Is Low Testosterone Causing Your Symptoms? by (Chris Iliades, MD)

Men sometimes tease each other about not having enough testosterone, but low hormone levels are no joke. Testosterone is the most important sex hormone in men — too little of it can cause a variety of symptoms.

"Distinguishing symptoms of low testosterone from symptoms of some chronic illnesses can be difficult. Feeling tired, loss of interest in sex, difficulty maintaining an erection, lack of energy, and mood changes all may be signs of many different issues. That is why it is important to see your physician," explains David Fenig, MD, associate director of male fertility and sexuality at Chesapeake Urology Associates in Baltimore, Md.


Normal Aging or Another Problem?
Research suggests that one in four men over 30 have low testosterone. Some of this is a result of natural aging, but much of it may be due to other causes as well. "Signs of testosterone deficiency such as anemia, osteoporosis, and changes in body composition are also associated with aging. Often low testosterone is overlooked as a cause of these signs or symptoms when patients present with other medical conditions," notes Dr. Fenig.

• Aging. "Normal decreases in testosterone levels are seen in the aging male and may or may not be associated with symptoms," says Fenig. It’s normal for men to have less interest in sex as they get older and to have fewer spontaneous erections, but it is not normal for older men to have no interest in sex. "Low testosterone is considered a level of less than 300 nanograms per deciliter (ng/dL); however, levels vary with age. Testosterone treatment may not be safe for some older men, such as men with active prostate cancer," says Fenig. If you are an older man with symptoms of low testosterone due to aging, ask your doctor about the risks and benefits  of testosterone treatment.
• Depression. Low testosterone and depression share many of the same symptoms. Both low testosterone and depression can cause decreased sex drive, sadness, difficulty concentrating, fatigue, lack of energy, and loss of interest in normal activities. Low testosterone can be a cause of depression in some men.
• Thyroid disease. Thyroid disease is more common in women than men, but men with thyroid disease may have many symptoms that are similar to low testosterone, including difficulty maintaining an erection, fatigue, irritability, and muscle weakness.
• Type 2 diabetes. Type 2 diabetes and low testosterone commonly occur together in men over the age of 45. It is not clear if one causes the other, but symptoms can often overlap. If you have type 2 diabetes, you should be aware of the increased risk for low testosterone, especially if you have symptoms of decreased sex drive.
• Damage to the testicles. "Testicular tortion, trauma, infections of the testicles, and treatment of testicular cancer can be causes of low testosterone," says Fenig.
• Drugs. Some studies have shown that long-term use of marijuana can cause decreased interest in sex and may lower testosterone levels. "Chronic opiate use frequently causes low testosterone. Withdrawal of anabolic steroids will result in low testosterone, which may be irreversible," adds Fenig.

Getting an Accurate Diagnosis
If you’re concerned about low testosterone, you need to see your doctor. Your doctor can do a blood test to measure your testosterone level. If it’s low, your doctor will do other tests to find out why. If your testosterone level is normal, your doctor will look for other causes of your symptoms.

Finding the cause of your particular symptoms, whether it’s low testosterone or something else, can be difficult. To help you get an accurate diagnosis, you may want to get a second opinion from a specialist who treats low testosterone, such as an endocrinologist or urologist.