American Urology Association (AUA) defines a testosterone level below 200 ng/dL as testosterone deficiency. (1)
About 2% of men suffer from testosterone deficiency. (2) Testosterone level in males drops about 1%-2% each year, normally starting in the early 30s. (3)
Normal testosterone levels
Testosterone levels vary among different demographics. Factors like gender, age, and life stage matter a lot when defining normal testosterone levels.
Males
Normal testosterone level is a controversial topic as there is no consensus on the cut-off value among different sources. The most common range is 280 ng/dL to 320 ng/dL in male adults. (4)
Testosterone level varies from age and lifecycle stage. (5)
a. Children
The average testosterone level between 0 to 5 months in males is 75-400 ng/dL. Between 6 months to 9 years, it ranges between 7 to 20 ng/dL. Between years 10 and 11, the testosterone levels vary from 7-130 ng/dL.
b. Adolescents
At ages 12 and 13 years, the testosterone level is less than 7-800 ng/dL. It increases to 7-1200 ng/dL in the 14th year. A high jump in testosterone level is seen between 15 and 16 years of age as it increases to 100-1200 ng/dL.
c. Adults
As a male enters adulthood, his testosterone level boosts from 300 ng/dL to 1200 ng/dL. It decreases to 240-950 from 19 years onwards
Female
After birth, the female testosterone levels are around 20-80 ng/dL. From 6 months old to 9 years, the level decreases to 7-20 ng/dL. In years 10 and 11 it rises to 7-44 ng/dL. During the early teen years, it goes to 7-75 ng/dL. In the last year of the teenage and first year of adulthood, it is 20-75 ng/dL. After 19 years onwards, testosterone levels are around 8-60 ng/dL.
Testosterone deficiency
Multiple factors contribute to testosterone deficiency:
• Severe obesity
An increase in waist circumference and obesity reduces testosterone levels. (11)
• Cancer of the ovaries or testes
Patients with cancer in their gonads have higher chances of testosterone deficiency (6). This may be due to the failure of the testes to produce sufficient testosterone due to the tumor.
• Failure of the testicles
Failure of the testes is called hypogonadism. In this condition, the testes produce little to no testosterone. This may be due to some disease that causes the testes to not respond to the pituitary hormones. It may even be because of some fault in the pituitary or hypothalamus. (7)
• Early or delayed puberty
Low testosterone can cause a delay in puberty, while an excess of testosterone can result in early puberty. (8)
• Chronic illness - diabetes or kidney disease
Diabetes can cause low testosterone levels. Patients with testosterone deficiency are more likely to suffer from diabetes in old age (9). Patients with renal disease or patients with kidney transplants are more likely to suffer from testosterone deficiency (10).
• Chemotherapy or radiation
Chemotherapy causes low testosterone levels. This is suggested to be caused by damage of the hypothalamus-pituitary-gonadal axis at the testicular level (12).
• Genetic conditions that appear at birth
Genetic conditions at birth, such as Klinefelter syndrome, may lead to low testosterone levels or hypogonadism.
Effects of testosterone deficiency on health
Testosterone deficiency has multiple effects on physical, physiological, and psychological health.
