Low Testosterone and IBD - Gastrointestinal Issues

Healthy testosterone levels are critical for the health and well-being of men. Testosterone contributes to sex drive and function, fat distribution, strength, muscle mass, red blood cell production, and mental health. Low levels of testosterone can negatively affect multiple organ systems and tissues, including:

  • Reproductive organs–sexual function, sperm production, decreased libido, infertility.
  • Bones–bone density, osteoporosis, increased risk of fractures.
  • Muscles–muscle mass and strength.
  • Fat distribution–regulation of fat distribution, increased body fat, especially around the abdomen.
  • Brain–Mood, motivation, cognitive function, depression, decreased energy, cognitive decline. 
  • Gastrointestinal system.

Inflammation is the underlying mechanism behind many pathological conditions that affect the body, including inflammatory bowel disease (IBD). Low testosterone levels are significantly associated with increased inflammation and inflammatory bowel disease.


Men with low testosterone have higher levels of inflammation, specifically, pro-inflammatory cytokines: proteins released by cells during injury, infection, or in response to inflammatory factors. For example, chronic inflammation is the leading cause of low testosterone levels in the obese population due to inflammatory cytokines released from adipose tissue. 

Men require adequate testosterone levels to optimize the health of many tissues and organ systems, such as the digestive system. Several studies suggest elevated levels of inflammation can cause a decline in testosterone levels. Contrarily, multiple studies have demonstrated that low testosterone is associated with increased inflammation due to processes that include: 

  • Cytokines-Increasing pro-inflammatory cytokines, a type of molecule secreted from immune cells that promote inflammation–TRT reduces cytokines. 
  • Neural regulation-Testosterone has an established role in the neural regulation of bowel function, linking low testosterone with common digestive disorders.

A new study suggests that testosterone helps limit stomach inflammation. In a study performed on mice, stomach inflammation increased without testosterone. Also, when female mice with stomach inflammation were administered testosterone, inflammation vanished. Based on these results, clinicians may consider whether testosterone deficiency contributes to their patients’ stomach-inflammatory diseases. 

Persistent stomach inflammation over many years can potentially lead to stomach cancer. Testosterone replacement therapy (TRT) increases gut permeability, protecting against inflammation. Low testosterone levels compromise the body’s ability to maintain gut health and function. More studies are necessary.

In addition, hormones of the gut, such as ghrelin and peptide YY, are affected by testosterone concentration. Ghrelin and peptide YY play an essential role in appetite regulation and metabolism. Also, low testosterone can indirectly affect gut health by altering glucose metabolism and insulin sensitivity.

Irritable bowel disease (IBD) and Crohn’s disease

Irritable bowel disease (IBD) is a group of chronic diseases that affects the digestive tract and is characterized by periods of active disease and remission: Crohn’s disease and ulcerative colitis (UC) are the prominent representatives of IBD. Low testosterone levels are linked to irritable bowel disease, including Crohn’s disease. Low testosterone is connected to inflammatory disease activity in IBD. Over 40% of men with IBD have low testosterone levels.

Crohn’s disease is a chronic inflammatory bowel disease characterized by an imbalance of pro-inflammatory mediators and increased leukocytes at infection sites. Low testosterone enhances inflammation, while TRT decreases inflammation. In addition, adequate testosterone levels are needed to support the immunomodulary effect on T cells. 

The results of a study in which 92 men received testosterone undecanoate for up to 7 years, and 14 men served as the control group suggested TRT in men with low testosterone and Crohn’s disease improves the clinical course of the disease and appears safe. Subjects in the testosterone group saw a decrease in Crohn’s Disease Activity Index (decreased symptoms), a decrease in the high-sensitivity C Reactive Protein, and a decrease in leukocytes–all indicative of decreased inflammation and decreased immune system activation. In addition, patients in the testosterone group showed increased hemoglobin and hematocrit, indicative of decreased blood loss and intestinal inflammation. Normalizing testosterone in hypogonadal men with Crohn’s disease appears to have a positive effect on the clinical course of the disease.

Inflammatory biomarkers

The systemic immune-inflammation index (SII) is a novel inflammatory biomarker identified as a better indicator of local and systemic inflammatory processes than other traditional factors in the body. There is a positive relationship between the systemic immune inflammation index (SII) and an increased prevalence of testosterone deficiency in a nationwide sample of adult men in the US. As a result, the gut can be damaged, leading to increased inflammation and even lower testosterone levels–a vicious circle that can eventually diminish health and foster disease. The close association between gut health and testosterone level means that enhancing the health of one, optimizes the other. 

C-reactive protein (CRP) is another biomarker of inflammation in the blood with a close association with low testosterone and IBD activity. Increased C-reactive protein (CRP) levels are associated with increased IBD activity. Low testosterone levels are significantly associated with high levels of inflammatory markers, including CRP, in different clinical conditions, such as obesity, metabolic syndrome, hypogonadism, and IBD.

Sexual dysfunction and IBD

IBD is a chronic disease that alters the quality of life of individuals due to symptoms, hospitalizations, surgery, deterioration of body image, psychological disorders associated with the disease, and other factors such as sexual dysfunction.

Several studies suggest that sexual dysfunction is higher in IBD patients than in the general population. Over 40% of men with IBD suffer from hypogonadism with low testosterone levels. 

In addition, more than 50% of CD patients are diagnosed before age 35, when interpersonal relationships and sex are more significant. In a review of 57 studies, female gender, age, fatigue, IBD activity, and steroid use were associated with increased body image dissatisfaction and decreased quality of life. 

Better known for its role in decreased libido, sexual function, and decreased muscle mass, low testosterone could increase the risk of developing several chronic conditions, including obesity, arthritis, and inflammatory bowel disease.

Testosterone plays a role in several aspects of digestive health:

  • Maintaining gut motility.
  • Reducing gut pain.
  • Decreasing the effects of adrenocorticotropic hormone (ACTC) on the digestive tract and minimizing the adverse effects of cortisol.
  • Decreasing gut inflammation, protecting men from leaky gut and brain fog.
  • Protecting the body from digestive disorders like small intestine bacterial overgrowth (SIBO).

Restoring testosterone levels can improve your overall health–not only in improving symptoms of hypogonadism such as low libido and erectile dysfunction–improvement in chronic inflammatory conditions that can lead to increased morbidity and mortality.

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