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Low Testosterone

Age can contribute to testosterone decline, but is usually not the only cause – and not the most common.  

The first step is to find out if you even have low testosterone

Understanding low testosterone

Testosterone is produced primarily by the testicles and its production is triggered by glands in the brain. If either the testicles or the brain aren’t doing their jobs as well as they should, too-low levels of testosterone can cause a number of physical changes:

  • Increase in body fat and decrease in muscle mass
  • Mild anemia
  • Loss of sex drive
  • Lower energy
  • Lack of concentration
  • Erectile dysfunction and infertility
  • Loss of bone density (osteoporosis)
  • Decrease in body hair
  • Changes in cholesterol and lipid levels

In healthy men, age can contribute to the decline of testosterone production, but it may not be the only cause. Production peaks in men during adolescence and early adulthood, and begins to gradually decline at about 1 percent a year after age 30.

More often, low testosterone is also caused by other health issues, such as cardiovascular or thyroid problems, or excessive weight or alcohol use.

There are many factors that can cause low testosterone.

What can cause low testosterone?

Low testosterone can be caused by:

  • Injury or infection
  • Cardiovascular problems
  • Chronic illness
  • Conditions affecting how much testosterone the glands in the brain (the thyroid and pituitary) tell the body to produce
  • Inflammation of the testicles
  • Alcoholism
  • Cirrhosis of the liver
  • Ongoing stress
  • Obesity

Making lifestyle changes on your own – or with the help of your doctor – can improve your testosterone levels or slow their decline.

Tips to improve low testosterone

  • Get more exercise
  • Decrease the amount of alcohol you consume, especially beer, or eliminate alcohol entirely
  • Decrease your consumption of meat and poultry (certain hormones in these foods can interfere with testosterone production)

Lower your stress level by practicing yoga or meditation, or using biofeedback therapy, a technique that trains you to control certain physiological processes by giving you immediate feedback.

Testosterone replacement therapy can improve the symptoms caused by low testosterone

What to expect

Your treatment plan will depend on the outcome of simple blood tests indicating low testosterone levels.  Additional tests to determine if the cause is due to an underlying health problem might be recommended based on your medical history and symptoms. Treatment will also depend on whether continued fertility is important to you since sperm production can decrease over time with certain common therapies.


If you and your doctor make the decision that you can benefit from increased levels of testosterone, treatment might include hormone replacement. This is called testosterone replacement therapy, or TRT. TRT can restore your sexual function, increase your energy level, improve muscle strength, and prevent bone loss. Testosterone replacement therapy can come in different forms – injections, gels, transdermal patches and tablets that dissolve under your lip. Each can be effective – and each has advantages and disadvantages:

Injections: Testosterone injections are generally safe and effective and only need to be given every one to two weeks. However, with this therapy, your testosterone levels may vary widely, e.g., too high after an injection and too low just before the next.

Gels: Testosterone gels are considered by many men to be the easiest way to receive therapy. You rub the gel into the skin of your lower abdomen, upper arm or shoulder at about the same time every day. As the gel dries, your body absorbs testosterone through your skin. Disadvantages can include irritation to areas where your skin is sensitive, like around the eyes, and the risk that the medication can rub off on your partner.

Transdermal patches: A patch containing testosterone is applied to the back, abdomen, upper arm or thigh each night and left in place for 24 hours. To lessen skin irritation, it is recommended that you continually rotate where you place the patch.

Tablets: This therapy delivers testosterone to your bloodstream in tablet form. You place the tablet under your upper lip against your gum and replace it every 12 hours. It quickly sticks to your gumline. When exposed to saliva, it softens into a gel and becomes absorbed. One advantage is that you can eat and drink normally. Disadvantages can include irritation to the gums, toothache, and a bitter taste.

Implants: Testopel is an implanted form of testosterone that will provide you with the appropriate levels for 3-4 months.

Need a Referral?

It helps to have a urologist from John Muir Health who knows your health history and can help you get the treatment that’s right for you more quickly.

For more information about our urology services, please call (925) 937-7740.