A Root Cause Medicine Approach
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April 26, 2022

11 Common Causes Of Low Male Testosterone (And How To Fix Them)

Medically Reviewed by
Updated On
September 17, 2024

If you are a man struggling with low libido, decreased energy levels, or fluctuations in mood, you may have a hormone imbalance. Hormones are your body's messengers that tell organs what to do and when to do it. One of the primary hormones in men is testosterone, a hormone critical for sexual function and masculine features. In the testosterone cycle, signals from the hypothalamus in the brain are sent to the pituitary gland, which in turn triggers the testes to produce testosterone. Ninety-five percent of testosterone is produced within the testes, with an additional small percentage produced by the adrenal glands. Research demonstrates that testosterone plays a crucial role in metabolism, vasculature, and brain function, in addition to its well-known effects on bone and body composition.

Male hypogonadism, the medical term for low testosterone levels, can lead to various symptoms. Approximately 40% of men over the age of 45 are hypogonadal. Because hormones play such significant and complex roles in controlling multiple bodily functions, a slight imbalance significantly impacts symptoms. The natural decline of testosterone that occurs with age can be accelerated through dietary choices, poor lifestyle habits, medication exposures, lack of physical activity, and increased stress.

An Integrative Medicine Approach to Low Testosterone in men includes evaluating genetics, diet, hormonal shifts, and other lifestyle habits to determine the root cause and potential treatments. By incorporating in-depth bloodwork and specialty lab testing to get the proper diagnosis treatment, many patients can have a long-term improvement in symptoms.

Low Male Testosterone Signs & Symptoms

Hypogonadism is characterized by serum testosterone levels < 300 ng/dL in combination with at least one clinical sign or symptom:

Signs of Hypogonadism Include:

  • Absence or regression of secondary sex characteristics
  • Anemia
  • Muscle wasting
  • Reduced bone mass or bone mineral density
  • Oligospermia
  • Abdominal adiposity

Symptoms of Post-Pubescent Hypogonadism Include Sexual Dysfunction Symptoms Such As:

  • Erectile dysfunction
  • Reduced libido
  • Diminished penile sensation
  • Difficulty attaining orgasm
  • Reduced ejaculate

Other Symptoms Can Include:

  • Reduced energy and stamina
  • Depressed mood
  • Increased irritability
  • Difficulty concentrating
  • Changes in cholesterol levels
  • Anemia
  • Osteoporosis
  • Hot flushes

Of the hypogonadal symptoms evaluated with the Aging Male (ADAM) questionnaire developed in 2000, "lack of energy" appears to be the most important symptom that predicted a low testosterone level in the under 40 population as opposed to decreased libido and erectile dysfunction, which were more frequent in the elderly population.

Low Male Testosterone Possible Causes

There are two main causes of low testosterone in men: primary hypogonadism and secondary hypogonadism.

Primary Hypogonadism

Testosterone levels decline naturally with age and are the highest at puberty (as the male body develops) and continue to decline 1-2% every year after 30 years old. Primary hypogonadism originates from a problem with the testicles. Common causes include Klinefelter's Syndrome, undescended testicles, hemochromatosis, testicular injury, chemotherapy, radiation, and aging.

Secondary Hypogonadism

In secondary hypogonadism, the testicles are normal but function improperly due to a problem with the pituitary or hypothalamus. Testosterone decline can be accelerated through poor lifestyle habits, dietary choices, medication exposures, lack of exercise, chemicals, heavy metals, and increased stress.

Obesity

There is a relationship between excess fat and lower testosterone. Adiposity suppresses the production of testosterone.

Medications

ketoconazole, cimetidine, glucocorticoids, and opioids have been demonstrated to lower testosterone levels

Vitamin D Levels

Low and High levels of Vitamin D are associated with hypogonadism. A study of 225 middle-aged men determined that men with very low levels (≤43.9 nmol/L) and very high 25(OH)D levels (>102 nmol/L) were at increased risk of hypogonadism, indicating a U-shaped association of vitamin D levels and hypogonadism.

Processed Sugar

Sugar can turn off genes responsible for regulating testosterone and estrogen in both men and women, leading to imbalances of these essential sex hormones. This discovery reinforces public health advice to eat complex carbohydrates and avoid processed refined sugar.

