteinizing hormone (LH) and follicle-stimulating hormone (FSH) which are precursors to testosterone that influence sperm and testosterone production in the testicles.
For men with abnormally low testosterone levels, testosterone replacement therapy (TRT) may be prescribed, particularly for men who can no longer produce their own T. TRT can be applied as an injection, topical gels, patches, or creams, mouth patches, implants, and other formulations currently under development.
Caveat emptor, though: all FDA-approved testosterone products contain warnings about how they might increase heart disease and stroke risks upon use based on scientific studies that TRT may indeed increase said risks. Other studies contradict the latter findings, with some determining that no tangible change in cardiovascular health risks. In short, more research is necessary to determine the true risks of testosterone replacement therapy in relation to heart health.
Nevertheless, before going on a regimen of testosterone therapy or lifestyle changes to promote testosterone production, consult your primary healthcare specialist and let them know about your potential symptoms that might indicate something amiss with your hormonal levels. From that point forward, your specialist will determine the most suitable course of treatment to follow for your particular case.
