Why Low Testosterone Isn't Just About Sex

Kristine Burke, MD
April 4, 2016

Hormones aren't something you've probably given much thought to, yet when it comes to your health, every man should be talking testosterone with their doctors.

Testosterone is your primary sex hormone and it's essential for building muscles and strong bones, your libido, and of course, your performance in the bedroom.

Like everything else, as you age it's inevitable that testosterone will dip. In fact, you start out with 700 million leydig cells — the ones that produce testosterone — and every year after age 20 you lose 6 million.

Testosterone deficiency is common. In fact, 13.8 million men (39 percent) 45 and older have the condition, a study in the International Journal of Clinical Practice found.

But here's the problem: Just because it's common, doesn’t mean it's normal.

Testosterone deficiency is starting earlier and earlier too. In fact, a study out of the University of Buffalo shows that teenage boys who are obese have 50 percent less testosterone than lean ones. Here are these young men, not even ready to start families, but they're already facing infertility!

And as men get older, low testosterone is linked to a host of other health conditions and diseases too, including:

  • Cardiovascular disease: heart attack, stroke, arrhythmia and heart valve problems
  • High cholesterol
  • Inflammation
  • Obesity
  • Leptin resistance
  • Insulin resistance
  • Type 2 diabetes
  • Fatigue
  • Depression
  • Cancer
  • Dementia
  • High blood pressure
  • Osteoporosis
  • Obstruction sleep apnea

Low testosterone can also lead to premature death. In fact, one study that followed men over 50 for 18 years, showed those with low testosterone had a 33 percent increase in death than those who had higher levels.

What's more, low testosterone is one of the earliest signs that your body is undergoing changes that will show up as high blood pressure, high blood sugar, obesity and type 2 diabetes in the future.

What causes low testosterone?

Although testosterone decreases with age, there are other causes:

  • Genetics/family history
  • Toxins, including alcohol, heavy metals, and chemical exposure
  • Vitamin D deficiency
  • Lack of sleep and obstructive sleep apnea
  • Inflammation of the testicles due to a sexually transmitted infection (STI)
  • Trauma to the testicles
  • A problem in the pituitary gland
  • Chronic illness
  • Liver disease
  • HIV
  • Renal insufficiency
  • An absence of the testes, either from birth or as a result of trauma
  • Infarction, or a blood supply blockage to the testes
  • A tumor

It's also common for low testosterone to occur alongside other conditions, including:

  • High blood pressure
  • High cholesterol and high triglycerides
  • Obesity
  • Type 2 diabetes
  • Erectile dysfunction
  • Anemia

Plus, a whopping 74 percent of men who use a class of painkillers known as opioids to treat chronic pain also have low testosterone, one study found.

The road to low T.

Testosterone deficiency isn't something that happens overnight. It can take between 10 and 15 years of testosterone declining for it to become a full-blown deficiency.

But what may surprise you is that testosterone doesn't simply slow down. It's converted.

Testosterone can actually be converted into different hormones through several enzyme pathways in the body.

One of these enzymes, known as 5-alpha-reductase, is found in many tissues in the body and is high in the prostate gland. When testosterone goes down this pathway, it gets metabolized into dihydrotestosterone (DHT). This downstream metabolite can cause hair loss on the scalp, and growth of the prostate, neither of which is desirable.

Another enzyme found in skin, fat, bone and brain cells is known as aromatase. In men who are overweight, excess aromatase activity decreases testosterone and increases estrogen.

So not only can it cause testosterone to decline, but it can wreak havoc on your health.

Should you supplement?

Studies show that testosterone supplements can reverse muscle loss and osteoporosis, increase bone mass in the lower back, strengthen memory, and ward off dementia in men with low testosterone levels.

Research also shows that men who receive testosterone replacement therapy with low starting levels are less likely to have metabolic syndrome turn into diabetes and cardiovascular disease.

Like everything else, supplements still carry risks and may not even be necessary. So it's a good idea to work with your physician to find out if you have a testosterone deficiency and what's causing it so you can devise a plan of action.

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