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Understanding Low Testosterone In Aging: Causes And Management

Men’s low testosterone levels, which are a natural byproduct of aging, can cause symptoms such as sadness, tiredness, and muscle loss. Its levels, which are typically low at 250-300 ng/dL, can be efficiently regulated with Testosterone Replacement Therapy (TRT). TRT is available as gels, injections, and patches, with varying effectiveness and adverse effects. Regular monitoring by a doctor is essential for efficient treatment and minimizing any adverse effects. Additionally, lifestyle modifications and some drugs might help boost natural testosterone production.

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Testosterone is the hormone that causes a man to have a deep voice, a muscular body, and hair on his body and face. A man’s testosterone levels peak in his late teenage years (around 17-19 years old) and begin to decline at a rate of one to three percent each year once he is about 40 years old.

In this article, we will discuss why low testosterone occurs with aging, the effects it can cause, and how it can be treated.

Why Low Testosterone Occurs With Aging

Low testosterone, sometimes called male hypogonadism, causes a man’s testicles to produce less testosterone or no testosterone at all.

There are two main types of hypogonadism: primary (caused by testicular health issues) and secondary hypogonadism (caused by issues with the pituitary gland or hypothalamus).

A decline in testosterone is a natural part of the aging process for men. A 2015 study found that this decline is mainly due to reduced functioning of the testes and the hypothalamic-pituitary axis in the brain.1

older man in his garage

In other words, it is a combination of primary and secondary hypogonadism rather than a single cause. In addition to age, other factors can reduce testosterone levels, such as:

  • Health issues like liver cirrhosis or kidney dysfunction
  • Obesity
  • Obstructive sleep apnea
  • Type 2 diabetes (particularly if it is not managed well)

The Effects of Low Testosterone in Aging

What is considered to be low testosterone levels are not unanimously agreed upon in the medical community. The American Urology Association (AUA) sets the threshold at less than 300 nanograms per deciliter (ng/dL), but some healthcare providers and researchers define low blood testosterone as less than 250 ng/dL.

Some men do not experience any symptoms due to low testosterone levels. However, low T can cause the following related health conditions and symptoms:

  • Depression
  • Erectile dysfunction
  • Fatigue
  • Irritability
  • Low sex drive
  • Reduced lean muscle mass

How Low Testosterone in Aging Can Be Treated

Low testosterone in older men can be treated with testosterone replacement therapy (TRT).
Except for testosterone undecanoate (Jatenzo), testosterone cannot be taken by mouth to treat male hypogonadism because oral testosterone can severely damage the liver, and it is not effective in keeping testosterone levels steady. Jatenzo is safe and FDA-approved because it is absorbed by the lymph system and is not as likely to cause liver damage.

Testosterone is available in many other forms, including:

  • A gel that you put on your skin (Androgel, Fortesta, Testim, or Vogelxo)
  • Gum and cheek (buccal cavity): A putty-like substance applied where your gum and upper lip meet
  • Injection into a muscle or under the skin (testosterone cypionate (Depo-Testosterone) and testosterone enanthate)
white gel package on a leaf
  • Nasal gel is administered twice in each nostril three times a day (Natesto)
  • Patch applied to thighs or torso every night (Androderm)
  • Surgically implanted pellets under your skin that are changed every three to six months (Testopel)

The form of TRT you use will depend on cost and insurance coverage, your doctor’s recommendation, and your preferences. It should be noted there are other treatments for low testosterone, including lifestyle changes, as well as medications that can help increase natural testosterone production, such as enclomiphene.

The side effects you may experience vary depending on the type of TRT you use. For example, a topical gel can irritate your skin and may rub off on other people, so you may want to avoid close contact or cover the area until the gel has dried completely. Patches can cause a severe skin reaction, while buccal cavity administration can irritate the gums. The nasal gel is less convenient than other methods because it needs to be applied frequently.

General risks associated with TRT include:

  • Acne
  • Enlarged breasts
  • Increased production of red blood cells
  • Prostate enlargement
  • Reduced sperm production/fertility
  • Sleep disturbances

Your doctor should monitor you to check for side effects and the effectiveness of the treatment every few months for the first year of TRT treatment and once a year each year after that.

Last Words

Low testosterone happens naturally as men age, but there are ways to manage and treat it. Low blood testosterone levels are below 250-300 nanograms per deciliter (ng/dL). Low testosterone can be treated with TRT. TRT is available in many forms, such as gels, injections, and patches. Side effects vary based on the type of TRT you receive. Your doctor should monitor you regularly to check for side effects and treatment effectiveness, especially during your first year of TRT.

Talk to your doctor if you have low testosterone and want to know if TRT is the most suitable treatment for your health.

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[1] Golan R. - Age-Related Testosterone Decline is due to Waning of Both Testicular and Hypothalamic-Pituitary Function;