None of us middle-aged men is the Energizer Bunny. Our testosterone (T) levels peak at around age 30 and fade, fade away after that. About 40% of men over 45 years old have low T. Before you run out and “juice up” with hormone replacement therapy, it’s important to understand the whole (complicated) story.
What Causes Low Testosterone?
Low T can be internal or external. Internal causes can come from diseases or testicular issues, hypothalamus, or pituitary gland problems.
External factors are legion, but include:
- Type 2 diabetes
- Sleep apnea or other insomnia
- Stress and anxiety
- Depression
- Alcohol over-use
- Opioids, steroids, such as prednisolone, and many other medications
- Obesity
- Hypothyroidism
Yikes!
Why should you wonder if you have low T?
Confusingly, symptoms of many other issues such as job or family stress, situational depression, and just getting older can jam your radar on whether you might have low T. Low T makes you subject to more atherosclerosis and heart disease, along with other chronic problems including loss of muscle tissue and bone density.
But fear not! We’re including the ADAM (Androgen Deficiency in the Aging Male) questionnaire below to help clear things up.
How Do Doctors Check for Low T?
T levels are not so simple. They can vary depending upon the time of day and anything else that is going on in your life.
You should have your blood test done early in the morning. Your doctor may also want a PSA (screen for prostate cancer), LH (pituitary T stimulator), thyroid tests, and glucose and HgbA1c to screen for diabetes. This will determine whether your T is low or not.
But wait! T varies through the day and with various life stressors. Your doc should repeat the test, not immediately treat, if it is anywhere near borderline.
Now Gimme the T!
There are several T preparations. The most comfortable is a hormone-infused skin gel, but in the sweaty tropics, absorption is wildly unpredictable.
Pellets (a small testosterone capsule that is inserted under the skin in the upper buttocks) can last two to four weeks but are not good as a starter Testosterone Replacement Therapy (TRT) if there are side effects. The gold standard is an intramuscular injection (since it is oil-based, the subcutaneous injection can cause abscesses).
It’s important to note that over time, the testicles will shrink, and you may become infertile with any T preparation. The way around this is Clomiphene, an indirect T stimulant that leaves your testicles intact.
Natural T Boosters
Before you medicate, meditate on other ways to boost your T:
- EXERCISE! Especially resistance work
- SLEEP! Always underestimated as a key to good health – and proper T levels
- MINIMIZE STRESS (and cortisol levels that drop your T)
- Good diet
- Go easy on the alcohol
- Plenty of Vitamin D and Zinc – if you don’t get all this tropical sunshine, take a supplement. Generally, a healthy diet should naturally have adequate levels of Zinc. The jury is still out on the value of Zinc supplements.
- Lead a generally healthy lifestyle with good social interaction
What does this all come down to? If you’re low T, the balls are in your court!
