low testosterone

10 warning signs of low testosterone men should never ignore

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If your sex drive isn’t as strong as it used to be, you can’t focus at work or you’re tired all the time, low testosterone could be to blame.

Approximately 4 out of 10 men over age 45 have low testosterone, according to the Urology Care Foundation.

Although it can affect your sex life, some men with the condition also have high blood pressure, high cholesterol and obesity. Low testosterone can also increase your risk for type 2 diabetes, according to a study in the journal Cell Metabolism.

If you suspect you have low testosterone, here are 10 are warning signs to keep an eye on and talk about with your doctor.

1. Low libido

Although some men will notice their libido decreases as they get older, the most significant and obvious sign of low testosterone is a sudden decline in sex drive, said Dr. Joseph Alukal, an assistant professor in the departments of urology and obstetrics and gynecology and director of Male Reproductive Health at NYU Langone Medical Center in New York City.

2. Extra weight

Carrying extra pounds can affect testosterone because fat cells convert testosterone to estrogen, which decreases circulating testosterone, said Dr. Philip Werthman, a urologist and director of the Center for Male Reproductive Medicine and Vasectomy Reversal in Los Angeles.


Although men who are overweight or obese can have low testosterone, it’s not clear whether they gain weight because their testosterone is low or if their testosterone is low because they’re overweight. Either way, eating healthy, exercising and losing weight is often enough for them to feel better, he said.

3. Erectile dysfunction

As many as 30 million men have erectile dysfunction and low testosterone could be to blame. In order to get and keep a strong erection, it’s necessary to have adequate blood flow, circulation, functioning valves, normal sensations and sex drive and testosterone is responsible for all of it, Werthman said.

4. Fatigue

If you’re exhausted by lunchtime, crash on the couch after work and find it challenging to get motivated to do anything, low testosterone could be zapping your energy.

5. Sleep problems

Men with low testosterone can experience insomnia but it’s also associated with obstructive sleep apnea, a sleep disorder which affects more than 18 million Americans and can lead to high blood pressure, heart disease and problems with mood and memory.

Although low testosterone doesn’t cause obstructive sleep apnea, many men who have sleep apnea are also overweight, which can lead to low testosterone, Werthman said. The bottom line: If your partner says you snore, or you feel tired after sleeping all night, see your doctor for a sleep study.

6. Lack of concentration

Since testosterone is responsible for focus, if the hormone is low, you can experience brain fog, have trouble concentrating and even have memory problems.

7. Depression

A study in the Journal of Sexual Medicine found that 56 percent of men who had borderline low testosterone also had significant symptoms of depression, were already diagnosed with depression and/or were taking antidepressant medication.

When men receive testosterone replacement therapy, they often see an improvement in their depression, and it’s more effective than the anti-depressants they were taking, Werthman said.

8. Breast growth

Since low testosterone causes the ratio of estrogen and testosterone in the body to become unbalanced, some men may grow breast tissue, a condition known as gynecomastia.

9. Aches and pains
Low testosterone can decrease muscle mass and strength so some men may experience joint pain, muscle aches and be more prone to injury.

10. Bone problems

Although osteoporosis is usually thought to affect women only, it can be a problem for men with low testosterone because it decreases bone density.

If you suspect you have low testosterone, make an appointment with your doctor who can diagnose it with a simple blood test and suggest several types of testosterone replacement therapy.

AACE releases position statement on testosterone therapy, CV events

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The American Association of Clinical Endocrinologists recently issued a position statement, published in Endocrine Practice, citing lack of evidence linking testosterone replacement therapy with cardiovascular events.

Neil Goodman, MD, FACE, of the University of Miami Miller School of Medicine, and colleagues for the AACE Reproductive Endocrinology Scientific Committee are calling for larger studies that will focus on the impact of testosterone replacement therapy on risk for CVD.

The association of low testosterone concentrations with CV problems, especially among older men, has been supported by recently published studies, but the position statement notes that low testosterone is often a marker of CV illness and not a causal factor.

Testosterone replacement therapy has been shown to have benefits in men with hypogonadism, including decreased insulin resistance, waist circumference and fat mass. Metabolic syndrome has also been reversed in some men following testosterone replacement therapy.

According to the committee, a thorough diagnostic work up should be performed on any man being considered for testosterone replacement therapy. The patients’ signs, symptoms and testosterone concentrations should guide the decision for the therapy rather than the underlying cause.

The committee added that the risk/benefit ratio of testosterone replacement therapy is still not completely clear.

“It needs to be emphasized that low testosterone is often a marker for chronic disease, and the underlying CVD risk factors should be addressed,” the researchers wrote. “In patients with vascular and minor symptoms of hypogonadism, a more cautious approach towards testosterone therapy is prudent. Physicians should have a detailed discussion with such patients … before embarking on testosterone replacement.” – by Amber Cox

Low plasma testosterone associated with CVD risk factors

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Key cardiovascular disease risk factors were associated with low plasma testosterone in men, but after adjustment, there was no association with mean carotid intima-media thickness, incident cardiac thickness or mortality, according to recent findings.

Adrian Dobs, MD, of the division of endocrinology, diabetes and metabolism at Johns Hopkins University School of Medicine, and colleagues evaluated 1,558 men (mean age, 63.1 years) not taking androgen therapy and without coronary heart disease, stroke or heart failure to determine the relationship between plasma testosterone and mean carotid intima-media thickness. The relationship with incident CVD, cardiac mortality and all-cause mortality was also examined.

Adrian Dobs

Adrian Dobs

The median plasma total testosterone was 377.6 ng/dL. No significant association was found between testosterone levels, age, race, LDL cholesterol or use of lipid-lowering medications.

Significantly higher BMI, greater waist circumference, higher prevalence of diabetes and hypertension and lower HDL cholesterol were found among participants with lower testosterone (all P for trend <.001).

Mean carotid intima-media thickness was 0.9 mm. No association was found cross-sectionally between testosterone quartiles with carotid intima-media thickness after adjustment for CV risk factors (P for trend=.56). Similarly, no association was found between incident coronary heart disease or incident cardiac heart failure and quartile testosterone after multivariable adjustment.

Overall, there were 347 deaths and 29 attributed to cardiac causes; however, there was no association between all-cause mortality or cardiac mortality and quartile testosterone after multivariable adjustment.

“Low serum testosterone in men did not predict the later development of heart disease,” Dobs told Endocrine Today.“However, it was highly associated with cardiac risk factors. Thus, low testosterone should be viewed, not as causative of later cardiac problems, but rather as a marker to suggest that aggressive treatment of classical risk factors need to be addressed.” – by Amber Cox