Zinc

Adequate zinc intake is associated with optimal production and regulation of testosterone.

Lifestyle

Smoking and chronic alcohol use lower testosterone levels

Thyroid

Hypothyroidism and serum TSH levels below 10 mIU/L are associated with a reduction in serum testosterone levels in males.

Stress-Induced Hypogonadism

Stress increases cortisol and decreases testosterone in response to stress. For example, low serum testosterone levels have been reported during psychological stress, physical stress, and actual stress (such as surgery).

Gut Microbiome Imbalances

A new study correlates gut bacteria with male testosterone levels. This study showed blood levels of testosterone positively correlated with the number of bacteria in the gut independent of other factors such as age, body mass index, triglyceride, and total cholesterol.

Integrative Medicine Labs to Test for Low Testosterone in Males

To measure hormone level imbalance, a practitioner should order the following.

Testosterone

Serum Testosterone, both total and free to get an idea of what's going on with androgens. Virtually all published studies of testosterone use serum levels as the gold standard. Note: Testosterone is secreted in a daily pattern, and it is therefore recommended to test in the morning to capture peak levels.

Sex Hormone-Binding Globulin (SHBG)

Other hormones that can impact testosterone levels include Sex hormone-binding globulin (SHBG). SHBG is a protein that binds to sex hormones in the body and controls the amount in circulation. If SHBG levels are high, fewer sex hormones are available.

Estradiol

As men’s testosterone levels fall, they may have relatively higher estrogen levels. Serum Estradiol in men can be used to evaluate men with symptoms of estradiol excess, which may manifest as decreased libido or increased body fat.

DUTCH Complete

The DUTCH Complete™ is a urine test evaluating sex hormones, adrenal hormones, and cortisol to provide a useful comprehensive picture of hormones.

Comprehensive Stool Test

A well-functioning gut is essential for overall health and keeps hormone levels balanced. A GI health stool test can evaluate the gut microbiome and any markers for inflammation and digestion/absorption deficiency. A new 2022 study correlated bacteria in the gut microbiome with male testosterone levels (linked and elaborated above).

Complete Thyroid Panel

The thyroid should be evaluated as it impacts mood, energy, and other hormones. A complete thyroid panel is recommended to rule out thyroid disorders.

Other Labs

Because testosterone plays a crucial role in metabolism and vasculature, bone and body composition, other serum lab tests to check include a Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), Iron panel, iron and ferritin levels, blood glucose, Vitamin D, and kidney and liver health to rule out health concerns and associations.

Iron

Too much iron in the blood can cause testicular failure or pituitary gland dysfunction, affecting testosterone production.

Iron Optimal Range: 85-130

Iron Standard Range: 40-160

Ferritin

Ferritin is a major iron storage protein. It's a marker of total iron stored in the body.

Ferritin Optimal Range for Adult Male 30-190 ng/mL

Glucose

Initial screening for diabetes or early blood sugar dysregulation

Glucose Optimal Range: 75-86

Glucose Standard Range: 65-99

Vitamin D

Vitamin D levels (low and high) are associated with hypogonadism, and Vitamin D Deficiency is directly linked to several health concerns, including osteoporosis, heart disease, cancer, and impaired immune function.

Vitamin D Optimal Range 35-50

Vitamin D Standard Range 30-100

Integrative Medicine Treatment for Low Testosterone in Males

Lifestyle Changes

While testosterone decline is a normal part of a man's life, incorporating strategies to balance lifestyle can mitigate symptoms. Incorporating an anti-inflammatory diet, prioritizing sleep and ideal body weight, avoiding excessive alcohol, practicing consistent physical activity, and using stress management techniques can be helpful.

Supplements

Vitamin D

A small study of vitamin D deficient men who were given 3,332 IU vitamin D daily for one year showed a significant increase in total and free testosterone levels.

Zinc

Adequate zinc intake is associated with optimal production and regulation of testosterone. Food sources including oysters contain more zinc per serving than any other food, but red meat and poultry provide the majority of zinc in the American diet. Other zinc food sources include beans, nuts, and certain types of seafood, such as crab.

