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| Low Testosterone Level |
Last updated: Nov 17, 2009 |
Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Other conditions that may be present | It can lead to... | Recommendations
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Some causes of low testosterone levels include congenital problems (such as deficiencies of male hormones and rare malformation syndromes), and acquired problems, including aging, chronic illness, drugs, starvation, stress, head trauma, infections, cancers, surgeries, alcoholism, removal of or trauma to the testicles, and infection or twisting of the testicles in their sack. Also, certain drugs compete with testosterone in the body.
A study in 1996 reported in the New England Journal of Medicine followed three groups of men. One group was given testosterone and prescribed a strength training program, one group was given testosterone and told not to exercise and one group was just given a training program without testosterone. To no surprise the group who exercised on testosterone gained the most muscle and lost the most fat, but to the researchers surprise the group who took testosterone without exercise actually had greater improvement in muscle and fat composition than the group who trained without it. You can’t build muscle without it!
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 Signs, symptoms & indicators of Low Testosterone Level: | | | | | | Lab Values - Hormones | Counter-indicators:
 Having normal/having high testosterone levels |
Symptoms - Aging |
 Health declining with age |
Symptoms - Hair |
Reduced underarm/pubic hair growth |
Symptoms - Metabolic |
Low stamina
Counter-indicators:
 High stamina |
Symptoms - Mind - Emotional |
 Impatient/hostile disposition |
Symptoms - Mind - General |
Being unmotivated
Counter-indicators:
 Being highly motivated |
Symptoms - Skeletal |
(Prolonged) morning stiffness
Joint pain/swelling/stiffness |
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Conditions that suggest Low Testosterone Level: | | | | | | Circulation | Atherosclerosis | Researchers at Columbia University Medical School found that serum testosterone levels were about 90ng/dl lower in patients who had suffered myocardial infarctions (MI) than in those who had not. These results suggest that low testosterone levels predispose men to MI and are lower in men with severe coronary artery atherosclerotic disease than in controls. |
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Hormones |
 Low Sex Drive
Low Progesterone or Estrogen Dominance| | Testosterone is converted into estrogen naturally. When this conversion is overactive the result is too little testosterone and too much estrogen. High levels of estrogen also trick the brain into thinking that enough testosterone is being produced, thereby reducing the natural production of testosterone. |
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Immunity |
AIDS / Risk| | An estimated 45% of men with untreated AIDS and 25% of asymptomatic, untreated HIV-infected men experience low testosterone levels. Both men and women may be negatively affected by testosterone deficiency. |
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Mental |
Depression
Stress
Counter-indicators:
Stress |
Metabolic |
Male Gynecomastia| | The basic mechanisms of gynecomastia are a decrease in androgen production, an absolute increase in estrogen production, and an increased availability of estrogen precursors for peripheral conversion to estradiol. |
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Musculo-Skeletal |
Osteoporosis / Risk| | Osteoporosis is hasteded by hormonal deficiencies, including both testosterone and estrogen, which occur in older men (although much more slowly than in women). Estrogen deficiencies may also a play a major role in osteoporosis in older men. Some 30% of men with spinal osteoporosis have long-standing testosterone deficiency, and one-third of men with testosterone deficiency have subnormal bone density that puts them at risk of fractures. |
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Nutrients |
Zinc Requirement| | (This relationship of testosterone levels to zinc status does not apply to women.)
Studies support the use of zinc supplementation in the treatment of low sperm count especially in the presence of low testosterone levels. Both sperm count and testosterone levels rose in men with initially low testosterone levels. Zinc status should be evaluated in men with decreased serum testosterone levels. [Nutrition Report, September-October, 1996;14(7): p.52] |
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Organ Health |
Enlarged Prostate |
Risks |
Increased Risk of Coronary Disease / Heart Attack| | Researchers at Columbia University Medical School studied 55 men undergoing X-ray exams of their arteries and found that those with a lower testosterone level had higher degrees of heart disease (blockage of the coronary arteries). This study also found that the protective HDL cholesterol levels were higher in men with higher testosterone levels.
Low testosterone is linked to hypertension, obesity, atherosclerosis and increased waist-to-hip ratio - all of these being heart attack risk factors. Administration of testosterone to men has been reported to decrease the risk factors for heart attack.
