How Low Testosterone Affects Sleep

Testosterone is an important hormone for men and women, but its effects aren’t limited to the reproductive system.

Your mood, bone strength, and sleep cycles are just a few of the functions that are also impacted by testosterone levels. Too much or too little testosterone can cause problems, but a high testosterone level is not a problem that many men experience naturally.

Low testosterone levels are more common, and this article will explore the impact this can have on sleep in particular. Read on to learn more about normal testosterone ranges and what testosterone replacements are recommended.

Low vs. Normal Testosterone

Normal testosterone levels are different for men and women and change throughout our lifetimes. For men, testosterone levels drop gradually with age at a rate of 1% to 2% each year.

In women, testosterone production peaks in a woman’s 20s and then declines gradually. However, unlike estrogen, testosterone is still produced in women after menopause.

Normal Testosterone Ranges

Low testosterone levels are anything below those normal ranges and can occur for a number of reasons. Some common reasons for testosterone levels to drop are:

• Chronic diseases like diabetes
• Malfunctions or tumors in the pituitary gland
• Obesity
• Stress
• Advanced age
• Alcohol abuse
• Testicular diseases or trauma
• Poor thyroid function
• Obstructive sleep apnea
• Medication side effects

How Does Testosterone Affect Women?

Testosterone isn’t just a male hormone. It’s also an important part of women’s health and is made in the ovaries and adrenal glands. This chemical plays a role in many of the same systems as it does in men, including:

Symptoms

Symptoms of low testosterone levels are different for men and women.

In men, the most common symptoms of low testosterone include:

• Low sex drive
• Impotence
• Depressed mood
• Inability to concentrate or loss of memory
• Infertility
• Loss of muscle mass
• Hair loss
• Weakened or brittle bones
• Male breast enlargement (gynecomastia)

In women, symptoms of low testosterone are often dismissed as psychological, but can include:

Why A Healthy Testosterone Level is Important

Testosterone isn’t just a reproductive hormone. It plays a role in a number of other body systems, impacting muscle and bone development, hair growth, behavior, cognition, and more.

There are several risk factors for a testosterone imbalance, including obesity, pituitary gland tumors, and congenital disorders like Klinefelter syndrome. Talk to your healthcare provider if you are concerned about how your testosterone level may be impacting your health.

Sleep and Testosterone Levels

There are many things that can impact our sleep quality, and testosterone is one of them.

Testosterone plays a role in the timing and organization of circadian rhythms, a type of internal clock. During puberty, testosterone levels increase and we start to stay awake later. Sleep deprivation or restriction, on the other hand, can cause testosterone levels to drop.

Testosterone levels and sleep typically work in harmony, with levels rising when we wake and dropping throughout the day. There are bursts of testosterone production throughout the day, too, usually about every hour-and-a-half. During sleep, testosterone levels are replenished, rising gradually and peaking for most men during the REM sleep cycle.

Although low testosterone levels at the start of sleep are natural, the longer it takes to reach REM sleep, the longer it will take for testosterone levels to rise. Disruptions in REM sleep—the deepest sleep stage where dreaming usually occurs—can be caused by things like:

Limiting things that can disturb sleep or addressing conditions that can lower testosterone levels may help, but there is some debate on when testosterone replacement works best. In one study, obstructive sleep apnea was linked not to testosterone levels, but to obesity. Weight loss helped improve the condition, while testosterone replacement didn’t help or worsen the severity of sleep apnea.

Are Low Testosterone and Sleep Apnea Related?

A number of studies have linked low testosterone levels to sleep apnea in one way or another. The leading theory is that low testosterone levels are caused in part by sleep disorders that are common in people with sleep apnea like:

Many of these are caused by apnea, or lack of breathing, and the resulting hypoxia it causes. Interrupted breathing causes a host of sleep problems, which in turn can impair testosterone production.

How to Increase Testosterone

There are several ways to increase your testosterone level. Some of these deal with removing lifestyle factors or issues that can cause your testosterone level to drop, and others involve supplementing to make up for low testosterone.

Below are a number of options for addressing a low testosterone level. You should talk to a healthcare professional to find the best option for your specific situation.

Reduce Testosterone Loss

One way to address low testosterone is to prevent testosterone loss caused by things like:

Increase Testosterone Naturally

There are also some ways that could help you increase your testosterone levels naturally. These include:

Testosterone Supplementation

If these methods don’t work for you, your healthcare provider may consider prescribing you testosterone replacement therapy. These can be taken a variety of ways including:

• Topical gel or cream
• Injections, long- or short-acting
• Oral pills
• Pellets inserted below the skin
• Intranasal gel

There are also a number of over-the-counter products that claim to boost testosterone production, but a recent study found little proof to back up these promises.

According to the study, while 90% of the 50 products tested claimed to increase testosterone, strength, and sex drive, just 24.8% were able to provide data to support their claims. The study also noted that 10% of the ingredients in the tested products are actually known to have a negative effect on testosterone levels.

A Word From Verywell

Low testosterone levels can have a big impact on both men and women. Loss of muscle and sex drive are commonly associated with low testosterone, but it is linked to poor sleep as well.

If you have symptoms of low testosterone or a known condition or injury that may reduce your testosterone production, talk to your healthcare provider about safe ways to boost your testosterone with medications or natural methods. Living a healthy lifestyle, avoiding drugs and alcohol, maintaining a healthy weight, and having a good sleep schedule may also help keep testosterone levels in balance.

Frequently Asked Questions

Your doctor may suspect your testosterone levels are low based on your symptoms and a physical examination, but a blood test is a more accurate way to diagnose an abnormal testosterone level.

For men, under 300 ng/dL is considered low, and under 15 ng/dL is low for women.

Just like in men, testosterone in women decreases with age. Lifestyle choices like alcohol and drug use can also play a role.

Testosterone is produced mainly in the testicles for men, and in the ovaries for women. Both men and women also produce some testosterone in the adrenal glands.

High testosterone is rare in men without the use of steroid replacements, but it can cause things like aggression, acne, and sleep problems. In women, high testosterone can develop with polycystic ovary syndrome.

Foods cannot increase testosterone levels, but too much of certain foods—like sugar—can cause increased obesity and other issues that can cause your testosterone levels to drop.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Harvard Health Publishing. Testosterone – what it does and doesn’t do.
2. North American Menopause Society. Changes in hormone levels.
3. Mount Sinai. Testosterone.
4. Davis SR, Wahlin-Jacobsen S. Testosterone in women-the clinical significance.Lancet Diabetes Endocrinol. December 2015;3(12):980-92. doi:10.1016/S2213-8587(15)00284-3.
5. MedlinePlus. Testosterone levels test.
6. WomensHealthConcern.org. Androgen deficiency.
7. British Menopause Society. Testosterone replacement in menopause.
8. Wittert G. The relationship between sleep disorders and testosterone in men.Asian J Androl. May 2014;16(2):262-265. doi:10.4103/1008-682X.122586
9. National Sleep Foundation. What is REM sleep?
10. Kim SD, Cho KS. Obstructive sleep apnea and testosterone deficiency.World Jour Mens Health. May 2018;37(1):12-18. doi:10.5534/wjmh.180017.
11. Urology Care Foundation. What is low testosterone?
12. VA.gov. Improving low testosterone naturally.
13. Clemesha CG, Thaker H, Samplaski MK. ‘Testosterone boosting’ supplements composition and claims are not supported by the academic literature. World J Mens Health. 2020;38(1):115-122.
14. NASM.org. Can foods boost testosterone for men and women?

By Rachael Zimlich, BSN, RN
Rachael is a freelance healthcare writer and critical care nurse based near Cleveland, Ohio.

7 signs you could have low testosterone

Low testosterone can affect men of any age, but do you know the main signs of low testosterone?

Author: Dr Daniel Grant – Head of Medical Education, MBBS, BSc

Low testosterone can affect men of any age, but the signs of low testosterone are more likely to affect you as you get older.

The symptoms of ageing often intertwine with the symptoms of low testosterone, but researchers are still trying to work out the exact relationship between low testosterone and ageing. We do know, though, that spotting low testosterone and treating it in the right way can be beneficial.

We look at the signs of low testosterone so that you can spot them and act if you need to.

What is testosterone?

