Men's Health

Men’s Health Questions Answered: What is Low Testosterone?

Men’s health topics are important to discuss with a doctor, but for many men it is difficult to have these conversations with their health care provider. Discussing sex, prostate health and hormonal imbalance can be uncomfortable, but understanding these conditions and how they affect overall health is critically important for every man.

Arnold Bullock, MD, Professor of Urologic Surgery at Washington University School of Medicine in St. Louis, specializes in men’s health. He encourages men to ask their questions and engage in honest conversations with their doctors. To help start this conversation, Bullock answers some of the questions regarding a common men’s health condition: Low Testosterone.

Low Testosterone: Frequently Asked Questions

What is Low Testosterone?

Low testosterone is a condition in which the testicles fail to produce the male sex hormone testosterone. According to the American Urological Association, about 2 men in every 100 have low testosterone.

The condition of low testosterone—also called hypogonadism—refers to an inadequate amount of testosterone to stimulate the male hormone receptors on some cells in the body, such as in the male reproductive organs, muscles and bones.

Testosterone levels change throughout a man’s life.

Newborn boys have very high testosterone levels, because they need that testosterone in utero to develop as males. From the age of two years until the start of puberty, a boy’s testosterone level is naturally very low. That level spikes again during puberty, causing boys to develop underarm hair, go through growth spurts and develop sexually. An adult male’s testosterone level should be between 270 and 1000. Testosterone levels peak at about the age of 20 years, and then the testosterone slowly declines with age. In younger men, the average testosterone level is in the range of 650. When the testosterone is under 300, that’s when we would consider an adult male to have low testosterone.

What are the symptoms of Low Testosterone?

There are several common signs of low testosterone:

  • Low Sex Drive
  • Erectile Dysfunction
  • Low Sperm Count or Low Ejaculate Volume
  • Depressed Mood
  • Decreased Sex Drive
  • Lethargy
  • Fatigue
  • Decrease in Muscle Mass
  • Loss of Pubic, Facial and Underarm Hair

Many of these symptoms could have different causes, which is why it is so important for a man to bring his concerns to a doctor. If we know that you are experiencing these symptoms, we can get to work on testing to identify and treat the condition.

Most of my patients with low testosterone say, “Doc, I just don’t have energy. I don’t feel like cutting the grass or playing golf.”

How is Low Testosterone tested?

If you have one or more of the above symptoms, we will measure your testosterone level with a blood sample.

Testosterone levels vary throughout the day. Men have much higher testosterone in the early morning than they do at night. This is called diurnal variation. Because of this variation, it’s important to schedule a blood draw in the morning—especially for younger men, whose testosterone levels vary more drastically than those of a man over 65.

Any level over 350 is considered average. Some labs report testosterone levels up to 800 or 1000, but the average man probably won’t measure that high, and there is not a benefit to having a significantly higher testosterone level. For instance, your sex drive at 500 is not going to differ from your sex drive at a level of 350.

It’s when the testosterone level is below 300 that we begin to think about treatment options for most men.

How is Low Testosterone treated?

Low testosterone can be treated directly by taking hormone replacement therapy.

Testosterone supplements can be taken in a variety of forms. The most common form my patients prefer is a gel. The gel is convenient, because you can rub it in once a day, after you shower, dry off and start dressing. This is a small addition to your daily routine, and keeps your testosterone level very stable from day to day.

There are other forms of testosterone supplement, such as a patch or injection, that we can discuss with men.

Oral testosterone supplement pills are associated with risks for heart disease and liver disorders. While a pill might be convenient, it comes with greater risks than other forms of testosterone supplement.

Should I take a “testosterone booster?”

There is a lot of advertising on the radio, television and internet for “testosterone boosters.” The guys in these ads talk about how the products changed their lives, and they show results through before and after pictures of men who are slimmer and more muscular.

The problem with the word “booster” is that it is not a medical term.

When you want to sell a product, you can claim that it does whatever you want to say it does, as long as you don’t include a medical diagnosis in that claim. “Boost” is not a medical term. If a product says it is going to “raise your testosterone level,” that’s a medical claim. In the medical world, though, “boost” does not mean anything.

What is a testosterone “booster?” Basically, a men’s health multivitamin. If you read the list of ingredients on the bottle, they are mostly the same as what you find in an inexpensive multivitamin at the store. The difference is in the cost. These products cost much more than the average multivitamin, and they give you the impression that they are raising your testosterone levels, but they are not actually doing so.

The results that men see after taking these “boosters” are really from the workout guide that comes with the “booster.” Healthy lifestyle changes—improved diet and exercise—can improve the symptoms of low testosterone. Diet and exercise can increase energy levels, help you avoid a sedentary lifestyle and naturally improve heart health. It’s too bad you can’t buy the workout guide and leave behind the expensive “boosters.”

Making these lifestyle changes, in conjunction with hormone replacement therapy through testosterone supplements, can raise a man’s testosterone levels. If your doctor suggests testosterone supplements, your levels will be monitored regularly to measure the outcomes and monitor your health.

Treating Low Testosterone with the Division of Urology

The Division of Urology is an international leader in providing innovative, high-quality medical care. For men with low testosterone, Arnold Bullock and Dane Johnson, MD, offer the most advanced care available in a compassionate, respectful and responsive environment.