Testosterone Levels - Causes and Treatments of Low and High Levels

Introduction:

Testosterone is the main sex hormone in men and plays a small role in female fertility as well. The testosterone levels are regulated by the hypothalamus and the pituitary glands. Maintaining a normal level of the hormone is crucial in both men and women. In men, a low level of testosterone can cause multiple health issues related to reproduction and fertility, along with general systemic health problems. Whereas a high level of testosterone in men has fewer complications, it is often more problematic when it is associated with steroid drug abuse. In women, low testosterone may or may not cause any fertility issues, whereas a high level of testosterone can cause female fertility issues, and it can be caused due to several conditions like polycystic ovarian syndrome (PCOS), ovarian cancer, etc.

What Is Testosterone?

Testosterone is the principal sex hormone in males. It is produced in the gonads, mainly in the Leydig cells of the testes. Some amount of testosterone is present in women as well, produced in the ovaries, and it is later converted into estradiol. The adrenal glands produce a small amount of testosterone in both men and women. The hormone is classified as androgen, which means it plays a key role in the development of male sexual characteristics and the development of male reproductive tissues in the testes and prostate. Testosterone is responsible for the growth of reproductive organs and secondary sexual characters along with the regulation of sex drive, growth of bone mass, regulation of fat distribution in the body, growth of muscle mass and strength, and production of red blood cells (RBC) and sperm. Too little or too much testosterone can cause multiple health issues in both men and women.

How Is Testosterone Controlled?

The hypothalamus and the pituitary gland are vital for the regulation of testosterone production by the testes. The hypothalamus releases the gonadotropin-releasing hormone, and in response, the pituitary gland produces the luteinizing hormone into the blood, which in turn stimulates the gonads to produce testosterone.

What Is the Normal Testosterone Level?

The normal level of testosterone varies extensively depending on age and gender. The normal testosterone level in an adult man is supposed to be 300 ng/dL. And for an adult woman, the normal testosterone level is below 8 ng/dL to 60 ng/dL. The different normal levels of testosterone in a man at different ages are:

• Early Infancy: The testosterone levels rise in the first week of life and remain in the pubertal range for a few months. Afterward, between the age of four to seven months, this reduces to non-detectable levels.

• Before Puberty: At the age of ten to 11 years, the testosterone level should be around 7 to 130 ng/dL.

• Puberty: The testosterone levels peak during the time of puberty, and it is supposed to be around 300 to 1200 ng/dL in late teenage.

• Adults: Adult men who are 19 years and older should have a testosterone level between 240-950 ng/dL. The standard value is, however, set at 300 ng/dL in adult men by the American Urological Association. The testosterone levels are supposed to reduce by one percent per year after the age of thirty.

What Is Low Testosterone Level?

According to the American Urological Association, a testosterone level below 300 ng/dL is considered low testosterone. This condition is also known as low-T, male hypogonadism, or testosterone deficiency syndrome. Testosterone levels physiologically fall as age advances, but an unusual fall in testosterone levels can cause several problems, and it is also an indication of underlying health issues. If testosterone levels are low during fetal development, then there will be a failure to develop male characteristics in the child. If testosterone deficiency occurs at puberty, then there will be the absence of a growth spurt which will eventually lead to no growth during puberty. There may be no growth of pubic hair, in size of the penis, and no change in the voice.

How Common Is Low Testosterone?

Low testosterone affects almost 40 % of the male population who are 45 years and above. Research suggested that compared to those who did not have diabetes, about 24.5 to 30 % of men with diabetes had lower testosterone levels. However, the data on the incidence of low testosterone is variable because different studies use different minimum cut-off levels of testosterone. Although, it has been speculated that every two young men out of 100 have low testosterone levels.

What Are the Symptoms of Low Testosterone Levels?

The common signs and symptoms associated with low testosterone levels are:

• Low libido (reduced sex drive).

• Impotency.

• Infertility.

• Erectile dysfunction.

• Change in the sleep cycle and sleep pattern.

• Difficulty in concentration and lack of motivation.

• Brain fog.

• Reduction in muscle mass and muscle strength.

• Reduction in bone density (osteoporosis).

• Breast enlargement in men (gynecomastia).

• Fatigue and tiredness.

• Depression.

• Irritability.

• Reduced stamina.

• Weight gain.

• Pain in joints.

• Decreased hemoglobin.

• Reduced body hair.

What Causes Testosterone Levels to Drop?

The primary cause of low testosterone in men is the advancement of age; the levels reduce by one percent per year after thirty years of age. However, several other reasons may lead to a drop in testosterone levels.

