Is low testosterone impacting your health and wellbeing?
It’s become widely known that men’s physical and mental health issues are related to testosterone levels. However just because a man is feeling depressed, has low energy, or is in poor general health does not mean the cause is low testosterone.
So if you think you might have low testosterone, before you start looking for testosterone supplements, read this article which will help identity more clearly whether your issues are due to testosterone, and what to do if you find out you have low testosterone.
What are the symptoms of low testosterone?
We know that men who experience a rapid cessation of testosterone as a result of treatment for prostate cancer (called androgen deprivation therapy, or ADT) experience a range of serious physical consequences e.g. loss of libido, hot flashes, osteoporosis, loss of muscle mass, breast enlargement, anaemia, fatigue, diabetes, hair growth changes, and cardiovascular disease. In addition, fertility may be impaired, because testosterone is required for the production and development of sperm. Men may also experience multiple sexual dysfunction symptoms, including a reduction in erections and erectile strength, reduced sexual thoughts and desires and ejaculatory issues such as delayed emission. The sudden total loss of testosterone with ADT may also cause mood swings, depression, cognitive impairment and low energy levels. It could be that men going through normal age-related reductions in testosterone experience a mild version of one or more of these symptoms.
Before you start thinking ‘Hey – that sounds like me’ please read on, because the issue is more complex that you think.
What are the causes of low testosterone?
Testosterone decreases with age by about 20-30%, partly due to normal biological aging processes, but also due to other factors such as chronic illness (e.g. type 2 diabetes), medication use, and obesity. In fact, there are many causes of low testosterone and can include:
· Testicular injury
· A history of bilateral cryptorchidism (undescended testicles)
· Orchitis (inflammation of the testes)
· Hormonal issues within the body
· Genetic conditions
· Treatments for cancer such as chemotherapy
· Performance enhancing drugs
· Polychlorinated Biphenyl (PCB) exposure
Being in a relationship is one of the main predictors of good mental health in men, but the down side of this is that the death of a man’s partner not only causes bereavement, but can lead to a drop in testosterone levels equivalent to 10 years of aging.
What other issues can cause symptoms of low testosterone?
Being overweight, diabetes, general poor health, or mood issues such as depression can all cause symptoms similar to those seen in people with low testosterone.
“If a man believes he is suffering from low testosterone levels, he should get his testosterone levels tested by a reputable medical establishment, because the symptoms he believes are due to low testosterone might be due to other causes.”
Is there such a thing as ‘the manopause’?
The term ‘late-onset hypogonadism’ is often used to describe the deficiency in serum testosterone levels associated with increasing age in men, but it’s not clear that this change - which happens gradually over decades - has much impact on the mental health of most men, over and above any other life stressors (e.g. work or relationship issues) that occur around this time. It’s probably fair to say that the hormone changes that impact men in mid-life are not comparable to menopause in women. This is because women’s sex hormones typically decrease dramatically at around age 50, which can cause sudden physiological and emotional changes. In contrast, testosterone in men falls very gradually from the 20s onwards, and only reach very low levels in a small percentage of elderly men.
How can I test whether I have low testosterone?
If a man believes he is suffering from low testosterone levels, he should get his testosterone levels tested by a reputable medical establishment, because the symptoms he believes are due to low testosterone might be due to other causes. The advice to get levels tested is especially important for anyone wanting to take testosterone or supplements to improve testosterone as these carry their own risks that need to be considered. It may also be sensible to consider that if a man is taking performance enhancing drugs (anabolic steroids) that have not been prescribed, they may be indivertibly masking a reduction in the natural production of testosterone. When men in this situation want to start a family, ceasing the use of androgenic anabolic steroids brings a new set of symptoms that can reduce their quality of life and should be considered carefully with a healthcare professional.
Testosterone has a diurnal pattern of secretion (varies through the day) and therefore most guidelines on testing will suggest an early morning test, ideally between 07:00 and 10:00. The ‘gold standard’ for a testosterone test is a blood sample - usually from the arm - by a healthcare professional, who sends the sample to a biochemistry laboratory for processing and reporting. (Alternative methods, such as taking a sample of blood from a finger, or a sample of your saliva, are generally considered of lower quality and may produce inaccurate results).
“There is some evidence that having a sense of winning gives testosterone a small boost, whether it’s winning a competition or being an avid supporter of a team or person who wins a competition.”
The results may differ depending on what type of test the laboratory uses, so it is unwise to compare your results to someone else’s, unless you are certain that exactly the same laboratory methods were used. It is vital that results are interpreted in conjunction with an appropriate healthcare professional so that laboratory and other factors are considered. Your physician might want to test other hormone levels too, which will give a better understanding of what your testosterone result means.
What can I do if I find out that I have low testosterone?
The first step should be to discuss this with an appropriate healthcare professional. A good place to start would be with your general practitioner (GP, or family doctor). They will most likely confirm any tests results and undertake a health review or consider referral to an endocrinologist, who specialises in hormones such as testosterone. Further referrals are not always considered necessary, especially with older men as it is often ‘expected’ that testosterone will be lower in older men, and therefore no action is taken. If the symptoms are impacting on quality of life, further appropriate action should be considered.