Testosterone is a sex hormone that is essential for many functions in the body, including:

In most men, levels of testosterone increase from puberty to adulthood, then gradually decline from the mid-30s or 40s onwards. Some people call this middle-aged drop or the ‘male menopause’ – although the NHS describes the male menopause term as being a little misleading! That’s because it suggests the symptoms are down to a sudden drop in testosterone in middle age, like what occurs in female menopause, which isn’t true. While testosterone levels do fall as men age, it’s a steady decline or less than 2% a year from around 30-40 years old.

Hypogonadism is when your body stops producing enough testosterone. Even though most men have normal age-related hypogonadism or late-onset hypogonadism, some men can have issues that cause testosterone levels to drop earlier in life, which is called early primary or secondary hypogonadism.

So, how do you know if you have low testosterone? The most important thing is learning to understand yourself as a whole – both physically and mentally. Low testosterone is a complex issue. For some people, low levels of testosterone won’t cause any symptoms at all, but for others, it can significantly affect their quality of life. Here are some of the signs that may indicate that you have low testosterone.

Signs you have low testosterone

1. Low libido

Your libido is another word for your sex drive. And testosterone helps to fuel it.

If your libido has gone from normal to low or non-existent, low testosterone may be a contributing factor.

Low libido doesn’t just mean that you’re less interested in sex, but it can also refer to your feelings during sex itself.

2. Erectile dysfunction

Erectile dysfunction can happen to anyone. Getting and maintaining an erection is a more complicated affair than you might think. It’s a culmination of vascular, neurological, anatomical, situational, and psychological factors.

One other factor is your hormones. Any disruption in the link between your testes and your brain, like low testosterone, can cause erectile dysfunction. So, if you’re struggling to get or maintain an erection, low testosterone may be one of the reasons why.

It is also common to get nocturnal erections during REM sleep, which we often know about when waking up with one. If your ‘morning glory’ stops happening altogether, it could be a sign that your testosterone is low.

3. Lack of muscle gains

Testosterone is one of the most potent anabolic hormones (hormones that stimulate growth and development). It works directly on muscles to build them up and stop them from being broken down.

The receptors on these muscles decline as we age, which means muscles don’t grow as much over time. But if you don’t have enough testosterone to stimulate these receptors, your muscle mass will also decline.

If you’ve noticed you’re getting weaker or your muscle mass is falling off over time, then it might be a good idea to check your testosterone.

Of course, low testosterone isn’t the only cause for lack of muscle gains. Read our blog: four reasons you’re not building muscle.

4. Low mood and memory

Testosterone acts as a signaller in the brain. Although mental health is very complex and unique to every person, testosterone plays a small but integral role.

Low testosterone can lower your mood, possibly contributing to depression, and it may negatively impact your memory.

We tend to see this most often in men as they get older, so if you have a low mood and you have low testosterone, you might be able to improve your symptoms by increasing your testosterone levels.

5. Fatigue

As well as affecting your mood, low testosterone is associated with fatigue and feeling exhausted. So, if you find yourself constantly tired and don’t know why then checking your testosterone is not an unreasonable move.

If your energy levels are at an all-time low, read our blog: five reasons you could be tired all the time.

6. Body fat and man boobs

Testosterone enhances the breakdown of fat and reduces fat uptake into tissues. As your levels drop, your body finds it easier to lay down visceral fat (fat around the tummy), which is associated with cardiovascular disease.

Yet, being overweight also causes low testosterone, which makes it harder to lose weight. Fat can accumulate around the breast tissue too, leading to man boobs (gynecomastia).

If you’re gaining weight or you’ve developed man boobs, it’s time to check your testosterone.

7. Hair growth or loss

Curiously, testosterone and its by-products can lead to both hair growth and hair loss.

Again, there are different factors at play here, but some men with healthy testosterone levels will lose hair on the head but can grow a full beard and other body hair. For these men, if beard or body hair growth becomes difficult over time, low testosterone may be to blame.

In some young men, low testosterone levels may contribute to early baldness. In these cases, you will also probably note other symptoms of low testosterone.

For more on this, read through our blog: 6 surprising causes of hair loss.

How to investigate low testosterone levels

If you are experiencing any of the symptoms of low testosterone, taking time to assess your physical and mental self can help. If you do go on to take a testosterone test, make sure to share these symptoms with your doctor so they can interpret your results alongside them.

Understand your physical self:

Understand your mental health:

• Assess your mood (both by yourself and with your trusted friends and family)
• Try to gauge your stress levels
• Try to assess your sleep
• Focus on your memory and make a mental note if you find it difficult to remember certain words

Understand yourself on the inside:

The best way to investigate low testosterone levels is to take a blood test. All testosterone blood test samples should be taken early in the morning. With a Medichecks test, your results will come with advice and any necessary follow-up steps from one of our doctors.

Our Testosterone Blood Test is a simple blood test that you can do at home to measure the total level of testosterone in your blood. For a more comprehensive test, have a look at our Advanced Well Man and Advanced Well Woman Blood tests, which both include tests for testosterone.

Alternatively, head over to the Test Finder to find the right test for you.

What to do about low testosterone

Before we get to testosterone replacement therapy (TRT), it’s best to see if there are some easily reversible causes to work on – particularly if you’re in your 30s to 50s.

1. Try to cut down on alcohol if you’re a heavy drinker – if you need extra support, some organisations can help to stop drinking.
2. Reduce or quit smoking – you can get help to quit smoking through the NHS.
3. Get moving – try to move five times a week – mixing cardio and resistance exercise is proven to boost your testosterone.
4. Measure your BMI – if are you overweight, obese, or have central visceral fat, losing weight in these situations may increase testosterone.
5. Think about what you’re eating – try to move to a wholefood, home-cooked diet.
6. Improve your sleep hygiene – cut out caffeine and screens just before bed to help you get better quality sleep.
7. Check your vitamin D levels – if you have low vitamin D levels, your testosterone can drop. By increasing your levels, you can help to optimise your testosterone production.

TESTOSTERONE REPLACEMENT THERAPY (TRT)

When testosterone levels drop too low, you may benefit from TRT in conjunction with the above tips. We’ve seen proven benefits from men who take TRT, including increased mood and increased sex drive. But it’s important to know that taking TRT comes with risks and the research isn’t yet there to know the long-term harm.

The key is to use TRT in conjunction with your GP’s input. It’s important to find the right formula for your lifestyle and to have a physical check-up each year. We also recommend keeping an eye on your levels with regular six-monthly monitoring via an Advanced TRT Blood Test. This will keep an eye on your hormones and make sure your red cells, cholesterol, sugar, and liver regulation don’t get thrown off by your therapy.

Remember, low testosterone is a complex issue but understanding your body inside and out is a great first step to ensuring you feel your best for as long as possible.

Testosterone and women

This blog is aimed more toward men’s experience of low testosterone. However, it is important to note that low testosterone can affect women too. You can read more about the importance of testosterone in women in our blog: testosterone – not just for men.

References

1. NHS.uk. 2022. The ‘male menopause’. [online] Available at: [Accessed 23 August 2022].
2. Up To Date – Clinical Features and Diagnosis of Male Hypogonadism: https://www-uptodate-com/contents/clinical-features-and-diagnosis-of-male-hypogonadism?search=testosterone&topicRef=7457&source=see_link
3. Up To Date – Approach to Older Men with Low Testosterone: https://www-uptodate-com/contents/approach-to-older-men-with-low-testosterone?search=testosterone&source=search_result&selectedTitle=3~148&usage_type=default&display_rank=2#H2505005012
4. Testosterone Deficiency, Weakness, and Multimorbidity in Men. Peterson, M. Scientific Reports 8, Article number 5897 (2018), https://www.nature.com/articles/s41598-018-24347-6
5. Review of health risks of low testosterone and testosterone administration. Jia H et al. World Journal of Clinical Cases. 2015 Apr 16; 3(4): 338-344 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391003/
6. Diagnosing and managing low serum testosterone. Rivas AM et al. Proceedings Baylor University Medical Centre. 2014 Oct: 27(4): 321-324 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4255853/
7. Physiology of Penile Erection and Pathophysiology of Erectile Dysfunction. Dean RC, Lue TF. Urology Clinics of North America. 2005 Nov; 32(4): 379-v. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1351051/

Testosterone as a Drug

The male hormone testosterone can feed the growth of prostate cancer, but in an interesting twist, when given in a very specific way, it may also cause its demise. Drugs that block the action of testosterone are commonly used to treat men with advanced prostate cancer therapy. Cutting off the supply of testosterone to the cancer works for a time, but eventually prostate cancer cells figure out a way around it and begin to grow again. Other drugs work at the molecular level to cut off prostate cancer cells’ access to testosterone, but their impact is temporary and comes with unpleasant side effects. “Men who have long-term hormone ablation have a good response initially, but eventually they become resistant to therapy, and then there aren’t many options left for them,” says prostate cancer expert Samuel Denmeade. These are the men most at risk of dying from prostate cancer.