This connection with heart disease was confirmed in a subsequent study in men with low levels of free testosterone. [Metabolism. 2004 March;53(3): pp.324-9] |
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Tumors, Malignant |
Prostate Cancer| | A low testosterone level has been considered desirable in prostate cancer or in those with an increased risk of prostate cancer. It is often lowered by the use of drugs, and nothing should be done to try and raise it.
However, preliminary research suggests that testosterone replacement therapy for men with low testosterone levels appears to have little effect on the prostate gland, contrary to some reports that this therapy may be harmful, according to a study in the November 15, 2006 issue of JAMA, a theme issue on men's health. |
Counter-indicators:
Prostate Cancer |
Uro-Genital |
Andropause/Male Menopause
Male Infertility (Low Sperm Count)| | We identified an endocrinopathy in men with severe male factor infertility that is characterized by a decreased serum testosterone-to-estradiol ratio. This ratio can be corrected by aromatase inhibition, resulting in a significant improvement in semen parameters in oligospermic patients." [J. of Urology, March 2001] |
Erectile Dysfunction (ED, Impotence) |
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Risk factors for Low Testosterone Level: | | | | | | Aging | Premature/Signs of Aging |
Autoimmune |
Hyperthyroidism| | Elevated estradiol and depressed bioavailable testosterone have been cited as the cause of sexual dysfunction common in hyperthyroid individuals. |
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Hormones |
Hypogonadism, Male
Hyperprolactinemia |
Lab Values - Hormones |
Having reduced/having low free testosterone
Counter-indicators:
Having normal/having elevated free testosterone |
Organ Health |
Diabetes Type II| | There are various complications already associated with type 2 diabetes such as eye, kidney and heart problems, but researchers have found another to add to the list: Low testosterone production or hypogonadism, found in men. In fact, one out of three male patients are affected by this condition.
Contrary to what many may think, hypogonadism is not caused by a defect in the testes. Instead, it is due to improper functioning of the pituitary gland (which controls production of testosterone) or in the hypothalamus (the region of the brain that controls the pituitary). Previous studies have linked erectile dysfunction and low testosterone levels in diabetic patients to lower levels of pituitary hormones. Also, a small portion of unbound testosterone in the blood, known as free testosterone, largely determines the amount of testosterone that is available in the tissues.
These findings are particularly important, as hypogonadism has not previously been recognized as a complication of type 2 diabetes. Thus, the high prevalence of patients affected (30 percent) was most certainly unexpected.
In the study, which involved over 100 men with type 2 diabetes, researchers aimed to further investigate the testosterone-related concern in male diabetics. None of the subjects tested had been previously diagnosed with low testosterone levels.
Findings Gathered From the Study- Nearly one-third of the men analyzed had hypogonadism
- The condition was not linked to obesity, as more than 30 percent of lean patients were hypogonadal, and 10 percent to 15 percent of the variation in low free testosterone levels was linked to body mass index
- Most of the men with low testosterone levels also had lower levels of pituitary hormones, compared to men with normal testosterone levels
- The concentration of pituitary hormones in the blood directly correlated with free testosterone levels
[Journal Clinical Endocrinology Metabolism November 2004;89(11): pp.5462-8] |
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Supplements and Medications |
Past testosterone use
Counter-indicators:
Testosterone use |
Symptoms - Food - Intake |
(Very) low fat/oil intake |
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Low Testosterone Level suggests the following may be present: | | | | | | Immunity | AIDS / Risk| | An estimated 45% of men with untreated AIDS and 25% of asymptomatic, untreated HIV-infected men experience low testosterone levels. Both men and women may be negatively affected by testosterone deficiency. |
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Low Testosterone Level can lead to:
Recommendations for Low Testosterone Level: | | | | | | Animal-based |  Glandular / Live Cell Therapy |
Botanical |
 Tribulus (Tribulus terrestris)| | In patients with below-normal serum testosterone levels, physiological levels were reached after treatment with Tribulus. Amongst patients with normal initial levels, the testosterone level was not significantly changed after treatment.
A product called Forza-T combines Tribulus, 6-OXO and ZMA to increase testosterone levels.