Herbs

A 2021 review of herbs and their effects on testosterone showed fenugreek and ashwagandha to have the most significant impact on testosterone concentrations in men.

Hormone Therapy

After a comprehensive assessment, if testosterone replacement is indicated, it is usually prescribed as an injection or via a topical skin gel or patch. Testosterone therapy has demonstrated improvements in symptoms of erectile dysfunction and low libido in men with low testosterone levels. It also impacts metabolism. In a study of 411 men with low testosterone, testosterone therapy produced significant weight loss and decreased waist circumference and body mass index (BMI).

While multiple studies document improvements, patients benefit from an individualized approach. In a study funded by the National Institutes of Health, the amount of testosterone required to maintain lean mass, fat mass, strength, and sexual function varied widely in men.

Testosterone therapy should not be prescribed for any reason with a history of prostate or breast cancer or sensitivity to any of the ingredients in the formulation.

Side effects from prolonged testosterone replacement may include breast enlargement, acne or oily skin, decreased testicular size, and an increased risk of prostate enlargement or prostate cancer.

Summary

Management of low testosterone in males is complex and lends itself to a functional medicine approach because of the overlap of symptoms, causes, and individualized treatment approaches.

A thorough history, physical exam, and specialty laboratory testing will help pinpoint a more accurate and comprehensive assessment to optimize health.

If you are a man experiencing low energy levels, changes in mood, or reduced interest in activities, it might be helpful to explore whether hormone levels are balanced. Hormones are important messengers in your body that help regulate various functions. One of the key hormones in men is testosterone, which plays a role in many bodily functions. In the testosterone cycle, signals from the brain's hypothalamus are sent to the pituitary gland, which then prompts the testes to produce testosterone. Most testosterone is produced in the testes, with a small amount also produced by the adrenal glands. Research suggests that testosterone is important for metabolism, blood vessel health, and brain function, in addition to its effects on bone and body composition.

Low testosterone levels, also known as male hypogonadism, can lead to various symptoms. Studies show that approximately 40% of men over the age of 45 may experience low testosterone. Because hormones play significant roles in controlling multiple bodily functions, even a slight imbalance can impact how you feel. The natural decline of testosterone with age can be influenced by dietary choices, lifestyle habits, medication, physical activity, and stress.

An Integrative Medicine Approach to low testosterone in men includes evaluating genetics, diet, hormonal shifts, and lifestyle habits to understand potential causes and ways to support health. By incorporating detailed bloodwork and specialty lab testing, individuals may find ways to support their well-being.

Signs & Symptoms of Low Male Testosterone

Hypogonadism is characterized by serum testosterone levels < 300 ng/dL along with at least one clinical sign or symptom:

Signs of Hypogonadism May Include:

  • Changes in secondary sex characteristics
  • Low red blood cell count (anemia)
  • Loss of muscle mass
  • Reduced bone density
  • Low sperm count
  • Increased abdominal fat

Symptoms of Post-Pubescent Hypogonadism May Include Sexual Health Concerns Such As:

  • Difficulty with erections
  • Reduced interest in sexual activity
  • Less sensation
  • Difficulty reaching orgasm
  • Reduced volume of ejaculate

Other Symptoms May Include:

  • Low energy and stamina
  • Feelings of sadness
  • Increased irritability
  • Difficulty focusing
  • Changes in cholesterol levels
  • Low red blood cell count (anemia)
  • Weak bones (osteoporosis)
  • Hot flashes

Of the symptoms evaluated with the Aging Male (ADAM) questionnaire developed in 2000, "lack of energy" appears to be a significant symptom that may indicate low testosterone levels in younger men, while decreased interest in sexual activity and difficulty with erections were more common in older men.

Possible Causes of Low Male Testosterone

There are two main categories of causes for low testosterone in men: primary hypogonadism and secondary hypogonadism.

Primary Hypogonadism

Testosterone levels naturally decline with age, peaking during puberty and decreasing 1-2% each year after age 30. Primary hypogonadism originates from issues with the testicles. Common causes include genetic conditions, testicular injury, and aging.

