When Low Testosterone Strikes: What Australian Men Need to Know
Disclaimer: We have come up with this explainer to teach Australian men what having low testosterone looks like and the issues that could follow. This is not medical advice in any way or form.
Just as you have been taught in science class in high school or university, testosterone is the male sex hormone. It is what is responsible for the male sex drive, sperm production, muscle strength, and bone density, among others. In essence, it is what makes a man, a man.
It typically kicks in at puberty to change the body of a male child. By the time the boy reaches maturity, i.e. becomes an adult, his testosterone levels (often called T-levels) should be around 10–30 nmol/L. Anything lower than that is a cause for concern.
It becomes “dangerously low” if the T-levels are well below 5–8 nmol/L (around 150–200 ng/dL). At this point, different health problems may begin to manifest through various symptoms.
Testosterone lives in the proteins in the blood (mostly sex hormone-binding globulin, SHBG). A small free fraction is bioavailable, however. The quickest way to drop testosterone levels in men is to be unfit, i.e. be obese, have a high body mass index (BMI), or have excess belly fat. Taking care of your fitness as a man helps keep your testosterone levels up.
Regardless of it all, testosterone levels still drop in men. Your T-levels at age 25 aren’t expected to remain the same at age 45. There’s a term for this: Andropause, similar to menopause in women.
Unlike menopause, however, andropause can be staved off for as long as the man stays healthy and engages in testosterone-boosting activities. Still, T-levels will drop because time conquers us all.
The average young man’s testosterone level, according to every available lab report, is between about 9.7–34.3nmol/L, with the average being around 18 nmol/L. Any man with T-levels below 7 nmol/L will be flagged, and the man will be diagnosed as having male hypogonadism.
As stated earlier, anything well below 5–8 nmol/L is dangerously low. This is where the health effects of having low testosterone start becoming evident. At this stage, raising testosterone levels may not be enough to deal with drawbacks, unless doctors say otherwise.
In Australia, men who are 40 and older and with proven T-levels of under 8 nmol/L (determined after two tests) have treatment subsidies available for them. These men must have no underlying health issues that could have caused low T levels, however.
Age (time) and medical issues could cause testosterone levels in men to drop. However, male hypogonadism or androgen deficiency happens as a result of one of the two main reasons described below:
Basic testicular function is sperm production and testosterone production. A problem with one of these basic functions amounts to testicular dysfunction. Many different issues can lead to the loss of testicular function.
One of the issues that can cause T-levels to drop in men is when one or both of their testicles shrink. This is known as testicular volume loss, and is a result of too much drinking, infections, trauma, among others. Medical procedures like chemotherapy and radiation treatments can also have testicular volume loss as a side effect, which means a loss of testicular function and low T-levels.
Another cause of primary hypogonadism is Klinefelter syndrome (where an extra X chromosome appears on the Y chromosome). This is a genetic mutation that nobody really has control over.
Undescended testes is another cause, as is testicular injury as a result of accidents, trauma (from fights or strenuous sporting activities), infections or a surgery that did not go as planned is another reason why testicular dysfunction happens.
This type of hypogonadism is a result of the brain not working as it should for different reasons.
The pituitary gland is the brain’s messenger to the testes, where testosterone springs from. The pituitary gland releases LH (Luteinising Hormone) to the testes after receiving command signals from the brain. LH then goes into the testes to activate them to produce testosterone.
Any break in this flow, for example, an injury to the pituitary gland as a result of a blow to the head, tumours, an infection or some genetic factor, means little to no testosterone will be produced, leading to secondary hypogonadism.
Too much belly fat, obesity, a high body mass index (BMI) and problems with metabolism drop T-levels by raising the oestrogen (female sex hormone) in men. Insulin resistance and Type 2 diabetes can also drop T-levels in men.
There are also certain medications that can mess with testicular function as well, which is why every supplement, steroid or basic tablet or capsule medication must be prescribed.
As mentioned earlier, chemotherapy is also a factor in reduced testosterone levels. If the person also has chronic liver or kidney issues, too much iron in their blood (hemochromatosis), or HIV/AIDS, their T-levels will take a hit.
Sleep apnea (loss of breath while sleeping) and anything that affects sleeping patterns can also affect T-levels.
Because time comes for us all, T-levels will eventually decline, no matter how dedicated a man is to keeping his T-levels up. This is because age affects the efficacy of the testes when it comes to their basic functions. So, even though you can say that male menopause (also known as andropause) is misleading, at some point, men start to lose testosterone “production capacity”, leading to low T-levels and the accompanying symptoms.
You should know that many illnesses share the same symptoms. In other words, some symptoms that are associated with low T levels could also be symptoms of another condition. Many symptoms of low T also overlap with general ageing. See your doctor for proper evaluation when you come across the symptoms listed below:
When you lose your excitement for sex (low or reduced sex drive), you probably have low testosterone. Erectile dysfunction (ED) and low sperm production are also a result of low testosterone.
When you find yourself putting on unnecessary weight, especially in the belly region, or losing strength and muscle mass (sarcopenia), and being unable to enjoy a kick about with your friends or being unable to last more than ten minutes playing with your kids, check your T levels.