One potential impact of low testosterone is erectile dysfunction. In around 85% of cases it is successfully treated by sildenafil (Viagra), but this should not be used as a quick fix, and alternative support should be considered, such as psychological therapies (see below), e.g. psychosexual therapy from trained individuals in healthcare, or exercise, which can also help.
There is some evidence that having a sense of winning gives testosterone a small boost, whether it’s winning a competition or being an avid supporter of a team or person who wins a competition. So being involved in competition can help, although this can backfire if on the losing side, where a small drop in testosterone may occur.
What if I have these symptoms, but it turns out my testosterone level is normal?
There are other physical and mental health issues that have similar symptoms to low testosterone. For example in middle-aged men, mental health may be impacted by life events that are typical at this age (such as work stress, unemployment, divorce, health issues, caring for elderly relatives etc).
Men at any age can experience depression. It is normal to feel sad if someone close to you dies, and feeling sad in these conditions is so normal that it isn’t in itself considered a clinical issue. It’s also normal to be impacted by ‘life events’ such as the breakdown of a relationship, stress of studying or failing an exam. Even things we think are good can be associated with stress, such as moving house, getting a new job, or the school term ending.
One of the greatest losses a man can experience is losing contact with his children, or having limited contact with them, as often happens as a result of family breakdown and divorce. Not only can this cause a man a great deal of distress, being a recently divorced middle aged man is one of the strongest predictors of suicide. For these and other reasons, it is good advice to treasure your relationships and do whatever you can to help them grow at whatever stage of life you are at.
Psychological therapies
There is some evidence that men in general tend prefer to deal with mental health issues differently to women. Where women tend to want to explore their feelings, men like to fix whatever is causing the problems. Men often benefit from low-intensity sports or activities such as walking in nature, playing ‘walking football’ or other team sports, joining a men’s talking group, or join a ‘Men’s Shed’ where men meet and engage in activities such as fixing furniture. For issues that aren’t helped in this way, it’s a good idea to get professional mental health support from someone who is male-friendly, and won’t treat your problems as being the result of patriarchy or ‘toxic masculinity’, or other unhelpful notions which themselves are possibly harmful.
How can I test whether I suffer from depression or low mental wellbeing?
You can get a diagnosis from a psychologist or psychiatrist, but you can get a rough idea by filling in a short questionnaire such as the PHQ-9. Or you can use a questionnaire that is more male-specific, such as the Male Depression Risk Scale (MDRS-7). If your score suggests you have depression, and if you don’t have any of the physical symptoms related to low testosterone (such as hot flashes, osteoporosis, loss of muscle mass, breast enlargement, anaemia, fatigue, diabetes etc listed above) then you should take action to deal with your depression first rather than exploring treatments to increase testosterone.
How can I support someone who has got low testosterone?
You might want to help a man in this situation, but find that he is irritable or aggressive. Try not to let this put you off. The impact of low testosterone can be very difficult, and sometimes men react to life stressors with irritability, aggression or substance abuse. There is some general guidance here that might be helpful.
Understanding the physical and psychological impacts of low testosterone on him can help. As men grow older they are naturally less able to do the things they used to, such as being able to work to provide an income for their loved ones, or being physically strong enough to defend the family and home if needed. This change is a normal part life, but is likely to impact their self-esteem, especially if these changes are remarked on by others, so some sensitivity is needed if raising the topic. Unless he can compensate for these changes (e.g. having a large pension or savings that allow them to continue the provider role) he will need to meet these challenges in some other way.
A man might experience these changes as losses of various kinds, such as a loss of his youth, his ability to do various things, or a loss of being useful to others. Loss of meaning in one’s life is often a central issue. It is important that men in mid-life or later life have, or develop, a sense of meaning in their lives, whether this is in their family connections, their post-retirement hobbies or activities, in sports etc. Whatever they do, it should be something that has meaning for them. Other more general advice is to maintain a healthy lifestyle in terms of diet, exercise, and being able to deal with stress effectively, all of which will help mind and body. Gently encouraging men to do things they are likely to enjoy (e.g. ‘walking football’, staying in touch with friends, revisiting old hobbies) can help.
Although masculinity is implicit in many aspects of low testosterone, it is generally not a good idea for a therapist or family members to talk about these issues as problems of masculinity. Testosterone is considered the ‘male hormone’ because it causes characteristics that are seen as masculine (e.g. muscle mass and hair growth) and influence behaviours we associate with masculinity (e.g. muscle power and energy make men more suited to being fighters and protectors). Many men will implicitly understand the connection between testosterone and masculinity, but are unlikely to see a conversation about this as the best way to go if their problem is low testosterone.
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Disclaimer: This article is for information purposes only and is not a substitute for therapy, legal advice, or other professional opinion. Never disregard such advice because of this article or anything else you have read from the Centre for Male Psychology. The views expressed here do not necessarily reflect those of, or are endorsed by, The Centre for Male Psychology, and we cannot be held responsible for these views. Read our full disclaimer here.
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