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Testosterone deficiency: symptoms, cause and treatment

by Josephine Andrews
Published: Last Updated on 290 views

In the case of a testosterone deficiency, those affected have too little of the male sex hormone testosterone in their body. A deficiency can occur in men in particular, but also in women. Important symptoms can include sexual reluctance, reduced testicles and increased sweating. The doctor usually treats a testosterone deficiency using hormone gels, injections or patches. Read more about symptoms, causes and treatment here!

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

E29 E23 E28

quick overview

  • Symptoms include decreased sexual desire, small testicles in men, loss of muscle and bone mass, hot flashes, infertility
  • Causes: including reduced hormone production in the testicles (in men) or the ovaries (in women), diseases (eg cirrhosis of the liver ), medication (eg contraceptive pills), unhealthy lifestyle
  • Treatment: The doctor compensates for the lack of testosterone using hormone gels, injections or patches if necessary.
  • Diagnosis: consultation with the doctor, physical examination, determination of the testosterone level in the blood

How do you recognize a testosterone deficiency?

A lack of testosterone can cause various symptoms that vary in severity from person to person. Depending on the cause of the testosterone deficiency, the symptoms develop over weeks, months or years. In most cases, the symptoms last for a longer period of time because those affected do not correctly identify the non-specific symptoms and therefore do not consult a doctor.

In most cases, the desire for sex decreases in people with a testosterone deficiency: They often report an unfulfilled sex life.

Some symptoms affect men and women equally. But there are also gender-specific complaints. The age at which the testosterone deficiency occurs (eg puberty, adulthood, old age) also influences which symptoms develop.

General symptoms

Regardless of age and gender, the following symptoms are more common in those affected with testosterone deficiency:

You are tired even though you get enough sleep.

  • You feel weak and listless.
  • You gain weight.
  • Body fat increases (especially on the abdomen).
  • You are aggressive.
  • You have depressed moods for no apparent reason.
  • You have trouble sleeping.
  • You have trouble concentrating.
  • The muscles break down.

The symptoms mentioned are non-specific. They may indicate a testosterone deficiency or various other diseases. They can also reflect natural fluctuations in performance and well-being, as long as they are temporary. Have the symptoms clarified by a doctor if they last longer than a few days!

symptoms in men

Testosterone is considered the male sex hormone par excellence. Men produce significantly more testosterone than women. Therefore, men are also much more likely to be affected by a testosterone deficiency and the associated symptoms.

The symptoms of testosterone deficiency depend largely on the age at which it occurs.

Symptoms before or during puberty

Testosterone is an important sex hormone in men. For example, it causes the primary (eg penis , testicles, epididymis , seminal ducts) and secondary (eg facial hair, broken voice, Adam’s apple, broad shoulders) sexual characteristics to develop and form during puberty.

If the body lacks testosterone during this time, this affects the sexual and sexual development of young men. It is even possible that puberty does not occur (eunuchism) and the male sexual characteristics remain underdeveloped.

Symptoms in young men with testosterone deficiency before or during puberty include the following:

  • Those affected have reduced testicles.
  • Male breast enlargement (called gynecomastia; a benign enlargement of the male mammary gland).
  • You have a high voice, your voice doesn’t break.
  • They have very little body hair (eg no facial beard, no pubic hair).
  • You don’t feel like having sex.
  • You are sterile (infertility).
  • Your bone mass decreases.
  • Your muscles break down.

