Is Low Testosterone a Serious Health Concern?

Ask a Doctor: Dr. Cameron Wilson

Testosterone is the primary male hormone responsible for keeping a man’s muscles and bones strong, and maintaining his interest in sex. In the normal developing male, testosterone peaks during early adulthood and once he reaches age 30, it is common for testosterone levels to slowly decline by approximately 1 percent a year.

Dr. Cameron Wilson, a board-certified urologist affiliated with Sharp Grossmont Hospital, answers a few questions about low testosterone among men, and shares information about when to see a doctor about testosterone levels.

What is low testosterone?
Low testosterone in men occurs when there is a lack or decrease of testosterone production. It occurs naturally and gradually as men age and is also known as andropause, or more accurately, Androgen Decline in the Aging Male (ADAM). ADAM describes age-related low testosterone in men and is often responsible for changes in sexual function, energy level or mood, which can be subtle and go on unnoticed for years.

"Male menopause" is sometime used to describe the natural decline in testosterone levels among men as they age. However, the term can be misleading, because female menopause is significantly different in comparison. Whereas women experience a dramatic decline in production of the hormone estrogen over a short period of time during female menopause, men undergo a gradual decrease in testosterone over a period of many years.

How common is low testosterone?
Low testosterone affects roughly 39 percent of all men over the age of 45, with the incidence of ADAM increasing with age.

When should a man be concerned about his testosterone level?
While a gradual decline in testosterone is a normal part of aging among men, a higher-than-normal drop in testosterone levels may be related to certain medical conditions or other various underlying factors, including medication side effects, pituitary or thyroid problems, depression and excessive alcohol use. Abnormally low-levels can cause symptoms that include:

  • Change in sleep patterns or insomnia
  • Decrease in energy or bone density
  • Emotional changes, including depression or confusion
  • Physical changes, such as increased body fat and reduced muscle bulk
  • Reduced sexual desire, sexual dysfunction or infertility

How is low testosterone diagnosed?
The only way for low testosterone to be diagnosed is through a blood test. It is important for a man to talk to his doctor if he suspects that he has low testosterone. The physician can help identify and treat any health issues that might be causing or contributing to signs or symptoms associated with low testosterone.

How is low testosterone treated?
Testosterone therapy is something that can be considered for men experiencing symptoms of low testosterone, but it’s important that he discusses options with his doctor. The use of replacement therapy is controversial among otherwise healthy men experiencing age-related decline in testosterone. For some men, therapy relieves bothersome symptoms associated with lower testosterone, but for other men, the benefits are unclear, and may expose them to certain risks including increased risk of prostate cancer, fluid retention or a possible worsening of sleep apnea.

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Dr. Cameron Wilson About the Expert
Dr. Cameron Wilson is a Sharp-affiliated urologist. He practices out of La Mesa, Calif.