What happens to testosterone as a man ages?

what happens to testosterone as a man ages?

What Happens to Testosterone as You Age

Along with the bummers of growing older comes this: Testosterone levels start to dip, too. Typically, when men hit their 30s, testosterone declines by 1% to 2% per year, notes Thomas A. Masterson III, M.D., a urologist and an assistant professor of urology at the University of Miami Miller School of Medicine in Florida. In their 60s, about one in five men are diagnosed with hypogonadism, medical-speak for low T—and the rate of occurrence climbs to 50% when men hit their 80s. Still, not all men experience the same drop in testosterone levels. What puts you at higher risk? Let’s take a closer look.

While doctors believe age has a lot to do with the decline, something else might also be going on. “Is this a natural drop off or is this secondary to other medical comorbid conditions?” says Dr. Masterson. “After the third decade of life, you also have an increase in high blood pressure, diabetes and heart disease,” he adds, all of which decrease testosterone production. Obesity is another factor: 40% of obese men (and 50% of obese men with diabetes) have low testosterone levels, studies show.

The pea-sized pituitary gland, located at the base of the brain, is known as the master gland. That’s because it tells other glands, like the testicles, to release hormones. As you age, the signaling isn’t as efficient and the entire system doesn’t work as well as it did when you were younger, says Tracy Gapin, M.D., a urologist and men’s health specialist in Sarasota, FL. Sometimes the testicles aren’t responding to the signal from the pituitary gland (that’s primary hypogonadism). Or the testosterone levels are already low and the pituitary gland isn’t sensing those lower levels—and therefore not stimulating testicles to produce more testosterone (known as secondary hypogonadism).

Normal levels of testosterone are anywhere between 300 and 1,000 nanograms per deciliter (ng/dL), but the lowest your testosterone can go is zero. “That’s not typical,” says Dr. Masterson. “That’s going to be men who are usually on treatments for other conditions.” For example, in men who have advanced prostate cancer, he says, doctors intentionally try to get them to so-called “castrate” levels. Doctors generally define low T as being below 300 ng/dL. Meanwhile, researchers from Johns Hopkins University suggest aiming for ranges from mid-400s to mid-600s, depending on age.

“The common misconception is that testosterone is only about sex and building muscle, but testosterone is critically important when it comes to normal metabolism, normal mood, bone health and cognitive function,” says Dr. Gapin. Throughout the body you have androgen receptors, places on the cell where testosterone can bind to a cell and cause changes — whether it’s building bone and muscle or supporting nerve function, he explains. Low levels of the hormone put you at a higher risk for heart attacks and strokes and type 2 diabetes. And there’s evidence that it leads to poorer overall health and early death.

Some of these symptoms overlap with other conditions (like thyroid problems or poor sleep), but they do affect your quality of life big-time. “These are symptoms like brain fog, difficulty concentrating and poor productivity at work,” says Dr. Gapin. “A guy might complain of low energy and fatigue and he’s falling asleep in the early evening. He has issues with performance in the bedroom at night. And as hard as he tries, he cannot get rid of the body fat.” Other signs include:

To be diagnosed with low testosterone, you must have symptoms and levels below 300 ng/dL from a blood draw taken before 10 a.m. (hormone levels peak in the morning). But “we try to rule out other conditions or other correctable causes,” says Dr. Masterson. Those include low thyroid, depression, small benign tumors of the brain (called prolactinomas), blood disorders and even sleep apnea. “Once we’ve ruled them all out, that’s when we talk about testosterone replacement,” he says.

Even if you eventually go the testosterone replacement route, you can also improve levels by cleaning up some habits. Eating too much processed foods, not getting good-quality z’s and too much stress can torpedo hormone levels. That’s why Dr. Gapin recommends his patients work out and strength train, eat healthier foods, lose weight and find ways to reduce stress, among other T-boosting strategies. It may not get your testosterone to optimal levels if you’re over 65, but it can help, says Dr. Gapin.

There’s no doubt that a testosterone boost will jumpstart your sex life, and that’s a plus. There’s evidence from a few small studies on older men that it will build up lean muscle mass (which you want) plus strengthen your muscles so you can climb stairs more easily. Testosterone therapy can also improve your bone health, especially in the spine and hips, and anemia. The evidence is mixed whether it can improve memory loss and focus, though it does seem to help ease depression if your low moods come from low testosterone levels.

The biggest is infertility because testosterone replacement therapy lowers FSH, a hormone responsible for stimulating sperm production. “About 60% of guys will become what’s called azoospermic, meaning there will be no sperm in their ejaculate,” says Dr. Masterson. That may not bother you if you’re an empty-nester, but if you’re young that can be an issue. “If a young guy is really sure he wants to do testosterone therapy, I typically offer at least a semen analysis and possibly even sperm freezing beforehand,” Dr. Masterson adds. Other side effects include hair loss and acne, notes Dr. Gapin.

Testosterone replacement doesn’t cause prostate cancer, but if you’ve had it, doctors typically don’t recommend testosterone therapy. Testosterone replacement can also over-stimulate red blood cell production, so it’s not advised for men with erythrocytosis (when you have too many red blood cells) or a history of blood clots. And if you have heart disease and are frail and elderly, your risk of strokes or heart attacks may be higher. The bottom line: If you’re older and have serious health conditions, speak to your doctor but don’t be surprised if your provider nixes the testosterone prescription.

Signs of Low T: American Family Physician. (2017.) “Testosterone Therapy: Review of Clinical Applications.” https://www.aafp.org/afp/2017/1001/p441.html

Benefits and Risks for Testosterone Therapy (1): Journal of Clinical Investigations. (2021.) “Testosterone replacement in aging men: an evidence-based patient-centric perspective.” https://www.jci.org/articles/view/146607

Benefits and Risks for Testosterone Therapy (2): Drugs and Aging. (2019.) “Is Testosterone Replacement Therapy in Older Men Effective and Safe?” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8596965/

Diet and Low T: Nutrients. (2018.) “Testosterone-Associated Dietary Pattern Predicts Low Testosterone Levels and Hypogonadism.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6266690/

Obesity and Low T: Current Obesity Reports. (2012.) “The Significance of Low Testosterone Levels in Obese Men.” https://link.springer.com/article/10.1007/s13679-012-0029-4

Optimal Levels of Testosterone: Journal of the Endocrine Society. (2019.) “Nationally Representative Estimates of Serum Testosterone Concentration in Never-Smoking, Lean Men Without Aging-Associated Comorbidities.” https://academic.oup.com/jes/article/3/10/1759/5526748

Notes: This article was originally published March 8, 2022 and most recently updated March 16, 2022 .

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