With testosterone viewed as a fuel for prostate cancer, most researchers are reluctant to explore it as potential therapy. However, what Denmeade and fellow prostate cancer researcher John Isaacs envisioned was different, and it all came down to the delivery. Taking a play right out of cancer’s playbook, Denmeade and Isaacs figured out what prostate cancer cells were doing to survive hormonal therapy and then beat them their own game. After prolonged treatment with testosterone-blocking drugs, prostate cancer cells adapted to living with low levels of the hormone by ramping up the activity and amount of receptors within the cell surface to suck up every bit of testosterone available.

With prostate cancer cells in this state, adapted to an environment with low levels of testosterone, Denmeade wondered what would happen if he flooded the cancer cells with a short burst of high-dose testosterone, using the hormone like a drug. “If we give testosterone acutely through injection to cause a sharp rise in the hormone, prostate cancer cells won’t like that, and some will die,” says Denmeade. “Prostate cancer cells might be killed by the hormone shock, and the cells that survived would make fewer receptors, making prostate cancer cells vulnerable once again to hormone-lowering therapies.” At first glance, it seems paradoxical to give testosterone to a prostate cancer patient, but Denmeade and Isaacs say this approach is very different from the chronic, ongoing supply of testosterone that naturally occurs in men or testosterone replacement therapy. “It’s pharmacologic testosterone, not physiological testosterone,” says Isaacs.

Prostate cancer cells are not expecting an intense dose of testosterone, and they don’t know that it’s a short burst. Cancer cells that survive will adapt again, this time turning down the activity of those cell surface testosterone receptors. “They will downregulate their receptors at a time when the drug is wearing off, so we will see a period of low testosterone, low receptor, and that’s not good for cancer cells,” says Denmeade. As the cells are continually challenged with these short bursts of testosterone, they are constantly adapting levels of cell surface receptors up and down. “We are taking the cancer cells’ options out of play by making the testosterone levels rise and fall rapidly,” says Denmeade. Denmeade turned the idea in a clinical trial of testosterone as a prostate cancer drug therapy. Following a pilot study funded by the One-In-Six Fund, the National Institutes of Health, and a $5 million Transformative Grant from the Department of Defense, he began to perform two studies—one at one at the Kimmel Cancer Center, and another at 18 sites across the U.S. Both clinical trials in asymptomatic men with prostate cancer that has progressed on hormone therapy were designed to see if a monthly injection of testosterone to make the testosterone level rise sharply for about a week would kill cancer cells.

Denmeade says about two-thirds of the men treated responded well to the therapy, at least keeping their prostate cancer stable. But Denmeade noticed that some of the men treated were resensitized to hormone therapy. That observation was the impetus for his Transformer Study, a new clinical trial to see if giving testosterone in sequence with hormone therapy could prevent or reverse hormone treatment resistance. One patient in the study had his cancer completely disappear for two years. Denmeade is now looking for biomarkers that predict which patients will respond best to the testosterone therapy. Prostate cancer expert Emmanuel Antonarakis identified a subset of patients with a variation in their cell surface receptors that predicts a more aggressive and resistant type of prostate cancer. Denmeade’s testosterone treatment may convert it to a less aggressive form of cancer. A new study, called the Batman Study, is funded by the Patrick Walsh Foundation, and is helping Denmeade and colleagues look more deeply into the specific molecular and cellular mechanisms that make this therapy work. With the exception of patients with prostate cancer that has spread to the bone, the short burst of testosterone makes most men feel better.

“Men were hugging me because they felt so good. People are clamoring for it,” says Denmeade. “We get emails from men all over the country and the world.” Denmeade says they are still learning about the best way to safely give the therapy. “So far, the side effects have been low grade, as long as the treatment is limited to men who are asymptomatic without any pain due to prostate cancer,” he says. “In some cases, the testosterone therapy makes men feel increased energy, less fatigue and restored sexual function.”

To date, 150 men have been treated with varying responses. “We have some patients whose PSA drops after treatment and their scans get better; we have others whose PSA doesn’t drop and even have some initial rises. For most patients, their prostate cancer is at least held in check,” he says. PSA stands for prostate-specific antigen. Tests that measure rising levels of PSA in the blood are used to screen for prostate cancer. Denmeade is studying cells from the one complete responder more closely in hopes it may provide critical clues. “If we can understand what happened in this one guy, it would provide a wealth of information,” he says.

One possibility is that the up and down of the testosterone attracts the attention of the immune system, which is always on patrol for things that look out of the ordinary. Deciphering what underpins these varied responses could reveal biomarkers that will help them decide who are the best candidates for the treatment and how long to give it. “There has been a groundswell of interest,” says Denmeade. “Right now, we have plenty of anecdotes and some evidence of how it works, but we need to do more research and test it in more patients.” The treatment with generic testosterone is a bargain at about $100 a month, but lacking a pharmaceutical partner, Denmeade and Isaacs are struggling to find funding to do additional combination studies. “Since we are using a generic form of testosterone we may have difficulty getting support from pharmaceutical companies,” says Isaacs. “So for now, it remains a completely homegrown project.”

8 Effects of Testosterone on a Man’s Body

In today’s blog, we’ll cover the eight effects of Testosterone, and how they impact every male alive on the globe.

Testosterone is the king of hormones, and has many roles in the human body. Without it, human beings’ survival would be at risk.

Testosterone

Testosterone Is a hormone produced by the male Testes. It is known for its effects in maturation, including deepening voice, growth of body hair, puberty, sex drive, and other body functions. Men and women both produce and survive with circulating Testosterone in the blood. Although it can have different effects and responses in different genders, it is still as important for each individual on planet earth.

Where Does It Come From?

The production of Testosterone is more elaborate than you would think. The body is an incredible machine. Thus, creating this hormone involves a system called a “feedback loop.”

This feedback loop broken down means that if you are not making enough Testosterone for your body, it will send signals to make more. In the reverse, if you are taking Testosterone Replacement Therapy (TRT), your body will see this added supply and shut down or limit your own production of the hormone. This can be controversial in the long run if the TRT is stopped or lessened. Your body no longer will make the hormone you need and your choice to stop TRT renders you to have Low T repeated.

For males, the production of Testosterone starts in the brain: with the Hypothalamus, or the Hypothalamus releases Gonadotropin-Releasing Hormone (GnRH). Once this is released, it stimulates the release of the Anterior Pituitary Luteinizing Hormone and Follicle Stimulating Hormone (FH). Luteinizing hormone then stimulates the Leydig cells , which then produce Testosterone.

Why Do I Need Testosterone?

Without this hormone, a lot of very important body functions would be decreased or non-existent. In order to progress physically in our lifetime as we get older, we need this hormone on board. When an individual suffers from too much Testosterone or too little Testosterone, there are also many side effects that arise.

Too Much Testosterone

When Testosterone levels being circulated in the body reach an abnormal high , there can be trouble ahead for the individual in the driver’s seat. One might experience increased amounts of facial acne and more breakouts than usual. Other symptoms one might experience would be high blood pressure, passing out and or fainting, headaches, nausea, dizziness, Erectile Dysfunction (ED), early male pattern baldness or excessive hair growth, depression, anxiety, irritability, stroke, abnormal prostate growth, heart attack, swelling, slurred speech, trouble breathing, the appearance of breast tissue, muscle and connective tissue damage, and pulmonary embolisms. A few factors that can cause an individual to have high Testosterone are using anabolic steroids to boost sports or physical performance, undergoing TRT for low T levels, accidentally coming in contact with or touching prescription Testosterone gel or cream, and having tumor growth or tumors grow on your testicles or Adrenal Glands.

