The truth about male testosterone

1 What is testosterone?

Testosterone is a sex hormone that plays a role in many important functions of the body. It’s produced in the testes in men, and in the ovaries and adrenal glands in women. It’s a steroid hormone that the body manufactures from cholesterol. While it’s produced in both men and women, men have around ten times more circulating testosterone than women.

2 What role does it play?

Testosterone has both anabolic effects (increasing the growth of muscle and bone) and androgenic effects (often linked to male characteristics such as a deep voice, hair growth, and sexual function). It impacts a range of key processes in the body, including metabolism, mental health, fertility, and cardiovascular health.

3 What happens to men’s testosterone as they age?

Almost all men will experience a gradual decline in testosterone as they age, although in some men, this decline can be more pronounced, leading to a deficiency. This has become more common in recent years due to higher rates of conditions such as obesity and diabetes, which negatively impact testosterone levels. In most men, the decline is relatively slow, unlike the more abrupt change in hormone levels seen in women during menopause. In rarer cases, some endocrine disorders can cause abnormally high or low levels.

4 What are the signs of low testosterone?

There are many symptoms, and men may present in different ways. The most obvious signs include a decrease in libido, erectile dysfunction, and loss of morning erections. Other symptoms include fatigue, mood changes, loss of muscle mass/fitness, increased body fat, and brain fog/poor work performance. If you search for the ‘ADAM questionnaire’ online, you can get a sense of whether you might be affected by answering ten simple questions.

5 How do doctors determine testosterone levels?

Testosterone levels can be checked with a blood test, typically taken first thing in the morning, as levels are at their peak at this time. Testosterone levels vary widely between men, so we must consider your levels alongside any symptoms. In addition to total testosterone levels, a doctor would usually measure how much “free” testosterone you have, as well as other hormone markers.

6 What treatment options are available?

As with many conditions, low testosterone can often be effectively managed through lifestyle changes. Losing fat, increasing muscle mass, eating a minimally processed diet rich in healthy fats, quitting smoking, managing stress, and getting enough sleep can lead to significant improvements. In some men, lifestyle changes alone may not be sufficient, and testosterone replacement therapy (TRT) may be considered. TRT involves administering testosterone in the form of topical gels, pills, or injections. However, TRT can lower sperm count, so for men who still wish to have children, alternative medications may be available to increase testosterone levels through other pathways.

Final thoughts

There’s no “one-size-fits-all” approach to managing testosterone levels. Men experience symptoms in different ways and at varying levels of testosterone. If you have concerns, it’s strongly recommended that you consult an experienced doctor and take an individualised approach, as what may have worked for a friend or colleague may not work for you. As with many health conditions, optimising your lifestyle in terms of diet, exercise, stress management, sleep, and avoiding harmful substances will go a long way in maintaining healthy testosterone levels.

Dr Neil Forrest is a well-established British Family Physician based at Osler’s Star Visa clinic (near Holland Road).
T: 6339 2727
osler-health.com