Secondary Hypogonadism

In secondary hypogonadism, the testicles are normal but may not function properly due to issues with the pituitary or hypothalamus. Factors such as lifestyle habits, diet, medication, and stress can influence testosterone levels.

Obesity

There is a relationship between excess body fat and lower testosterone. Adiposity may affect testosterone production.

Medications

Certain medications like ketoconazole, cimetidine, glucocorticoids, and opioids have been shown to influence testosterone levels.

Vitamin D Levels

Both low and high levels of Vitamin D are associated with hypogonadism. A study found that men with very low or very high Vitamin D levels were at increased risk of hypogonadism, suggesting a U-shaped relationship.

Processed Sugar

High sugar intake can affect genes responsible for regulating testosterone and estrogen, leading to imbalances. It is advised to consume complex carbohydrates and limit processed sugars.

Zinc

Adequate zinc intake is linked to healthy testosterone production and regulation.

Lifestyle

Habits such as smoking and chronic alcohol use can influence testosterone levels.

Thyroid

Thyroid function, particularly hypothyroidism, is associated with changes in testosterone levels.

Stress-Induced Hypogonadism

Stress can increase cortisol and may influence testosterone levels. Low testosterone levels have been reported during various stress conditions.

Gut Microbiome Imbalances

A study suggests a correlation between gut bacteria and male testosterone levels, indicating that gut health may play a role in hormone balance.

Integrative Medicine Labs to Consider for Low Testosterone in Males

To explore hormone levels, a healthcare provider may suggest the following tests:

Testosterone

Testing serum testosterone, both total and free, can provide insights into androgen levels. It is often recommended to test in the morning to capture peak levels.

Sex Hormone-Binding Globulin (SHBG)

SHBG is a protein that binds to sex hormones and influences their availability. SHBG levels can impact testosterone availability.

Estradiol

As testosterone levels change, estradiol levels may also be evaluated to understand hormone balance.

DUTCH Complete

The DUTCH Complete™ test evaluates sex hormones, adrenal hormones, and cortisol for a comprehensive hormone profile.

Comprehensive Stool Test

A GI health stool test can assess gut microbiome health, which may influence hormone balance.

Complete Thyroid Panel

A complete thyroid panel can help rule out thyroid disorders that may affect hormone levels.

Other Labs to Consider

Because testosterone is involved in metabolism and body composition, other tests such as a Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), Iron panel, and Vitamin D levels may be helpful to assess overall health.

Iron

Iron levels can influence testosterone production. Monitoring iron levels can be part of a comprehensive health assessment.

Ferritin

Ferritin is a marker of total iron stored in the body and can provide insights into iron status.

Glucose

Monitoring glucose levels can help screen for blood sugar regulation issues.

Vitamin D

Vitamin D levels are associated with various health concerns, and maintaining balanced levels is important for overall health.

Integrative Medicine Approaches to Support Testosterone Levels in Males

Lifestyle Changes

While testosterone decline is a normal part of aging, lifestyle changes can support overall well-being. Consider incorporating a balanced diet, prioritizing sleep, maintaining a healthy weight, limiting alcohol, engaging in regular physical activity, and practicing stress management techniques.

Supplements

Vitamin D

A study found that vitamin D supplementation may support testosterone levels in men with low vitamin D.

Zinc

Adequate zinc intake is linked to healthy testosterone production. Foods rich in zinc include oysters, red meat, poultry, beans, nuts, and certain seafood.

Herbs

A review suggests that herbs like fenugreek and ashwagandha may support testosterone levels.

Hormone Therapy

After a thorough assessment, testosterone therapy may be considered if indicated. It is typically administered as an injection or topical gel/patch. Testosterone therapy has been shown to support certain symptoms in men with low testosterone. However, it should be approached with caution and under medical supervision, especially in individuals with a history of certain health conditions.

Potential side effects of testosterone therapy may include changes in breast size, skin conditions, and an increased risk of prostate issues. It is important to discuss the risks and benefits with a healthcare provider.

Summary

Managing low testosterone in males involves a comprehensive approach that considers symptoms, potential causes, and individualized strategies. A thorough history, physical exam, and laboratory testing can help create a plan to support overall health and well-being.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or on this website.

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