Too Little Testosterone

This condition of too little Testosterone is also clinically termed “Hypogonadism.” There are a vast variety of symptoms associated with this condition. Symptoms of Hypogonadism are as follows: trouble with erections, ED, fatigue, mood changes, reduced bone mass, hair loss, reduced testicular size, reduced sperm production, Osteoporosis, decreased muscle mass, lowered sexual desire, hot flashes, increase in body fat, increased cardiovascular risk, or gaining weight. There are generally 2 types of Hypogonadism, namely primary and secondary . Primary Hypogonadism is characterized by the testicles not responding to hormone stimulation. In Secondary Hypogonadism, a disease or other state can interfere with the Pituitary Gland or the Hypothalamus, which are the main areas in the body that affect the production of Testosterone. Certain diseases or other states that cause type 2 Hypogonadism would be; cirrhosis of the liver, toxins, stress, obesity, or malnutrition. Other factors that can cause Low T are depression, anxiety, consuming extremely low amounts of food and or calories, decreased fat intake, drug and alcohol use, chronic illness and poor sleep patterns. The (AUA) has said that a Testosterone level of at least 300 nanograms per deciliter is considered a normal level for a male. Anything below this level would be termed “Low T.” Levels ranging from 450-600 are considered to be normal.

Treatment Options to Increase Testosterone Levels

Injection: This option is a series of injections done in the office and or in your home. The first visit can be used to demonstrate how to administer the injections, and then if chosen, the individual can choose to continue treatments at home.

Cream: This is a prescription Testosterone Cream that you can apply directly to your skin. Coming in contact with this cream for anyone who is not wanting to adjust their Testosterone is advised to proceed with caution.

Patches: This route of therapy uses medical Testosterone patches placed directly on the skin. These patches release Testosterone into the bloodstream and are changed every 24 hours.

Pellets: Pellets are small devices that are placed directly under your skin. You will have them placed around the buttocks and thigh region of your body. Testosterone is released gradually and slowly over time. This is an option for individuals who are looking for low maintenance, as they do not need to be replaced frequently—only every 3-6 months.

Oral Medications: This category is for the pills you take by mouth. They also release Testosterone into your body at a gradual pace.

Free Online Testosterone Self-Test

If you suffer from Low T, or feel you may have some signs but aren’t sure where to start—begin here. This test will prompt you with a series of questions and have you talk to our specialists for a discounted rate after you get your results

Here is a sample of some of the questions you might see on the quick self-test we provide, checking all that apply:

This online test will protect your privacy and also allow us to help you get the results you need. You can find our self-test here

What Else Can I Do To Keep A Healthy Testosterone Level?

Taking care of your body is going to be the number 1 factor in how well your body produces and uses Testosterone. Investing in your body and mind will have positive effects for years and years to come. You can never go wrong with taking the time and effort to put self-care at the top of the list. Here are a few things you can start working on to increase your chances of a healthier life with normal Testosterone ranges:

1. Exercise regularly & consistently
2. Eat a balanced diet
3. Consume enough Micronutrients and Macronutrients each day
4. Get 7-9 hours of restful sleep each night
5. Invest in your mental health

8 Effects of Testosterone on a Man’s Body

Every male goes through puberty in their lifetime. Although the age can vary, it usually starts around age 12. Voices deepen, body odor increases, body hair appears on private areas and under the arms, on the legs, face, and chest. Acne can sometimes be a factor as well as hitting a growth spurt. Maturity of penis and testicles is also a byproduct. Testosterone levels rise during this puberty phase of life and level off in early adulthood. Usually, around age 30-40, levels of Testosterone start to decrease slowly over time. By the age of 80, Testosterone levels drop significantly, simply as a byproduct of the aging process. This is a normal part of getting older, and in most cases does not require any form of therapy. Experiencing some difficulty with erections and sexual libido once in a while can be considered normal in a man’s life. When individuals are experiencing symptoms of low Testosterone in the youthful years of their life that are becoming increasingly more common or occurring 50% or more of the time, then it is advised to seek additional help.

Testosterone increases the number of neurotransmitters in the body, which in turn affect tissue growth. This special hormone also increases levels of Growth Hormone, which makes it easier to build muscle during exercise or training. Androgen exposure early in life will determine the size and number of motor units in our muscles. These factors, along with physical features, determine the size of muscle fibers. Simply put, when male babies are in the womb and growing, androgen exposure can determine how well their muscles will grow in adulthood.

Exercise is another factor that can affect muscle growth. It depends on the intensity and consistency of the exercise completed. Performing exercise can show a short-term release of Testosterone which will aid in muscle growth. The harder you work, the more Testosterone you will get. This can also be true on the flip side. If you are working out in mostly an endurance-based exercise program, your Testosterone levels will likely decrease or be suppressed.

What’s one hormone that tells the bone marrow to manufacture more red blood cells? Testosterone. When Testosterone levels are normal, bone density is accurate.

Increased amounts of body hair is a result of Testosterone production. We see this mainly in adolescence when males hit 12 years old. Hair starts to grow heavier on the body. In instances where too much Testosterone is introduced to the body via TRT or other methods, excess body hair is also a by-product for males and females alike. Hair growth can also be shown in the reverse for increased Testosterone production. Male pattern baldness can be a risk when T levels get higher than normal.

Sometimes in the media and movies, Testosterone is portrayed by Hulk-like anger or in-depth mood swings. Although mood swings and roller coaster emotions can happen, generally in puberty and adolescence, this drastic visual is not accurate. In some cases where Testosterone is being taken with TRT, the mood and mood swings can become more drastic. This is not until later in life when an individual chooses to start TRT if their own Testosterone levels are low on their own.

In a review conducted by The Current Opinion in Endocrinology, Diabetes, and Obesity, a link between weight loss and TRT was found. When men who were considered obese who also suffered from low T or underwent TRT, they saw a significant reduction in weight.

-Regulation of Sex Drive

When individuals suffer from low T, their sexual libido, or sex drive, will automatically decrease. Less Testosterone circulated in the body means less sexual feelings and drive for sex. A symptom of having less than normal levels of Testosterone is fatigue. It comes as no surprise that when an individual gets too tired or fatigued, sex or foreplay seem less appealing.

This process is termed “Spermatogenesis.” This is the process by which sperm is produced in the male’s body in the Testes. Testosterone regulates this sequence.

Testosterone is absolutely crucial to spermatogenesis , including meiosis and spermiogenesis.

Visit Genesys Men’s Health for Your Testosterone Needs

At Genesys Men’s Health, We are here to serve you every step of the way. With vast amounts of knowledge on Testosterone levels in our patients, we are equipped with the tools to help you on the path to a healthier and happier lifestyle. There are many effects of Testosterone in the male body, and we can help you determine if you need additional resources. We understand each individual that walks through our doors is unique, and so is their situation. If you have questions about your Testosterone levels, look no further. Our office is located in Sandy, Utah. Come in and talk with our friendly staff, or give us a call at (801)-671-7456. Contact us today!

Hyperandrogenism

Hyperandrogenism happens when you have an excess amount of androgens (a group of sex hormones) in your body. It most commonly affects people assigned female at birth and can cause hirsutism, acne and irregular periods.

Overview

What is hyperandrogenism?

Hyperandrogenism happens when you have an excess amount of androgens in your body. Androgens are a group of sex hormones. They help start puberty and play a role in reproductive health and body development.

Hormones are chemicals that coordinate different functions in your body by carrying messages through your blood to your organs, muscles and other tissues. These signals tell your body what to do and when to do it.

Everyone makes androgens, but men or people assigned male at birth (AMAB) make more of them. Women or people assigned female at birth (AFAB) make about one-twelfth the amount of androgens of people AMAB. Testosterone is the most common androgen.

The testicles in the male reproductive system and the ovaries in the female reproductive system make androgens. Your adrenal glands, which sit on top of each of your kidneys, also produce these hormones. Other tissues, such as fat and skin, play roles in converting weak androgens into more potent (powerful) ones.

Hyperandrogenism causes different symptoms based on your age and sex. It has several possible causes and can be treated.

Is hyperandrogenism the same as PCOS?

While hyperandrogenism and polycystic ovary syndrome (PCOS) are closely connected, they’re not the same thing.

Hyperandrogenism is the defining sign of PCOS, a hormonal imbalance caused by the ovaries (the organ that produces and releases eggs) creating excess male hormones. It affects people AFAB.

While PCOS is a common cause of hyperandrogenism, hyperandrogenism can have other causes and can affect people AMAB. Similarly, PCOS has other symptoms aside from hyperandrogenism, including ovarian cysts.

Who does hyperandrogenism affect?

Hyperandrogenism can affect anyone — both children and adults. But it more commonly affects people assigned female at birth of reproductive age.

