Insights on Low vs. High Testosterone Levels for Men's Health

Testosterone plays a crucial role in male health, influencing physical strength, mental well-being, and sexual function. Understanding the balance between low and high testosterone levels is vital for identifying and addressing health issues.

Understanding testosterone

Testosterone is a steroid sex hormone primarily produced in the sex organs — testes in men and ovaries in women. For men, it stimulates the development of male traits.

The normal range for testosterone depends on the male’s age as well as the type of lab test.

Low testosterone levels: what does it mean?

Low testosterone, or testosterone deficiency, can have several possible causes. Naturally, testosterone levels decrease with age as production decreases. Other causes can include conditions that affect the testicles, certain genetic conditions like Klinefelter’s syndrome or Noonan syndrome, certain types of tumors, chemotherapy, and anabolic steroid use.

Symptoms of low testosterone in adult males include:

  • Reduced energy, endurance, and motivation
  • Fatigue
  • Low sex drive
  • Erectile dysfunction
  • Shrinking testicles
  • Osteoporosis
  • Depressed mood
  • Irritability
  • Unexplained reduction in muscle mass
  • Increase in body fat

The American Urological Association defines a diagnosis of low testosterone as having a total testosterone level below 300 ng/dL in the early morning on two different occasions. Besides lifestyle modifications, testosterone replacement therapy is a medical treatment used to combat testosterone deficiency.

High testosterone levels: an overview

High testosterone levels, or hypergonadism in males, are very rare. This may occur in children, resulting in precocious puberty, meaning puberty begins much earlier than normal. For boys, precocious puberty would be before age 9 with signs such as deepening voice, body hair, muscle development, and enlargement of the penis and testicles. Less than 5 in every 10,000 boys will be affected by precocious puberty.

Rarely high testosterone can also occur when the hormonal regulation for testosterone production is disrupted. This can happen with certain tumors affecting parts of the brain or testes that regulate testosterone. For example, some tumors can secrete β-human chorionic gonadotropin (β-hCG), resulting in increased production of testosterone.

Synthetic testosterone, commonly known as anabolic steroids, is used to medically treat patients with low testosterone or to increase muscle mass in patients with cancer or acquired immunodeficiency syndrome (AIDS). Unfortunately, anabolic steroids can be misused by individuals wanting to increase muscle mass, resulting in elevated blood levels.

Symptoms of high testosterone can depend on age. As stated, young boys may start puberty early. Adult men may have a range of symptoms, including hair loss, acne, and excessive muscle mass. High testosterone can have varying effects on sex drive and may also be associated with infertility.

Treatment for high testosterone depends on the underlying cause. If the increase is due to the presence of a tumor, then options include surgical intervention and possible radiation and chemotherapy. Hormone therapy, such as gonadotropin-releasing hormone analog (GnRHa) therapy, to decrease blood levels of testosterone is another possibility.

Low testosterone vs. high testosterone

Since testosterone is an important hormone in men, it affects many different aspects of men’s health.

Impact on physical health

Testosterone is important for creating and maintaining muscle mass. Having too little testosterone can impede muscle growth or even cause muscle loss, whereas high testosterone may result in excessive muscle mass. Testosterone increases bone density, so low testosterone can increase the likelihood of bone fracture or bone loss.

Athletes who abuse anabolic steroids have artificially high testosterone levels. This can result in an increased risk of blood clots and skin issues such as acne, fluid retention, and prostate enlargement.

Impact on mental health

Testosterone affects mental health, too. Some studies have indicated that normal testosterone levels potentially decrease anxiety, while other studies show that the risk for depression increases as testosterone levels decrease. Lower testosterone may contribute to a decrease in self-confidence and motivation. Testosterone replacement therapy may help decrease depression and improve low libido in men diagnosed with low testosterone.

Men who abuse testosterone have an increased risk of major depressive disorders, self-harm, and suicide attempts. Other psychiatric effects include mania and increased aggression.

Impact on sexual health

Since testosterone helps regulate libido, lower testosterone levels result in decreased libido, while higher levels are associated with an increase. Additionally, sperm count is affected by testosterone since testosterone is required for sperm production.

Either too much or too little testosterone can affect fertility in men. A multi-center study by the World Health Organization demonstrated that excess artificial (exogenous) testosterone injections can result in male infertility (azoospermia). On average, the men in this study achieved male infertility in 120 days. However, within a few months of stopping the testosterone injections, the men were again able to produce sperm.

Testosterone and aging

Testosterone levels vary with age. For example, a male infant 5 to 7 months old will typically have a normal total testosterone level around 6 ng/dL, but a male 19–39 years old can have a normal total testosterone level over 900 ng/dL.

After peaking in early adulthood, testosterone levels in men will begin to decline. Starting in their mid-30s, the total serum testosterone decreases at an average of 1.6% each year for men. By age 60, approximately 20% of men will have testosterone deficiency, and this number rises to approximately 50% of men by the age of 80.

Ways to manage your testosterone levels

Managing testosterone levels is important for maintaining overall good health. Having a healthy lifestyle can promote healthy testosterone production, but testosterone replacement therapy can be used as a clinical treatment.

Testosterone replacement therapy

Testosterone replacement therapy is not meant to combat normal aging in men. It should be used for men who have clinically validated low testosterone and who are experiencing several symptoms associated with low testosterone.

Most symptoms of low testosterone can be alleviated with testosterone replacement therapy. However, some, like replacing lost muscle mass, can take months.

Risks of therapy include worsening sleep apnea, acne, and increased risk of blood clot formation.

Lifestyle changes

Making simple lifestyle changes can impact testosterone levels. To decrease the risk of low testosterone:

  • Maintain a healthy diet
  • Decrease alcohol consumption
  • Regularly exercise
  • Manage stress
  • Get adequate sleep

Myths and misconceptions about testosterone

Testosterone is the topic of many myths. These misconceptions may adversely affect whether a patient would seek medical attention for low testosterone. These myths include:

  1. A man’s testosterone level does not significantly change. First, testosterone levels change with a man’s age. Second, the time of day affects testosterone levels. One study found that a man in his 30s will have 20–25% lower testosterone at 4:00 p.m. compared to 8:00 a.m. on the same day. This is why clinical guidelines recommend testosterone testing in the morning.
  2. Testosterone replacement therapy causes heart disease. A recent study found no association between testosterone replacement therapy and cardiovascular events, such as heart attacks.
  3. High testosterone increases fertility. Although testosterone has positive effects on sexual function, too much testosterone can have negative effects on sperm and fertility.
  4. Testosterone replacement therapy can be bought without a prescription. Testosterone medications can only be prescribed by a doctor and are, in fact, a controlled medication. If used without the supervision of a healthcare professional, it could lead to several fatal risks.

The importance of regular check-ups

Maintaining healthy testosterone levels is important for overall high-quality health in men. As men age, testosterone testing may be added to their routine annual check-ups with their primary care provider.

If a man exhibits multiple symptoms of low testosterone, is experiencing sexual dysfunction, or is having difficulty conceiving a child with his sexual partner, he should consult his healthcare provider. Any child exhibiting signs of early puberty must consult a physician.

Testosterone is important for developing male characteristics and various bodily functions. Dysregulation of testosterone in men can have a wide range of effects, from infertility to higher mortality. Regular medical check-ups with a healthcare provider to monitor testosterone are important for maintaining overall health and well-being.

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