Symptoms after puberty

If the testosterone deficiency occurs after puberty, men have the following symptoms, among others:

  • You may become sterile (infertility) and your testicles will produce less sperm.
  • They have less sexual desire and less often
  • You have trouble getting an erection spontaneously.
  • The testicles shrink.
  • you loose armpit or pubic hair; the beard growth decreases.
  • You lose muscle mass and muscle strength.
  • You have hot flashes and sweat profusely.
  • You gain weight due to the increased storage of abdominal fat (= increase in abdominal circumference). Sometimes the buttocks widen and the shoulders narrow.
  • Breast growth (gynecomastia).
  • Your skin will sag and your hair may fall out.
  • Muscle mass and bone density decrease.

symptoms in old age

Testosterone levels naturally decrease with age. Depending on the strength and severity of the deficiency, those affected develop symptoms that vary greatly from person to person. Doctors refer to this form of testosterone deficiency as late-onset hypogonadism. The declining testosterone levels are expressed in those affected, among other things, as follows:

  • Those affected have little or no desire for sex
  • They are less efficient, both in everyday tasks and in sports.
  • You have problems getting an erection (erectile dysfunction).
  • The muscle mass is reduced.
  • The bones become more unstable and brittle ( osteoporosis ).
  • Those affected develop anemia (anemia).
  • The blood sugar level increases (up to diabetes).
  • Sometimes sufferers lose their sense of smell ( anosmia ).
  • You have depressive moods.

symptoms in women

In women, signs such as reduced desire for sex, fatigue, lack of strength and even depression may be related to a testosterone deficiency. It is also known that women who have had their ovaries removed report sexual symptoms (eg loss of libido, listlessness) after the operation.

If girls already lack testosterone before puberty (eg because the ovaries produce too few hormones ), it is possible that they will start puberty much later and will not have their periods for a long time. The latter is also possible in adult women with a testosterone deficiency.

How does a testosterone deficiency develop?

There are different reasons for a lack of testosterone in men and women. Basically, women produce significantly less testosterone than men. While in men the testicles are primarily responsible for testosterone production, in women it is the ovaries in particular.

hypofunction of the testicles

When a man is underactive, the testicles produce too little testosterone (so-called primary hypogonadism ), which means that the testosterone level in the body is too low. The hypofunction of the testicles is triggered by various causes, such as certain diseases (e.g. Klinefelter syndrome) or injuries as a result of an accident.

the pill and estrogen

If women take birth control pills (consists mostly of the female sex hormones estrogen and progesterone ), the testosterone concentration in the blood may drop. This is also the case when menopausal women take estrogen supplements to compensate for estrogen deficiency.

Over time, this leads to a lack of testosterone. If women stop taking the preparations, the lack of testosterone compensates in most cases.

Treatment with antiandrogens

When women experience acne or hair loss , doctors sometimes prescribe antiandrogens to relieve the symptoms. Antiandrogens inhibit the action of testosterone in the body. Symptoms similar to those of an actual testosterone deficiency are possible (note: there is potentially enough testosterone here, but its effect is inhibited by the antiandrogens).

Disorders in the pituitary gland and hypothalamus

In both men and women, a lack of testosterone is caused by a disturbance in the higher control centers in the brain – in the pituitary gland ( pituitary gland ) and in the hypothalamus . They produce too little of certain hormones that stimulate testosterone production in the testicles (male) or ovaries (female).

Testosterone deficiency in old age

In both sexes, testosterone levels decrease with age. From the age of about 40, it decreases in men due to the decreasing function of the testicles. This is what medical professionals refer to as late-onset hypogonadism, or “aging male hypogonadism.” Many women also develop a testosterone deficiency with increasing age, but mostly only during and after the menopause. Again, the reason is the decreasing hormone production.

diseases

Chronic diseases such as liver cirrhosis, sickle cell anemia , cancer (eg ovarian cancer) or kidney failure are possible triggers for testosterone deficiency in both men and women.

taking anabolic steroids

Anabolic steroids are substances that mostly young men and sometimes women take to build muscle faster. The artificial testosterone contained in anabolic steroids supports the body in a similar way to natural testosterone in enlarging the muscles.

However, anyone who continuously takes anabolic steroids over a longer period of time (months to years) throttles the body’s own testosterone production. Later, the body may no longer be able to produce enough testosterone itself. There is a testosterone deficiency.

taking drugs

Alcohol, nicotine and other drugs or environmental toxins can negatively affect testosterone production in both men and women. Because regular drug use and environmental toxins disrupt hormone production in the testicles and ovaries.