• Injury to the testes.

• Infection in the testes.

• Chemotherapy or radiation exposure.

• Hemochromatosis (excess of iron in the body).

• Dysfunction of the pituitary gland.

• Certain drugs like Opioids.

• Excess alcohol consumption.

• Liver cirrhosis.

• Kidney diseases and kidney failure.

• Obesity.

• Type 2 diabetes (uncontrolled).

• Hypothyroidism.

• Excess estrogen.

• Various syndromes like Kallman syndrome (abnormal development of the hypothalamus) and Klinefelter syndrome (genetic disorder associated with males born with an extra copy of the X chromosome).

• Ambiguous genitalia.

• HIV/AIDS (human immunodeficiency virus infection or acquired immunodeficiency syndrome).

How Is Low Testosterone Diagnosed?

Low testosterone levels are diagnosed by means of blood examinations. Most of the testosterone present is attached to a certain type of protein, and the rest of the testosterone is called free testosterone. There are two kinds of testosterone tests:

1. Free Testosterone: Measure just free testosterone.

2. Total Testosterone: Measures both free and attached testosterone.

The highest levels of testosterone are present in the morning, around 7 to 8 am, which is why most doctors advise testosterone sampling in the morning.

How Is Low Testosterone Treated?

The primary treatment modality for low testosterone is testosterone replacement therapy. This therapy is available in various forms like intramuscular injections, testosterone gels, testosterone patches, etc.

• Transdermal: These include topical gels, creams, liquids, and patches of testosterone that can be applied on or through the skin.

• Injections: There are short-acting and long-acting testosterone injections. The short-acting injections are given on the skin or intramuscular, whereas the long-acting injections are given only intramuscularly. These injection doses may be repeated every week, two weeks, or every month.

• Oral: The oral form of testosterone comes in the form of patches that can be placed over the canine tooth; the drug is released over a time of twelve hours.

• Intranasal: The prescribed dose of testosterone is pumped into each nostril three times a day.

• Pellets: Testosterone pellets are placed under the skin of the hips, and it is changed every three to six months.

What Are High Testosterone Levels in Men, and What Are Its Symptoms?

Higher testosterone levels are a bigger problem for women than men. However, in men, an abnormally high testosterone level is called hypergonadism, and any level above 950 ng/dL is considered high testosterone. The free testosterone level is also above 30 in case of high testosterone. The possible signs and symptoms of high testosterone include:

• Both young men and women with a high level of testosterone may enter precocious puberty (when puberty starts at a very early age). Precocious puberty may lead to infertility in some cases.

• Acne.

• Aggression is most commonly associated with increased testosterone in men.

• Excess body hair.

• High sex drive.

• Increased risk-taking and criminal behavior.

Abnormally high levels of testosterone in men can be caused due to:

• Adrenal or testicular tumors.

• Anabolic steroid abuse (common among athletes).

• Testosterone supplements.

How Does a High Level of Testosterone Affect Women?

A high testosterone level in women is associated with several health issues that can affect fertility and general health. Testosterone is the main sex hormone in men, but a small amount of it is present in women as well. However, most of this testosterone in women is eventually converted into estradiol. Symptoms of high testosterone in women include:

• Acne.

• Abnormal hair growth.

• Hair thinning on the scalp (male pattern balding).

• Irregular or absent menstrual cycles.

• Growth of facial hair.

• Infertility.

• Enlarged clitoris.

• Increased muscle mass.

• Weight gain.

• Deepening of voice.

• Lack of ovulation.

Possible causes of high testosterone in women are:

• Polycystic Ovarian Syndrome: A condition caused by a hormonal disorder and characterized by enlargement of the ovary with the presence of small cysts on the outer edges.

• Congenital Adrenal Hyperplasia: A genetic disorder that limits hormone production in the adrenal glands.

• Adrenal or Ovarian Cancers: Cancer or tumor in adrenal glands or the ovaries.

• Anabolic Steroid Abuse: The use of synthetic testosterone is common among female athletes (just like male athletes).

Conclusion:

Low testosterone levels are a bigger problem in men, and high testosterone levels are a bigger problem in women. However, the condition is easily treatable with hormone replacement therapy and other drugs. The testosterone replacement therapy, which is used to treat low testosterone, has certain side effects like acne, fluid retention, prostate stimulation, difficulty sleeping (sleep apnea), etc. The testosterone replacement therapy is also contraindicated in the case of an enlarged prostate, a lump on the prostate that has not been evaluated by the doctor, breast cancer, severe congestive heart failure, etc.