How common is hyperandrogenism?

Hyperandrogenism is fairly common in people assigned female at birth of reproductive age. It affects about 5% to 10% of that population.

Hyperandrogenism less commonly affects children and adults assigned male at birth.

Symptoms and Causes

What are the signs and symptoms of hyperandrogenism?

Hyperandrogenism has various symptoms depending on your sex and if you’ve been through puberty or not.

It’s important to note that you could have these symptoms of hyperandrogenism but have normal levels of androgens in your blood. This is because each of these symptoms has other possible causes. It’s also possible to have bloodwork tests show that you have high androgen levels while having mild or no physical symptoms.

If these symptoms develop rapidly and suddenly, it’s important to see your healthcare provider as soon as possible since the cause in this case is often an androgen-secreting tumor.

Symptoms of hyperandrogenism in pre-pubertal girls or children assigned female at birth (AFAB) include:

Symptoms of hyperandrogenism in pre-pubertal boys or children assigned male at birth (AMAB) include:

Symptoms of hyperandrogenism in women or adults AFAB include:

In men or adults AMAB, the effects of hyperandrogenism depend on if the source of excess hormones is from your adrenal glands or an outside source (such as anabolic steroid injections). Elevated levels of adrenal androgens have few noticeable physical effects in adults AMAB, but it can suppress the function of your testes and cause infertility.

What causes hyperandrogenism?

In people assigned female at birth, the ovaries, adrenal glands and fat cells produce androgen hormones. In people assigned male at birth, the testicles and adrenal glands produce androgens.

There are also several other hormones that influence the production and release of androgens, such as luteinizing hormone (LH) and adrenocorticotrophic hormone (ACTH). Your pituitary gland releases both of these hormones.

If any one or more of these organs and/or hormones aren’t functioning properly, it can cause hyperandrogenism.

Hyperandrogenism has several possible causes, including:

• Polycystic ovarian syndrome (PCOS) — the most common cause.
• Congenital adrenal hyperplasia.
• Cushing disease.
• Androgen-secreting tumors.
• Certain medications.

Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is the most common cause of persistent hyperandrogenism beyond early puberty in adolescents and adults AFAB. Approximately 80% to 90% of people AFAB with hyperandrogenism have PCOS.

In PCOS, chronically elevated luteinizing hormone and insulin (hyperinsulinemia) levels lead to increased androgen production within your ovaries. In addition, hyperinsulinemia prevents your liver from producing sex hormone binding globulin (SHBG), which results in increased levels of free testosterone in your blood.

Congenital adrenal hyperplasia (CAH)

Congenital adrenal hyperplasia (CAH) consists of a group of genetic conditions affecting your adrenal glands.

In CAH, genetic mutations (changes) cause shortages of certain enzymes, such as 21-hydroxylase, that help your body produce needed hormones. For many people with CAH, the enzyme shortage causes their adrenal glands to overproduce other hormones, like testosterone.

Non-classical congenital adrenal hyperplasia, which involves a partial 21-hydroxylase deficiency, is the most common adrenal cause of hyperandrogenism. Approximately 2% of women or adults assigned female at birth with hyperandrogenism have late-onset nonclassical CAH.

Cushing disease

Cushing disease is a type of Cushing syndrome. Cushing syndrome is an uncommon syndrome that happens when your body has too much cortisol (a hormone).

Cushing disease is caused by a benign tumor located in your pituitary gland that releases too much ACTH (adrenocorticotropic hormone), which in turn increases cortisol.

Excess ACTH causes your adrenal glands to release excess androgens, which then causes hyperandrogenism.

Cushing syndrome has several other symptoms, including:

It’s important to see your healthcare provider as soon as possible if you have these symptoms.

Androgen-secreting tumors

Certain adrenal tumors and tumors in your ovaries or testicles can produce and release (secrete) androgens. This causes higher-than-normal androgen levels in your body. Hyperandrogenism caused by these kinds of tumors is often very severe and sudden.

Hyperandrogenism due to ovarian or adrenal tumors is rare. It’s responsible for only 0.2% of cases. But it’s important to see your provider right away if you have sudden symptoms of hyperandrogenism.

Certain medications

Certain medications can cause hyperandrogenism. The most common medications that cause it include:

• Anabolic-androgenic steroids (synthetic versions of testosterone that athletes sometimes misuse as performance-enhancing drugs).
• Synthetic progestins (medications that cause changes in the uterus and are used for multiple purposes).
• Antiepileptics (medications to prevent seizures).

Diagnosis and Tests

How is hyperandrogenism diagnosed?

If you’re a woman or person assigned female at birth and are concerned you may have hyperandrogenism, your healthcare provider will perform a physical exam to assess the possible physical symptoms of hyperandrogenism, such as excessive body hair growth. They’ll also ask you several questions about your medical history, including:

• Your age when your breasts started to develop.
• Your age when you started to grow pubic hair.
• Your age when you had your first menstrual cycle (period).
• If you shave or have had laser hair removal.
• If you’ve used nonprescription anabolic steroids or testosterone.
• The frequency, length and heaviness of your periods.

If your provider suspects hyperandrogenism, they’ll likely order blood tests to measure certain hormone levels. These tests can help with a diagnosis.

What tests will be done to diagnose hyperandrogenism?

If you have signs or symptoms of hyperandrogenism, your provider may order certain blood tests, including:

• Total testosterone: This is the total amount of all the testosterone in your bloodstream. Total testosterone levels are often mildly elevated in people AFAB with PCOS. Highly elevated levels may indicate an ovarian or testicular tumor.
• Free testosterone: This testosterone is unattached to any proteins and is a small percentage of the total testosterone. Free testosterone levels may be elevated in people AFAB with PCOS.
• Androstenedione: Androstenedione is a steroid hormone that has weak, androgenic effects on your body. But it mainly acts as a stepping stone in the production of testosterone and estrogen within your body. Elevated levels may indicate PCOS.
• Dehydroepiandrosterone sulfate (DHEAS): DHEAS is a sex hormone that your adrenal glands release, so it’s a good marker for adrenal androgen production. A mildly elevated DHEAS level is common in people AFAB with PCOS. Highly elevated levels may indicate an adrenal tumor.
• 17-hydroxyprogesterone: Measuring levels of 17-hydroxyprogesterone in your blood is a screening test for non-classic congenital adrenal hyperplasia, which is one of the causes of hyperandrogenism.

Since each of the symptoms of hyperandrogenism has several other causes, your provider may order additional blood tests to rule out other possible causes of your symptoms.

Your provider may also order certain imaging tests to help diagnose the cause of hyperandrogenism, including:

Management and Treatment

Healthcare providers aim the medical treatment of hyperandrogenism at lowering ovarian or adrenal androgen production, reducing the free androgen levels and blocking the androgen action.

However, people with hyperandrogenism typically seek medical care for the treatment of its main symptoms, such as hirsutism, acne and irregular periods.

Medical treatment for hyperandrogenism

The medical treatment for hyperandrogenism depends on its cause. For example:

• Adrenal hyperandrogenism is slowed down by low-dose corticosteroids.
• Surgical removal may be necessary for ovarian, testicular or adrenal tumors. Oophorectomy (surgical removal of one or both ovaries) may be necessary for severe hyperandrogenism in menopausal or perimenopausal people.
• If you’re taking medications that are causing hyperandrogenism, your provider may recommend stopping the medication or taking a different one.

Antiandrogen drugs are also a common treatment for hyperandrogenism. They work by blocking the effects of androgens, such as testosterone.

• Oral contraceptive (birth control pill) containing ethinyl estradiol (estrogen) and antiandrogenic progesterone: These include cyproterone acetate (co-cyprindiol or Diane®-35, Estelle® 35 and Ginet-84™), drospirenone (Yasmin®, Yaz®) or dienogest (Valette®). They can help treat acne, hirsutism and irregular periods.
• Spironolactone(Aldactone®): This antiandrogen treats hormonal acne and excessive body hair.
• Cyproterone: This medication can help treat PCOS, reduce testosterone levels and reduce the production of acne-causing oils.

Treatment of hyperandrogenism symptoms

People with hyperandrogenism may seek treatments specifically for their symptoms, including:

• Acne: Treatment for acne includes topical anti-acne agents, oral antibiotics such as tetracycline, antiandrogens (hormone therapy, including birth control pill) and isotretinoin pills.
• Hirsutism: Most people AFAB with hirsutism use physical methods of hair removal, such as waxing, shaving and laser hair removal. They may also take the birth control pill.
• Irregular periods: People AFAB may take hormonal birth control to try to regulate their periods.

