Men's Health

What are the Reasons for Low Testosterone in Men?

Reasons for Low Testosterone

What is Testosterone? 

Testosterone is the primary sex hormone and anabolic steroid in males. It is a hormone made by the testicles. It is important for a man’s sex drive and physical appearance. 

What does Testosterone do?

Testosterone is supposed to regulate sex drive or libido, bone mass, fat distribution, muscle mass and strength, and the production of red blood cells and sperm. It plays a key role in the development of male reproductive tissues such as the testes and prostate, as well as promoting secondary sexual characteristics such as increased muscle and bone mass, and the growth of body hair.

What is low Testosterone? 

Low testosterone or male hypogonadism is a condition in which the Leydig cells in the testicles do not produce enough testosterone. Other names for low testosterone and male hypogonadism include:

  • Testosterone deficiency syndrome.
  • Testosterone deficiency.
  • Primary hypogonadism.
  • Secondary hypogonadism.
  • Hypergonadotropic hypogonadism.
  • Hypogonadotropic hypogonadism.

Can Testosterone levels really go down? 

Testosterone naturally starts to decrease in men, every year, post the age of 30 years. In some men, this can be substantial. In the global population, somewhere between 19 to 39 percent of older men may have low levels of testosterone. In addition to age, certain health conditions, medicines, or injuries can also lead to low testosterone (low-T). 

Late-onset hypogonadism (LOH) is a type of secondary male hypogonadism that results from normal aging. As males age, they have a deterioration of hypothalamic-pituitary function and Leydig cell function that decrease testosterone and/or sperm production. LOH and low testosterone are more common in people who have Type 2 diabetes, are overweight, and/or obese.

Top Reasons for Low Testosterone in Men 

There are several possible causes of low testosterone. The two major classifications of male hypogonadism are:

  • Primary hypogonadism or testicular disorder
  • Secondary hypogonadism or pituitary/hypothalamus dysfunction

Causes of primary and secondary hypogonadism can also be further divided into: 

  • Congenital or at birth 
  • Acquired or developed later in childhood or adulthood 

1. Congenital conditions/reasons that affect testicles and can lead to primary hypogonadism

  • Absence of testicles at birth (anorchia).
  • Undescended testicles (cryptorchidism).
  • Leydig cell hypoplasia (underdevelopment of Leydig cells in the testicles).
  • Klinefelter’s syndrome (a genetic condition in which people AMAB are born with an extra X chromosome: XXY instead of XY).
  • Noonan syndrome (a rare genetic condition that can cause delayed puberty, undescended testicles, or infertility).
  • Myotonic dystrophy (part of a group of inherited disorders called muscular dystrophies).

2. Acquired conditions/reasons that affect testicles and can lead to primary hypogonadism

  • Testicle injury or removal.
  • Orchitis, which is inflammation of one or both testicles. This is most often the result of a bacterial infection, such as a sexually transmitted infection, but it can be due to viral infections, such as mumps.
  • Chemotherapy or radiation therapy to testicles.
  • Certain types of tumors.
  • Anabolic steroid use.

3. Congenital conditions that can lead to secondary hypogonadism include 

  • Isolated hypogonadotropic hypogonadism (a condition that causes low levels of gonadotropin-releasing hormone from birth).
  • Kallmann syndrome (a rare genetic condition that causes loss of the development of nerve cells in your hypothalamus that produce the gonadotrophin-releasing hormone, and can also cause a lack of smell) 
  • Prader-Willi syndrome (a rare genetic multisystem disorder that can cause hypothalamus dysfunction)

4. Acquired conditions/reasons that can lead to secondary hypogonadism

  • Hypopituitarism (This condition may result from an adenoma, infiltrative disease, infection, injury, radiation therapy, or surgery that affects your pituitary gland.)
  • Hyperprolactinemia
  • Iron overload or hemochromatosis
  • Brain or head injury
  • Cushing’s syndrome
  • Cirrhosis of the liver
  • Kidney failure
  • Alcohol use disorder
  • Poorly managed diabetes
  • Obesity
  • Obstructive sleep apnea
  • Certain medications, including estrogens, psychoactive drugs, metoclopramide, opioids, leuprolide, goserelin, triptorelin, and newer androgen biosynthesis inhibitors for prostate cancer.

Can low Testosterone levels be cured? 

Low testosterone or male hypogonadism, is usually treated with testosterone replacement therapy. Testosterone replacement therapy is carried out in multiple forms as mentioned below:

  • Testosterone skin gels
  • Intramuscular testosterone injections
  • Testosterone pellets
  • Buccal testosterone tablets
  • Testosterone nasal gel
  • Oral testosterone or undecanoate pills 

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