Living with Testosterone Deficiency

Testosterone affects more than just your sex drive. It plays an important role in your heart health, the development of your bones and muscles and impacting your brain function.

What Causes Low T?

Low T is a condition in which your testicles don’t produce enough testosterone. It has several possible causes, including conditions or injuries affecting your testicles, pituitary gland or hypothalamus.

Low T can also occur in older men. Testosterone levels peak by early adulthood and drop as you age—about 1% to 2% a year beginning in the 40s. As men reach their 50s and beyond, this may lead to signs and symptoms, such as impotence or changes in sexual desire, depression or anxiety, reduced muscle mass, less energy, weight gain, anemia, and hot flashes. While falling testosterone levels are a normal part of aging, certain conditions can hasten the decline.

Testosterone drops about
per year beginning in your 40s
Low T affects an estimated
20 million
men from ages 25 -75 in the US.

If you have Low T, you are not alone!

Studies suggest that as many as 20 million men in the United States ages 25 to 75 may be suffering from Low T, which can have significant impacts on overall health and quality of life.1 Studies also suggest that Low T also affects approximately 40% of men older than 45 years of age and 30-50% of men with obesity or type 2 diabetes.2

Stay Informed about Symptoms & Conditions

Low T is also a common symptom of several health conditions.


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Did you know that almost 1/3 of men with T2D have Low T?

Many of the men who suffer from type 2 diabetes also have Low T. The two main factors impacted by testosterone levels are insulin sensitivity and glycemic control. Insulin resistance occurs when your body’s ability to respond to insulin is compromised in some way. Glycemic control refers to blood sugar level management for those with diabetes.

Insulin resistance is also linked to low levels of both total testosterone and free testosterone. Therefore, low testosterone often accompanies diabetes.The link between Low T and an increased risk of diabetes suggests that taking testosterone replacement therapy could potentially help prevent type 2 diabetes in certain individuals. Several studies have shown that testosterone therapy can reduce markers such as glycated hemoglobin, total cholesterol, and triglycerides in men with low testosterone, which may lower their risk of developing diabetes.

Dhindsa S, Miller MG, McWhirter CL, et al. Testosterone concentrations in diabetic and nondiabetic obese men. Diabetes Care, 2010:33(6):1186-1192
Did you know that approximately half of men who are overweight have Low T?

There are a number of reasons why obesity contributes to Low T, but there is one major cause: fat cells. Scientists have discovered that fat cells have a high amount of a particular enzyme (molecules that speed up chemical reactions) named aromatase. Aromatases have an interesting job description: they’re tasked with building estrogen out of testosterone molecules (estrogen is a key female sex hormone, though men need this hormone, too –albeit in much smaller amounts).

So when a man starts gaining weight from extra fat tissue, he’s got more and more aromatases converting his testosterone into estrogen. And thus, his testosterone levels will begin to fall. (Under healthy conditions, aromatases convert only a small amount of your testosterone to estrogen, so you have just the right amount of estrogen – not too little or too much.)Plus, abdominal fat is known to produce especially large amounts of aromatases – so it can be particularly devastating for a man’s testosterone levels if his extra pounds tend to gather in this part of his body.

Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Mulligan T, Frick MF, Zuraw QC, Stemhagen A, McWhirter C Int J Clin Pract. 2006 Jul; 60(7):762-9
Did you know that more than 2/3 of men suffering from ED also have Low T?

If you have Low T, your levels of testosterone may drop below normal. When that happens it may affect your sex life. Your sex drive could go down. And you might develop erectile dysfunction (ED). Men with ED have trouble getting or maintaining an erection suitable for sex. It is important to remember that Low T isn’t the only cause of ED.

Erections depend on testosterone, but the relationship between the two is complex and not fully understood. Some men have healthy erections despite testosterone levels well below the normal range.

What is clear is that low testosterone levels are linked to a number of the same chronic conditions that play a role in erectile dysfunction, such as type 2 diabetes, obesity, and heart disease.

Yassin, A.A. and Saad, F. (2008), Testosterone and Erectile Dysfunction. Journal of Andrology, 29: 593-604.
Did you know that men with Low T are 4x more likely to be diagnosed with clinical depression?

Testosterone levels tend to decrease normally as you get older, but they can also fluctuate for many different reasons. Studies have shown that these changes in testosterone can impact your mood in different ways.

And these changes can occur in response to many different factors, including stress, lack of sleep, changes in diet, aging and increasing or decreasing physical activity If your testosterone levels are low, you may feel extremely tired, depressed, weak or low in energy.

Shores MM, Sloan KL, Matsumoto AM, Moceri VM, Felker B, Kivlahan DR. Increased Incidence of Diagnosed Depressive Illness in Hypogonadal Older Men. Arch Gen Psychiatry. 2004;61(2):162–167.
Did you know that Low T can be a cause of osteoporosis in older men?

Low T is the primary cause of osteoporosis in men. In older men, osteoporosis commonly causes spine fractures and hip fractures, because bone mineral density has a close relationship with testosterone levels in men. When men undergo androgen deprivation therapy for prostate cancer, a common side effect is osteoporosis. Bone mineral density tends to decrease in the first year after treatment.

Research also suggests that men who have Low T have a higher risk of fracture than men with testosterone in an average range. However, it’s not clear whether testosterone supplementation decreases the risk of fracture.

Gary Golds, Devon Houdek, Terra Arnason, "Male Hypogonadism and Osteoporosis: The Effects, Clinical Consequences, and Treatment of Testosterone Deficiency in Bone Health", International Journal of Endocrinology, vol. 2017, Article ID 4602129, 15 pages, 2017.
Did you know men with psoriasis and LowT treated with testosterone replacement therapy showed significant improvement in their skin disease?

The link between psoriasis and decreased fertility may be due to how systemic inflammation affects the production of sex hormones.

Inflammation triggers a cascade of inflammatory cytokines (a type of protein), which can have a destructive impact on a variety of organ systems, including reproductive systems.

This influx of cytokines may lead to decreasing sex hormone production and sperm production.

The link may also be related to the inflammation of sexual accessory glands. In one small 2017 study7, 70 percent of participants with psoriasis were found to have signs of inflammation of the accessory glands. No one in the non-psoriasis control group showed these signs.

  1. F. Saad, A. Haider & L. Gooren. “Hypogonadal men with psoriasis benefit from long-term testosterone replacement therapy – a series of 15 case reports”, Andrologia 2016 48, 341-346.
  2. 7. Giacomo Caldarola et. Al. “Untreated Psoriasis Impairs Male Fertility: A Case-Control Study”, Dermatology (2017) 233 (2-3): 170–174
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