Severe malnutrition

Malnutrition disrupts the body’s hormonal balance. The release of various hormone changes. If those affected are severely malnourished (eg due to anorexia nervosa or anorexia), a possible consequence is a lack of testosterone.

What testosterone levels are normal in men and women?

Men produce significantly more testosterone than women. In adult males, the value is between 3.5 and 11.5 ng/mL (12–40 nmol/L). Women have significantly less testosterone in their bodies than men. Testosterone levels in adult females range from 0.15 to 0.6 ng/mL (0.5 to 2.0 nmol/L). Fluctuations in the value are considered normal because age, cycle and time of day affect androgen levels.

The testosterone values ​​​​measured differ significantly from one another depending on age and the laboratory that measures the values. Their informative value is therefore limited and should only be interpreted by a competent doctor.

What can you do about a testosterone deficiency?

If those affected have a testosterone deficiency and there are no other diseases behind the symptoms, the doctor prescribes hormone treatment with testosterone in most cases. The doctor uses this to replace the missing testosterone in the body of the person concerned.

In order to support the therapy and prevent a deficiency, it is also possible for those affected to boost the body’s own production in a natural way (eg through nutrition, exercise).

Your doctor will inform you about the treatment and prognosis and explain possible risks and side effects.

testosterone replacement therapy

In testosterone replacement therapy, the doctor usually administers testosterone to the person concerned in the form of gels, injections or patches. The doctor chooses the dosage so that the testosterone level levels off in the normal range.

Your doctor will decide what dosage you will receive. He will also work with you to determine which form of administration (e.g. gel, patch, injection) is most suitable for you.

gel

The doctor often prescribes a testosterone-containing gel that keeps the testosterone level in the blood largely constant. Gels are usually the most comfortable and easiest to use for sufferers.

To do this, apply the gel to a large area every day (eg on the upper arms, shoulders, stomach). It is important to apply the gel to clean, dry and healthy skin (it is not necessary to rub it in) and let it dry (eg before putting on clothes).

pavement

Skin patches are also suitable for delivering testosterone evenly into the body. To do this, the affected person sticks a plaster on their back, stomach, upper arm or thigh once a day. It is also important to apply the patch to clean, dry and healthy skin.

syringes

Doctors often give depot shots in the upper arm to correct testosterone deficiency. Depending on the preparation and needs, the doctor injects them at intervals of about two weeks. For some preparations, an injection every two to three months is sufficient.

tablets

Testosterone is also available in the form of tablets or capsules. However, these preparations are usually no longer recommended by doctors because they have to be taken several times a day and often do not bring the desired success.

When should testosterone not be given?

Importantly, men with prostate cancer or people with breast cancer do not receive testosterone. According to the current state of knowledge, the administration of testosterone does not increase the probability of developing cancer, but it often worsens an existing disease.

Doctors also advise against administering testosterone if:

  • The PSA level is too high (PSA stands for Prostate Specific Antigen). Elevated PSA levels can indicate prostate cancer.
  • Lumps in the prostate are palpable.
  • The prostate is grossly but benignly enlarged.
  • The red blood cells in the blood of those affected are increased (polycythemia).
  • Those affected have severe heart failure.
  • A pronounced and untreated sleep apnea (stopping breathing during sleep) is present in those affected.

What side effects are possible?

The administration of testosterone is associated with some undesirable effects. These include, among other things:

  • proliferation of red blood cells
  • Oily skin or acne
  • Decreased sperm production and fertility
  • Worsening of an existing prostate cancer

Those affected also report other undesirable effects:

  • In men: benign enlargement of the mammary glands and/or prostate
  • hair loss (androgenic alopecia)
  • sleep apnea

In addition, each dosage form has its advantages and disadvantages and in some cases leads to specific side effects: testosterone injections often trigger mood and libido fluctuations, tablets can increase liver values . Band-aids may irritate the skin and once the gel is applied there is a risk of it being transferred to other people through direct physical contact.