When these symptoms are unresponsive to conventional therapy because of hormone imbalances, your provider may consider stronger antiandrogen medication.

Prevention

Can hyperandrogenism be prevented?

Unfortunately, there’s no concrete way to prevent hyperandrogenism.

There’s no proven way to prevent PCOS, the most common cause of hyperandrogenism, but you can take small steps to reduce your symptoms. For example, eating nutritious foods, exercising regularly and managing your weight can help you reduce the effects of PCOS and hyperandrogenism.

Outlook / Prognosis

What is the prognosis (outlook) of hyperandrogenism?

Therapies for most causes of hyperandrogenism are lifelong. In some cases, people AFAB with PCOS-related hyperandrogenism no longer have PCOS after significant weight reduction. Most people, however, need continued therapy throughout their lifetime to minimize signs and symptoms of hyperandrogenism.

The signs and symptoms of hyperandrogenism can affect your self-esteem and mental health. It’s important to see a psychologist or therapist if you’re experiencing stress, anxiety and/or depression due to these symptoms.

Living With

When should I see my healthcare provider about hyperandrogenism?

If you’ve been diagnosed with hyperandrogenism and are taking medication for it, you’ll likely need to see your healthcare provider regularly to make sure your treatment is working.

If hyperandrogenism is affecting your mental health, it’s important to see a psychologist or therapist for help.

A note from Cleveland Clinic

Hyperandrogenism is a fairly common condition in women or people assigned female at birth. While its signs and symptoms may make you feel embarrassed or ashamed, know that you’re not alone and that the condition is treatable. Talk to your healthcare provider about treatment options and be sure to see a psychologist or therapist if it’s affecting your mental health.

Last reviewed by a Cleveland Clinic medical professional on 01/23/2023.

References

• Abdel-Rahman MY. Androgen Excess. (https://emedicine.medscape.com/article/273153-overview) 2022 Feb 7. In: Medscape. Accessed 1/23/2023.
• DermNet NZ. Anti-Androgen Therapy. (https://dermnetnz.org/topics/anti-androgen-therapy) Accessed 1/23/2023.
• DermNet NZ. Hyperandrogenism. (https://dermnetnz.org/topics/hyperandrogenism) Accessed 1/23/2023.
• Hafsi W, Badri T. Hirsutism. (https://www.ncbi.nlm.nih.gov/books/NBK470417/) 2021 Aug 7. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022. Accessed 1/23/2023.
• Nassar GN, Leslie SW. Physiology, Testosterone. (https://www.ncbi.nlm.nih.gov/books/NBK526128/) 2022 Jan 4. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022. Accessed 1/23/2023.
• Sharma A, Welt CK. Practical Approach to Hyperandrogenism in Women. (https://pubmed.ncbi.nlm.nih.gov/34688417/) Med Clin North Am. 2021; 105(6): 1099-1116. Accessed 1/23/2023.
• The American College of Obstetricians and Gynecologists. Screening and Management of the Hyperandrogenic Adolescent. (https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/10/screening-and-management-of-the-hyperandrogenic-adolescent) Accessed 1/23/2023.

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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

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Endocrinology & Metabolism Institute

Cleveland Clinic’s Endocrinology & Metabolism Institute is committed to providing the highest quality healthcare for patients with diabetes, endocrine and metabolic disorders, and obesity.

The big male nose: Why men’s noses are bigger than women’s

Date: November 18, 2013 Source: University of Iowa Summary: Why are men’s noses bigger than women’s? The answer, according to a new study lies in our physiology. Men’s noses are about 10 percent larger than female noses, on average, because males have more lean muscle mass, which requires more oxygen for muscle tissue growth and maintenance. It also explains why we have smaller noses than our ancestors. Share:

Human noses come in all shapes and sizes. But one feature seems to hold true: Men’s noses are bigger than women’s.

A new study from the University of Iowa concludes that men’s noses are about 10 percent larger than female noses, on average, in populations of European descent. The size difference, the researchers believe, comes from the sexes’ different builds and energy demands: Males in general have more lean muscle mass, which requires more oxygen for muscle tissue growth and maintenance. Larger noses mean more oxygen can be breathed in and transported in the blood to supply the muscle.

The researchers also note that males and females begin to show differences in nose size at around age 11, generally, when puberty starts. Physiologically speaking, males begin to grow more lean muscle mass from that time, while females grow more fat mass. Prior research has shown that, during puberty, approximately 95 percent of body weight gain in males comes from fat-free mass, compared to 85 percent in females.

“This relationship has been discussed in the literature, but this is the first study to examine how the size of the nose relates to body size in males and females in a longitudinal study,” says Nathan Holton, assistant professor in the UI College of Dentistry and lead author of the paper, published in the American Journal of Physical Anthropology. “We have shown that as body size increases in males and females during growth, males exhibit a disproportionate increase in nasal size. This follows the same pattern as energetic variables such as oxygenate consumption, basal metabolic rate and daily energy requirements during growth.”

It also explains why our noses are smaller than those of our ancestors, such as the Neanderthals. The reason, the researchers believe, is because our distant lineages had more muscle mass, and so needed larger noses to maintain that muscle. Modern humans have less lean muscle mass, meaning we can get away with smaller noses.

“So, in humans, the nose can become small, because our bodies have smaller oxygen requirements than we see in archaic humans,” Holton says, noting also that the rib cages and lungs are smaller in modern humans, reinforcing the idea that we don’t need as much oxygen to feed our frames as our ancestors. “This all tells us physiologically how modern humans have changed from their ancestors.”

Holton and his team tracked nose size and growth of 38 individuals of European descent enrolled in the Iowa Facial Growth Study from three years of age until the mid-twenties, taking external and internal measurements at regular intervals for each individual. The researchers found that boys and girls have the same nose size, generally speaking, from birth until puberty percolated, around age 11. From that point onward, the size difference grew more pronounced, the measurements showed.

“Even if the body size is the same,” Holton says, “males have larger noses, because more of the body is made up of that expensive tissue. And, it’s at puberty that these differences really take off.”

Holton says the findings should hold true for other populations, as differences in male and female physiology cut across cultures and races, although further studies would need to confirm that.

Prior research appears to support Holton’s findings. In a 1999 study published in the European Journal of Nutrition, researchers documented that males’ energy needs doubles that of females post-puberty, “indicating a disproportional increase in energy expenditure in males during this developmental period,” Holton and his colleagues write.

Another interesting aspect of the research is what it all means for how we think of the nose. It’s not just a centrally located adornment on our face; it’s more a valuable extension of our lungs.

“So, in that sense, we can think of it as being independent of the skull, and more closely tied with non-cranial aspects of anatomy,” Holton says.

Thomas Southard, professor and chair of orthodontics in the UI College of Dentistry, is a contributing author on the paper. Other authors are Todd Yokley, from Metropolitan State University in Denver, and Andrew Froehle, from Wright State University, in Dayton, Ohio.

The Department of Orthodontics in the UI College of Dentistry funded the research.

Testosterone Test — Men’s

Testosterone is a key sex hormone produced in the testes (testicles) and may affect sex drive, fertility, muscle mass, and bone health. Measure levels in your blood to determine if your level is normal, high, or low.

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9 Things That Can Happen To Your Body After You Start Taking Testosterone

TESTOSTERONE IS AN ESSENTIAL hormone for your body. It helps you maintain muscle mass, facial and body hair, sex drive, and red blood cell production. So when your levels are low, also known as low T, you can experience many side effects.

When you have low T, you might need testosterone therapy to boost your levels and reduce your symptoms.

“Testosterone therapy supplements or replaces an important hormone produced naturally by your body in those men with testosterone deficiency,” says Darshan Patel, M.D., assistant professor of urology at the University of California San Diego’s Men’s Health Center.

As you age, your levels of testosterone tend to decline. And that can be problem: Testosterone binds to proteins throughout your body and brain called androgen receptors, which help control and regulate a whole range of different bodily functions, explains Ronald Tamler, M.D., Ph.D., associate professor of medicine at the Icahn School of Medicine at Mount Sinai.

