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Low Testosterone: How Do You Know When Levels Are Too Low?

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What Is Testosterone and Why Does It Decline? continued...

"A lot of the symptoms are mirrored by other medical problems," Hedges says. "And for a long time, we were not attributing them to low testosterone, but to diabetes, depression, high blood pressure, and coronary artery disease. But awareness and appreciation of low testosterone has risen. We recognize now that low testosterone may be at the root of problems."

Doctors will want to rule out any such possible explanations for symptoms before blaming them on low testosterone. They will also want to order a specific blood test to determine a man's testosterone level.

"The blood test is really the thing," Mezitis says.

Low Testosterone: How Low Is Too Low?

The bottom of a man's normal total testosterone range is about 300 nanograms per deciliter (ng/dL). The upper limits are 1,000 to 1,200 ng/dL. A lower-than-normal score on a blood test can be caused by a number of conditions, including:

  • Injury to the testicles
  • Testicular cancer or treatment for testicular cancer
  • Hormonal disorders
  • Infection
  • HIV/AIDS
  • Chronic liver or kidney disease
  • Type 2 diabetes
  • Obesity

Some medicines and genetic conditions can also lower a man's testosterone score. Aging does contribute to low scores. In some cases, the cause is unknown.

A low score does not always translate to symptoms, Mezitis says, "but we often find something that's off when we see scores of 200 or 100 ng/dL."

Hedges agrees and warns that even if a man does not have symptoms, he may be well advised to seek treatment. Low testosterone scores often lead to drops in bone density, meaning that bones become more fragile and increasingly prone to breaks.

"That's something I would want to have a conversation about," Hedges says. "Bone density issues are not always apparent." 

Low Testosterone Treatment

Having a gradual decline in your testosterone level as you age is to be expected. Treatment is sometimes considered if you're experiencing symptoms related to low testosterone.

If a young man's low testosterone is a problem for a couple trying to get pregnant, Mezitis and Hedges say testosterone injections are the best option. Given every few weeks, the injections stimulate sperm production and motility ("swimming ability"). When fertility is not an issue, the ideal testosterone delivery method is a daily gel or patch. Because they are applied on a regular and frequent basis, these treatments keep a man's testosterone at a steady level and keep his symptoms at bay. If you are using testosterone gel on your skin, be careful not to expose other people to the gel.

Hedges also describes implantable testosterone pellets, a relatively new form of treatment in which several pellets are placed under the skin of the buttocks, where they release testosterone over the course of about three to four months.

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