Regular laboratory tests of testosterone levels are important in order to monitor the success of the therapy and to adjust the treatment if necessary.

What can I do on my own?

There are a number of things you can do yourself to maintain a healthy, balanced testosterone level. This includes a balanced diet, regular exercise and adequate sleep.

Balanced nutrition

Eat a balanced diet with lots of fruit and vegetables. Eat enough fiber (eg found in grains, fruits, vegetables, legumes), proteins (eg meat, fish, eggs, dairy products, nuts, soy products) and healthy fats (eg found in avocados, nuts, canola oil and olive oil) as well complex carbohydrates (e.g. in whole grain products, rice, corn, millet, potatoes, fruit, lentils, beans, peas, quinoa, amaranth, buckwheat).

Regular exercise

In order to bring the hormonal balance into balance, it is important to train strength and endurance regularly. However, don’t stress your body too much and take regular rest days. Because if you do too much sport, you may overwhelm your body. The body then releases more of the stress hormone cortisol . This, in turn, can affect testosterone levels.

Sufficient sleep

Lack of sleep has an overall negative effect on the hormone balance. Too little sleep, especially in young men, often results in significantly lower testosterone levels. It is therefore best to sleep seven to eight hours a day. This will help normalize your hormone levels.

avoid stress

Stress also plays an important role. Chronic stress slows down the production of the sex hormones estrogen and testosterone. Therefore, allow yourself some time for yourself every day and relax: meditate, do yoga, go for a walk or take a short power nap in between. Just try what is good for you.

How does the doctor diagnose testosterone deficiency?

If you observe symptoms in yourself and suspect that they indicate a lack of testosterone, first consult your family doctor. With the help of a blood test, he usually quickly determines whether a corresponding deficiency is present.

If necessary, your family doctor will refer you to a specialist in internal medicine who specializes in hormones (eg an endocrinologist). If necessary, he will carry out further investigations.

conversation with the doctor

If a testosterone deficiency is suspected, the doctor will first conduct a detailed discussion with you (anamnesis). Among other things, he asks the following questions:

  • What are your symptoms?
  • When did the symptoms first appear?
  • Do you have other illnesses?
  • What medication are you taking?

Physical examination

The doctor then performs a physical exam, during which he/she feels the body, measures the blood pressure, and listens to the heart and lungs with a stethoscope.

blood test

The doctor then carries out a blood test, in which he measures the testosterone level in the blood. The blood is taken in the morning hours (between 7 am and 11 am) because this is when the testosterone level in the body is highest. The doctor repeats this a second and sometimes a third time at intervals of 20 to 30 minutes.

Since the testosterone level in the blood often fluctuates, a single measurement is not enough to reliably diagnose testosterone deficiency.

Measurement of total testosterone

If the value of the total testosterone in all blood samples examined is below certain normal ranges, there is probably a testosterone deficiency.

Measurement of free testosterone

Doctors may also measure free testosterone in the blood, especially if total testosterone measurements are inconclusive. Background: In the blood, testosterone is mostly (about 97 percent) bound to proteins such as sex hormone-binding globulin (SHBG), luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

Only a small part (about one to three percent) circulates freely in the blood (free testosterone). In order to narrow down the causes of the testosterone deficiency, the doctor also examines the concentration of SHBG, LH and FSH in the blood.

Further investigations

The doctor may carry out further tests to confirm the diagnosis and rule out other diseases. These include, for example, an ultrasound examination (sonography), computed tomography (CT) or magnetic resonance imaging (MRI).

So far, there are no uniform thresholds as to when a testosterone deficiency actually exists. Therefore, the meaningfulness of the testosterone values ​​is limited.

What is the prognosis for a testosterone deficiency?

Testosterone deficiency can usually be treated well and usually remedied. Symptoms usually improve within three to six months after people start testosterone replacement therapy.

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