Sure, we can chuckle about “manopause” (some joke it’s when a man has more hair growing from his nose and ears than his head), but hormone fluctuations in males aren’t merely funny fodder. Noticeably low testosterone levels often point to troublesome health issues, and treatment necessitates more than just grabbing a supplement from the nearest health store. Here, Roper St. Francis Healthcare endocrinologist Dr. Sherif Yacoub gives us the lowdown on “low T” (low testosterone).
A slow fade
The male hormonal slide, medically referred to as andropause, isn’t exactly analogous to menopause in a woman. But a man’s hormonal balance does shift as he ages, with testosterone naturally decreasing and estrogen increasing. (That’s right, his endocrine system produces estrogen, too!) But unlike the rapid drop that women experience in their dominant sex hormone, testosterone levels in men diminish only by about one percent each year after age 40.
This gradual decline can result in muscle loss, fatigue and increased belly fat, though “the natural decrease of testosterone shouldn’t really cause significant problems,” Dr. Yacoub says. “If testosterone levels drop enough to cause symptoms, there’s usually another underlying cause, such as excessive alcohol use or sleep apnea.” Only about one in 10 cases is the result of damage to the testicles; in the remaining nine, the pituitary (the master gland in the base of the brain) doesn’t secrete enough of the hormone that signals the testicles to produce testosterone.
Calculated response
When patients report symptoms such as reduced sex drive or erectile function, loss of lean muscle mass, or loss of hair, doctors will often use a quantitative questionnaire such as the ADAM (Androgen Deficiency in the Aging Male) to determine if these could be the result of excessively low testosterone. The weighted questions ask patients about decreased sex drive, erectile dysfunction, muscle strength, energy levels, fatigue and more. A morning blood test might also be used to measure hormone levels, since “testosterone levels peak in the morning and can go down by 30 to 50 percent throughout the day,” explains Dr. Yacoub. “Checking testosterone levels in the afternoon can result in a false diagnosis of low T.”
Take as directed
While hormone replacement therapy (HRT) can be used to treat low T, the endocrinologist stresses the importance of understanding why testosterone levels are diminished before jumping into treatment. Taking a hormone replacement without addressing any underlying cause may bring testosterone levels back up, but symptoms won’t abate until the root of the problem is managed. An undiscovered issue also opens the door for bigger health problems. “The two factors I see most often are excessive drinking and obstructive sleep apnea, but low T can also be the result of pituitary tumors or brain trauma,” Dr. Yacoub says.
For a man who has pituitary or testicular damage and cannot secrete testosterone anymore, HRT is an appropriate course of action. “When giving testosterone, the goal is to restore normalcy rather than striving for industrial strength,” says Dr. Yacoub. “More isn’t necessarily better.” In fact, exceeding the recommended amounts of testosterone may negatively impact cholesterol, blood pressure and the cardiovascular system. And since the body will come to rely on the cream or injection and loses its ability to naturally produce the hormone, men should only use HRT when truly necessary.
With or without HRT, a healthy lifestyle helps maintain the body’s hormonal equilibrium, so be sure to eat a nutritious diet marked by whole foods, lean proteins, low sugar and high-quality fats. Regular exercise also works to regulate testosterone and hormones like insulin, adrenaline, cortisol and others linked to energy, stress and growth. So while comedians may still make jabs about low testosterone, remember that the condition isn’t a laughing matter.