Low testosterone levels can also directly affect a man’s mental state. Erectile dysfunction, a reduced sex drive, and very visible physical changes already put a strain on the mind, but low T levels on their own, without either of the last two symptoms, can cause mood shifts, mild depression, irritability or anxiety. It can also cause brain fog, where your concentration takes a hit for a few minutes or hours, several times a day. In older men, it straight up causes cognitive decline.
Lack of sleep can affect testosterone levels, but testosterone levels can also affect sleeping habits. You might have excessive sleepiness to the point of almost looking hypersomniac.
Going bald from nowhere and developing breasts that look almost feminine are pointers, too. Low T also shrinks your “balls”.
The following symptoms are not to be taken lightly:
As stated earlier, they could be signs of any other issue, but they are also associated with low T levels. Because of how these symptoms overlap, doctors will carry out hormone tests and/or a blood test first to check your testosterone levels before moving on to other tests.
After listening to a patient list out the symptoms they are dealing with, the doctor does a blood test.
They do not draw blood randomly, however, because testosterone has a daily cycle (it is usually produced between 8 and 10 in the morning and drops in the evening). They have to draw blood early enough, which means the patient could be asked to return early the next day.
As alluded to in earlier sections, one test is not enough. T-levels fluctuate frequently, even after the production cycle is complete. Also, something as simple as a slight headache could affect the readings. More tests will be done on different days and tallied to make a proper diagnosis.
When blood tests for testosterone levels are carried out, what they’re checking are the total testosterone levels. If the numbers are not looking good, or the levels of the sex hormone-binding globulin (SHBG) in the blood are abnormal, the doctor will check the free testosterone (also known as bioavailable testosterone) levels.
This is because factors like obesity, liver or kidney issues, thyroid issues and gut issues can change SHBG levels, which directly affect T levels.
Hypogonadism isn’t just low T. It is low T AND symptoms. In other words, a man’s testosterone levels can be low without him having any symptoms.
If the patient has no symptoms, doctors will go on to check for other issues like obstructive sleep apnea, thyroid issues, obesity, body mass index and so on. They will also provide education on habits that could lower T levels.
If the patient is presenting symptoms, the doctor will do other hormone tests. These hormone tests will focus on the levels of hormones like LH that work closely with testosterone.
For example, if the test reveals that LH is high but there is low T, then it means the testes have failed (primary). If the LH is low or normal and there is low T, then it’s a problem with the pituitary gland (secondary).
Depending on the levels the tests reveal, doctors could check for prostate cancer by doing a digital rectal examination (DRE) to check the prostate. If the patient is a middle-aged man or older, they do this test regardless. This is to rule out benign prostatic hyperplasia (BPH).
If the patient has dealt with low testosterone for a while or the patient has risk factors (age, stature, family medical history), the doctor will order a bone density test for them.
A bone density test measures how strong a person’s bones are, because bone density is directly proportional to the risk of osteoporosis. Low testosterone can lead to weak bones.
Because T-levels fluctuate during the day, and because malformed data from lab results occur regularly, it is unwise to rely on the first lab result.
Not everyone has the same “low” or “normal” numbers. There is a range that doctors operate with (8—12 nmol/L). When the numbers fall below that range, doctors check other things like the free (bioavailable) testosterone or SHBG, or other health conditions that could cause it.
Low T and many other conditions have symptoms that overlap, so diagnosis must follow a clear pattern, rather than just assuming a related symptom is a result of low testosterone.
Underlying health conditions could also cause T levels to drop, which is why doctors must check first for any health issues. If a patient is on any medication or using steroids, it can cause T levels to drop. Always provide your full medical history, just in case.
The following health problems have been linked to low testosterone levels in men:
Low T means bones will lose strength easily, which leads to osteoporosis, a condition that causes fractures on a whim.
Low T also causes metabolic issues, which can lead to obesity, high blood sugar, and high cholesterol, among others. Low T is also associated with insulin resistance and can exacerbate the onset of Type 2 diabetes.
Low T in men means poor heart and lung function, which can easily become a cardiovascular disease. It is not clear if it is associated with heart disease; however, many men who have battled cardiovascular disease have been shown to have low testosterone.
Depression, anxiety, and cognitive decline have been linked to low T. In fact, many elders with dementia have been confirmed to have low T.
The biggest casualty of low T is usually sexual health. Sex drive plummets, erectile dysfunction rears its head, and even sperm production is affected. This also affects fertility because there won’t be enough sperm for reproduction.
Testosterone keeps muscles strong, which means that low T can cause muscles to lose their strength. You can even lose the muscles you have as a result of low testosterone (sarcopenia).
Side note on testosterone replacement therapy risks: Testosterone therapy is one of the first points of call for low testosterone-related health issues. However, it has many side effects, like acne, oily skin, increased red blood cell count (which can cause blood clots), and possible enlargement of the prostate. Testosterone therapy is not something you opt for without a proper sit-down with your doctor.
Having learned what testosterone is to the man, it is important to note the main point behind this explainer: low or dangerously low testosterone levels must come with symptoms to be a “problem”.
It is not just about chasing numbers, but if you get unfavourable numbers after a test, then you should do what you have to do to raise them.
The male body relies too much on this hormone for it to be an afterthought. It is appropriate to say that without testosterone, a man’s body cannot function properly.
If you recognise any of the symptoms described in previous sections of this explainer, see your doctor. And most importantly, make sure to seek their counsel before taking any treatments for low T, such as testosterone replacement therapy.