If there’s not enough testosterone to go around, those androgen receptors all over your body and brain stay silent, leading to symptoms like low libido, weak erections and orgasms, inability to build muscle mass, low energy, or just feeling a little blue. A condition called hypogonadism develops when your body can’t produce enough of that hormone.

Testosterone replacement therapy helps raise your low testosterone levels. If you are prescribed testosterone therapy, you’ll likely start to see some changes, big and small, pleasant and not-so-pleasant. You may not see them all, and they may not all appear right away, but there are several things to know about testosterone therapy.

What is testosterone therapy?

Testosterone therapy is designed to reverse some of the effects of hypogonadism.

Doctors will test your testosterone levels to see if you’re a good candidate for the therapy, says Ryan Smith, M.D., associate urology professor and urologic microsurgeon specializing in men’s health at the University of Virginia Health.

They’ll perform two blood tests in the morning (on different days) when testosterone is at its highest, Dr. Smith explains. Low is considered under 300 nanograms per deciliter (ng/dL) by some accounts, 264 by others. Doctors also factor in any symptoms you’re having, like low libido, fatigue, or just feeling blah.

There are numerous types of testosterone therapy out there: injectibles, topical gels, cream patches, under-the-skin pellet therapy, pills, and nasal sprays, says Dr. Patel. Each comes with its own set of unique side effects.

Which treatment is right for you comes down to personal preference, your individual situation, and what your insurance covers, says Dr. Tamler.

Why you should take testosterone under a doctor’s supervision

Testosterone is often easy to get online without a prescription. But taking it without a doctor’s approval and supervision can be harmful, says Justin Dubin, M.D., a urologist and men’s health specialist at Memorial Healthcare System.

In a 2022 study that Dr. Dubin co-authored, researchers found that many online platforms are not providing testosterone therapy in accordance with the American Urological Association and Endocrine Society guidelines. Using a secret shopper, they found that the platforms offered therapy to men who didn’t meet the guidelines and didn’t mention the risks or benefits of testosterone therapy.

Working with a doctor ensures that you’re prescribed testosterone only when you need it and that you’re taking the right dose. Then, they can work with you to make sure your testosterone levels respond appropriately. They like to recheck everything every six months to make sure you’re not having any negative side effects.

Testosterone therapy side effects

It can take a few weeks to a month or two to see your symptoms improve after starting testosterone replacement therapy, Dr. Smith says. Here are some of the side effects—good and bad—that come with testosterone therapy:

1. Effect of testosterone: Your sex drive jumps

When you’re low on testosterone, you might notice your sex drive dip. Testosterone replacement can activate the androgen receptors in the part of your brain that controls desire, says Abraham Morgentaler, M.D., clinical associate professor of urology at Harvard Medical School; and author of Testosterone for Life.

Regaining a healthy sex drive is one of the biggest benefits of testosterone replacement therapy, he says. T-therapy can possibly make your erections more satisfying, too.

This isn’t the only piece of the puzzle, though—erections also rely on healthy nerves and blood flow. So that means that testosterone therapy by itself isn’t a cure for erectile dysfunction itself.

2. Effect of testosterone: It’s easier to build muscle

Muscles respond to testosterone, and starting T-therapy can increase muscle mass, says Dr. Morgentaler. That’s because testosterone activates the androgen receptors in muscle tissue to stimulate growth.

Of course, to make the most of this benefit, you’ll need to be doing your part by strength training as well. He cautions that while testosterone replacement therapy may strengthen muscle, it won’t turn you into a bodybuilder by itself.

Some men also report fat loss. While testosterone doesn’t directly incite fat loss itself, part of it may be thanks to the uptick in muscle mass—the more muscle you have, the higher your basal metabolic rate (or BMR) will be, which means your body will burn more calories at rest.

Jed Kaminetsky, M.D., a clinical assistant professor in the department of urology at NYU Langone Medical Center also notes that this may be partially because testosterone improves overall motivation to get up and sweat it out, so if you’re motivated to put in the work again, you’ll see results.

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3. Effect of testosterone: Your energy levels can soar

Fatigue is a common symptom of low T. “And when we treat them, a lot of men will say that their energy has improved,” says Dr. Morgentaler.

While researchers aren’t exactly sure how exactly testosterone plays a role in energy yet, he says it’s believed it might affect your mitochondria, which produce energy within cells. The theory is that “testosterone turns them on, so they’re more productive in terms of creating the energy that the cells need.”

Dr. Tamler also notes that it may be tied back to androgen receptors. “If they don’t get sufficient input, that can cause fatigue,” he says. So bringing testosterone levels back up can help reverse this.

4. Effect of testosterone: Your mood can improve

Experts don’t have a definitive answer to why testosterone impacts mood so deeply—after all, “the brain is a complicated thing,” says Dr. Tamler. But the positive benefits of T therapy on mood is a potential life-changing benefit.

A study published in The Aging Male found that after 12 months of testosterone therapy, the percentage of guys with moderately severe to severe depression symptoms decreased from 17 percent to 2 percent. And a large randomized trial of testosterone, the T Trials, showed that men who received T had a greater improvement in mood than men who received a placebo.

5. Effect of testosterone: It can affect your fertility

The most important thing to know about testosterone therapy is its impact on your sperm production and fertility—it can decrease sperm production and pose a risk of infertility.

It might affect the size of your testicles, too. “Most of the size of the testicle is dedicated to making sperm, so when you’re making less sperm, the testicles get smaller,” says Dr. Morgentaler.

Sperm production may or may not go back to normal after stopping treatment, says Dr. Kaminetsky. A 2017 study in Fertility & Sterility found that increasing age and longer length of T-therapy were linked to lower chances of normal sperm recovery.

6. Effect of testosterone: Your feet and ankles may swell

Some people notice a little swelling in their feet and ankles because testosterone can encourages your body to hold onto excess fluid, says Dr. Morgentaler.

This isn’t a big deal for most people, he says, and its more common to see it if you’re taking a non-daily treatment like an injection, where you’re getting a higher dose of T in one sitting.

7. Effect of testosterone: Your skin type may change

Testosterone replacement therapy may change your skin type—for better or for worse, says Dr. Morgentaler.

Testosterone can increase oil production, which isn’t necessarily a bad thing. It’s important for healthy skin, so you may actually end up with a better complexion. However, too much oily buildup can lead to breakouts.

Thankfully, this isn’t that common, says Dr. Morgentaler, and it’s typically seen in men who have a history of acne.

Skin changes are mainly seen with treatments like injections, when you’re getting a higher dose all at once.

8. Effect of testosterone: Your breasts may enlarge

In all men—whether you’re taking T or not—some testosterone is converted into the hormone estradiol, a form of estrogen. And in men who have more breast tissue by nature, the T they’re taking that’s naturally converted into estradiol could stimulate this breast tissue to grow.

This is called gynecomastia, says Dr. Morgentaler, and it’s not as common as other side effects. If it does happen, your doctor will likely stop treatment for a month or two to allow your breast tissue to go back to normal, and then start you back up with T along with a drug that blocks the conversion of testosterone to estradiol.

9. Effect of testosterone: You can transfer the hormone to others

One thing to worry about if you’re going the topical testosterone therapy route is transference, especially to female partners or children, Dr. Patel says. Testosterone from gels or creams can be spread from skin-to-skin contact or from your clothing and absorbed by someone else.

“You really have to be careful to wash your hands well and not expose others,” Dr. Smith says.

Contact with excess testosterone can affect children’s genitalia and cause premature pubic hair development and aggressive behavior.

10. Effect of testosterone: The link between testosterone and serious risks is still murky

Testosterone replacement therapy has traditionally come along with serious warning labels that your risk for heart attack, stroke, and prostate cancer could rise, but this is still very controversial—and recent evidence has begun to debunk some of these fears.

In the case of heart attacks and strokes, the concern is that testosterone thickens blood because it binds to androgen receptors that stimulate bone marrow to produce more red blood cells. Thicker blood is linked to a greater risk of heart attack and stroke. But some recent studies actually suggest that normal testosterone levels might actually protect against these risks, says Dr. Morgentaler.

The link to prostate cancer is fuzzy, too. Because there are androgen receptors in the prostate, testosterone can make it grow. So if you already have an enlarged prostate that makes it difficult to urinate, testosterone could exacerbate the issue, says Dr. Tamler. However, there isn’t evidence to suggest that T actually causes prostate cancer.

Is Testosterone Therapy Safe?

Testosterone replacement therapy is safe and approved by the U.S. Food and Drug Administration for men with a testosterone deficiency, Dr. Patel.