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Not recommended:
 Licorice Root (Glycyrrhiza glabra)| | 17 healthy males between 22 and 24 years of age consumed 7g/day of licorice tablets containing 7.6% glycyrrhizic acid over a 7-day period. On days 4 and 8, serum testosterone levels were decreased by 25%, with an increase in 17-hydroxyprogesterone and luteinizing hormone, and a slight but not significant reduction in free testosterone. [Exp Clin Endocrinol Diabetes. 2003;111: pp.341-343] |
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Diet |
 High Fat Diet| | A Swedish study showed that switching from a high-fat to a low-fat diet lowered blood testosterone levels by 10 percent. |
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Drug |
Conventional Drugs / Information| | The most commonly used aromatase inhibitor in bodybuilding is aminoglutethimide (Cytadren). This drug also inhibits an enzyme (desmolase) necessary for synthesis of cortisol, but fortunately, aromatase can be inhibited with levels of drug that cause only limited inhibition of desmolase.
For an average male, a dose of 250mg per day (one tablet) appears optimal. The half-life is 8 hours, so the drug is better taken in divided doses. The best plan seems to be to take half a tablet on arising, and quarter tabs six and twelve hours later. This keeps levels generally fairly constant, but allows a small drop in the hours shortly before arising, which is then compensated for by the higher dose on arising. With this scheme, inhibition of cortisol production is generally too low to be noticed, and generally there is no rebound effect on discontinuance. However it is not a bad idea nonetheless to taper off, first omitting the midday quarter tab dose for a few days, then omitting both quarter tab doses, then reducing the initial dose to one quarter tab, and then ending completely. A week is sufficient for the taper.
Some people suffer a degree of lethargy or sedation from aminoglutethimide, even at this low dose, but most do not.
Anastrozole (Arimidex) is a superior aromatase inhibitor which does not have the above side effects. It is, however, very expensive. With moderate doses of testosterone it seems that 1mg perday is sufficient, and some have claimed half a tab to be sufficient. |
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Extract |
Chrysin
DIM (di-indolmethane)/I3C (Indole-3-Carbinol)| | Clinical studies using testosterone injections, creams, or patches have often failed to provide a long-lasting, libido-enhancing effect in aging men. This is because testosterone can be converted to estrogen. The estrogen is then taken up by testosterone receptor sites in cells throughout the body. When an estrogen molecule occupies a testosterone receptor site on a cell membrane, it blocks the ability of serum testosterone to induce a healthy hormonal signal. It does not matter how much serum free testosterone is available if excess estrogen is competing for the same cellular receptor sites.
Aromatization is the process of converting testosterone to estrogens. This process increases with age. Aromatase blockers such as DIM and Chrysin can reduce estrogen levels and enhance testosterone levels. If these fail to increase free testosterone and lower excess estradiol, then ask your doctor to prescribe the potent aromatase inhibiting drug Arimidex (anastrozole) in the very low dose of 0.5mg, twice per week. Arimidex reduced estradiol by approximately 70% within 24 hours and by approximately 80% after 14 days of daily use.
The usual dose range of DIM for men is 200 - 400mg per day taken with food. For men involved in a plan of muscular development or fat loss, the dose of bioavailable DIM should be increased to 400 to 500mg per day. |
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Hormone |
Testosterone
DHEA| | Androstenedione is a metabolite of DHEA and a natural precursor of testosterone. 25 to 50mg of androstenedione taken at bedtime, and perhaps again first thing in the morning, will mimic the body's normal diurnal rhythm of testosterone.
This same dose may be taken 30 to 60 minutes before exercise to enhance performance, or after completion of exercise to enhance muscle recovery and growth. Serum levels of testosterone start rising about 15 minutes after oral administration and stay elevated for around 3 hours. Blood testosterone levels usually peak in around 1 to 1.5 hours after ingestion. Because the elevated testosterone levels swiftly return to normal baseline levels, there is little risk of negative feedback suppression of your usual testosterone levels. |
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Lab Tests/Rule-Outs |
Test Testosterone Levels
Test / Monitor Hormone levels |
Miscellaneous |
Reading List| | The Testosterone Syndrome by Dr. Eugene Shippen and William Fryer. In this inexpensive paperback, they successfully demonstrate that testosterone replacement has made significant improvements in the symptoms of male menopause, and they discuss the role of testosterone in men's overall health. |
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KEY | | Weak or unproven link | | | Strong or generally accepted link | | | Proven definite or direct link | | | Weakly counter-indicative | | | Strongly counter-indicative | | | Very strongly or absolutely counter-indicative | | | May do some good | | | Likely to help | | | Highly recommended | | | Reasonably likely to cause problems |
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