And, it’s safe as long as you follow your doctor’s orders and don’t seek it out on your own. “It requires regular monitoring by your doctor,” he adds.

While there are several myths about testosterone therapy and the risk of cardiovascular disease and prostate cancer, there’s no conclusive evidence, Dr. Patel emphasizes. “This is an ongoing area of research.”

Alexa is a Denver-based contributor who covers all things lifestyle, wellness, travel, home, and beauty. When she’s not writing, you can find her sweating it out at boxing or Pilates, planning her next travel adventure, or drinking red wine.

Erica Sweeney is a writer who mostly covers health, wellness and careers. She has written for The New York Times, HuffPost, Teen Vogue, Parade, Money, Business Insider and many more.

Androgens

Androgens like testosterone are sex hormones. Androgens help people enter puberty and mature physically. Females with high androgen levels may develop acne, facial hair and other issues. Males with too little androgen may have low sex drives and develop breasts (gynecomastia). Adrenal gland tumors and other conditions can affect androgen levels.

What are androgens?

Androgens are a group of sex hormones. They help start puberty and play a role in reproductive health and body development.

All genders make androgens, but males make more of them. Testosterone is the most common androgen.

The testicles in the male reproductive system and the ovaries in the female reproductive system make androgens. The adrenal glands that sit on top of each kidney also produce these hormones.

What are the types of androgens?

Testosterone is the predominant androgen in all genders. Other androgens include:

What is the role of androgens?

What is the role of androgens in men?

In people assigned male at birth (AMAB), androgens contribute to:

What is the role of androgens in women?

In people assigned female at birth (AFAB), other body chemicals convert androgen into estradiol, a form of estrogen. This hormone:

How do healthcare providers measure androgen levels?

Your healthcare provider uses a calculation called the free androgen index (FAI) to measure androgen levels. FAI starts with a blood test to measure:

SHBG is a protein that carries androgens (testosterone and DHT) and estrogen in the blood. Your provider compares total testosterone to SHBG to determine the FAI or amount of androgen in the blood.

Androgen levels can change throughout the day. They naturally decline with age. A woman’s age, menstrual cycle stage or menopause status can also affect hormone levels.

What are common androgen-related health problems?

High levels of androgen (hyperandrogenism) is more commonly a problem for people assigned female at birth (AFAB). The most common cause of hyperandrogenism is polycystic ovary syndrome (PCOS). Rarely, adrenal or ovarian tumors case hyperandrogenism.

Low levels of androgen (hypoandrogenism) can lead to:

What androgen conditions affect males?

Androgen can fuel the growth of prostate cancer. Some people take hormone medications to lower the body’s natural production of androgen as part of treatment for prostate cancer.

Low androgen or low testosterone (male hypogonadism) can cause fatigue, anxiety and depression, difficulty concentrating, poor exercise tolerance, low sex drive and erectile dysfunction. It can also lead to breast development (gynecomastia).

What androgen conditions affect females?

People with polycystic ovary syndrome or high androgen levels may have:

What androgen conditions affect children?

Androgen helps genitals as the fetus develops in your uterus. At birth, some babies have disorders of sex differentiation. These conditions affect a child’s reproductive organs and how the genitals look.

A parent may pass a gene mutation (change) to a child. The gene mutation can cause:

• Androgen insufficiency syndrome (AIS): In a baby with AIS, the body doesn’t respond to its androgen or testosterone. The baby has male chromosomes, but the penis may be unusually small (micropenis) or not fully formed. The genitals may look female or be a mix of sexes.
• Congenital adrenal hyperplasia (CAH): High androgen levels cause a baby with female chromosomes to have genitals that look male.

A note from Cleveland Clinic

While some people view androgens as primarily male sex hormones, these hormones help people enter puberty and develop physically and sexually. When androgen levels are too low or too high, it can affect your energy level and sex drive. Unhealthy androgen levels can also increase your risk of problems like diabetes. A blood test can measure androgen levels. Your healthcare provider can treat tumors and other issues that affect androgen levels.

Last reviewed by a Cleveland Clinic medical professional on 10/24/2021.

References

• American Cancer Society. Hormone Therapy for Prostate Cancer. (https://www.cancer.org/cancer/prostate-cancer/treating/hormone-therapy.html) Accessed 10/29/2021.
• Burger HG. Androgen production in women. (https://www.fertstert.org/article/S0015-0282(02%2902985-0/fulltext) Fertility and Sterility. 2002;77(4):3-5. Accessed 10/29/2021.
• Jordan CL, DonCarlos L. Androgens in health and disease: An overview. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676684/) Horm Behav. 2008;53(5):589-95. Accessed 10/29/2021.
• Lab Tests Online. Sex Hormone Binding Globulin (SHBG). (https://labtestsonline.org/tests/sex-hormone-binding-globulin-shbg) Accessed 10/29/2021.
• McMaster Pathophysiology Review. Sex Hormone Synthesis, Regulation and Function. (http://www.pathophys.org/sexhormones/) Accessed 10/29/2021.
• National Health Service (UK). Overview: Androgen Insensitivity Syndrome. (https://www.nhs.uk/conditions/androgen-insensitivity-syndrome/) Accessed 10/29/2021.
• Victoria State Government Better Health (Australia). Androgen Deficiency in Men. (https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/androgen-deficiency-in-men) Accessed 10/29/2021.

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Related Institutes & Services

Endocrinology & Metabolism Institute

Cleveland Clinic’s Endocrinology & Metabolism Institute is committed to providing the highest quality healthcare for patients with diabetes, endocrine and metabolic disorders, and obesity.

Early and late long-term effects of vasectomy on serum testosterone, dihydrotestosterone, luteinizing hormone and follicle-stimulating hormone levels

Purpose: We investigated whether the association between vasectomy and prostate cancer has a hormonal basis.

Materials and methods: We examined serum testosterone, dihydrotestosterone, luteinizing hormone and follicle-stimulating hormone levels by radioimmunoassay on 91 pairs of men who did and did not undergo vasectomy.

Results: Men who underwent vasectomy 10 to 19 years previously had higher dihydrotestosterone levels than age matched controls. In men who underwent vasectomy 20 years or more ago testosterone was higher than in corresponding controls. No statistically significant difference in luteinizing hormone and follicle-stimulating hormone levels was noted between the men who had had vasectomy and controls.

Conclusions: Our results indirectly support the hypothesis that there is an elevated risk of prostate cancer among men who underwent vasectomy 20 or more years previously.

PIP: Researchers compared data on 91 men who had undergone vasectomy at least 10 years earlier with data on 91 healthy men matched for age, weight, height, and neighborhood who had not undergone vasectomy to examine whether the link between vasectomy and prostate cancer is based on changes in serum hormone levels. All the men lived in suburban Xiangtan in Hunan Province, China. Cases had a higher mean serum dihydrotestosterone level than controls (1.18 vs. 1.05 nmol/l; p 0.05). Yet men who had undergone vasectomy less than 20 years earlier not only had a higher dihydrotestosterone level than age-matched controls (1.46 vs. 1.22 nmol/l; p 0.01) but had a lower testosterone/dihydrotestosterone ratio (14.5 vs. 20.1; p 0.005). On the other hand, men who had undergone vasectomy more than 20 years earlier had a higher testosterone level than age-matched controls (27.2 vs. 23.9 nmol/l; p 0.05). Men who had undergone vasectomy when they were less than 35 years old had a higher FSH level and those who were 35-39 years old at vasectomy had a higher dihydrotestosterone level than age-matched controls (19.5 vs. 14.8 mIU/ml and 1.31 vs. 1.09 nmol/l) (p 0.05). Even though men who were at least 40 years old at vasectomy had a higher dihydrotestosterone level than matching controls (1.24 vs. 1.09 nmol/l), the difference was not statistically significant. These findings suggest that vasectomy may cause a reduction in testosterone levels by minimizing the conversion from testosterone to dihydrotestosterone in the long term. Thus, they support the hypothesis that a long-term effect of vasectomy may be an elevated risk of prostate cancer. More research is needed to confirm or refute this hypothesis.

Comment in

Kliesch S, Roth S, Hertle L. Kliesch S, et al. J Urol. 1996 Nov;156(5):1784-5. doi: 10.1016/s0022-5347(01)65531-9. J Urol. 1996. PMID: 8863615 No abstract available.

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