i. Mood
Studies suggest that low testosterone levels cause depressive disorders in some patients (14). Some studies suggest that testosterone treatment for patients with hypogonadism and depression may have an antidepressant effect. (15)
ii. Energy
Reduced energy may be accompanied by low testosterone levels (16). Studies show that in addition to sexual dysfunction, the main reason for men to take prescription testosterone is to address low energy problems. (17)
iii. Hair
Dihydrotestrone (DHT) is an androgen that is derived from testosterone. It helps with the development of sex characteristics during puberty. Too much DHT can cause the hair follicles to shrink, resulting in male pattern baldness (androgenic alopecia). (18)
Deficiency of DHT can result in issues in sex organ development. It can cause gynecomastia and increases the risk of prostate cancer. (19)
iv. Muscles
Testosterone plays an important role in muscle building. As Testosterone levels decline with age, the result is decreased muscle mass and strength. (20)
v. Bones
Testosterone deficiency is the major factor of osteoporosis in elderly men. An Optimal level of androgens is important for maintaining healthy bones. (21)
vi. Skin
According to the Journal of Dermatology, low testosterone makes the skin dry and causes psoriasis. (22)
vii. Emotions
Lower levels of testosterone can cause the testosterone receptive cells in the brain to be dysfunctional. This can cause mood swings, irritability, stress, anxiety and depression (23). Brain Functions
In addition to sexuality, testosterone levels affect brain functions, psychological health and cognitive performance (24). The risk of Alzheimer’s disease is greater in elderly men with low testosterone levels. (25)
Testosterone excess
Tumor growth near glands like the pituitary, adrenal or testes can cause excess testosterone production. Using steroids for athletic performance or to increase muscle mass may have adverse effects due to testosterone excess. Overdose or misuse of T supplements and gels may lead to excess T levels. (26)
Effects of excess testosterone on health
• Excessive sweating and acne without any other obvious reason may indicate excess testosterone levels.
• Changes in blood pressure may be due to spiked T levels. It can result in dizziness, headaches, fatigue, nausea and fainting.
• Changes in sexual desire and performance are major indicators of abnormal testosterone levels.
• High testosterone levels may lead to excess body hair growth and male pattern balding on the head.
• Abnormally high testosterone levels can affect mood. It causes irritability, anxiety or depression.
Ways to improve testosterone levels
• Exercise
People who regularly exercise have higher testosterone levels and they have better fitness. (28) (29)
Weight lifting and high intensity interval training are more effective in the short term and long term. (30)
• Diet
A balanced diet of fat, protein and carbohydrates based on whole foods can optimize hormone levels and overall health. (31)
• Stress control
Stress causes Cortisol hormone increase, causing a decrease in testosterone levels. Stress and high cortisol can increase food consumption resulting in obesity. Obesity reduces testosterone levels in the body.
• Vitamin D
Getting enough vitamin D is crucial for testosterone production. Sunlight exposure is necessary for vitamin D. (32)
• Sleep
People who sleep 4 to 5 hours daily are more likely to be testosterone deficient (33) (34). For every additional hour of sleep, T levels rise by 15%. (35)
• Avoid alcohol and drug use
Alcohol and some drugs reduce testosterone levels. Try to avoid them and consult a doctor before taking any drugs.
• Testosterone Replacement Therapy (TRT)
TRT is used for testosterone deficient patients. With prescription testosterone administration many of the benefits of naturally produced testosterone are regained. (36)
– Health risks of TRT
TRT has health risks involved which should be communicated before treatment. TRT may lead to exacerbation of prostate enlargement, prostate cancer, and male breast cancer. It can increase the number of red blood cells, making the blood thicker. Obstructive sleep apnea may be a result of TRT (37). Considering the risks of TRT it is better to use natural ways to improve T levels.
Conclusion
Testosterone levels not only regulate sexual health but are important for physical and mental wellbeing. A healthy lifestyle and regular medical checkups are necessary for optimal testosterone levels.
References
1. https://www.nature.com/articles/ijir201418
2. https://pubmed.ncbi.nlm.nih.gov/24016385/
3. https://www.ncbi.nlm.nih.gov/books/NBK77260/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6765788/#B13-ijerph-16-03261
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6765788/
6. https://ghr.nlm.nih.gov/condition/androgenetic-alopecia
7. https://www.healthline.com/health/dht#purpose-and-function
8. https://academic.oup.com/jcem/article/95/2/639/2596855
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5036835/
10. http://www.ncbi.nlm.nih.gov/pubmed/25728622
11. https://www.urosurgeryhouston.com/blog/how-low-testosterone-affects-your-mental-health
12. https://www.sciencedirect.com/science/article/pii/S2050052115000086
13. https://link.springer.com/article/10.1007%2Fs12035-015-9315-y
14. https://www.healthline.com/health/signs-of-high-testosterone#causes
15. https://www.healthline.com/health/signs-of-high-testosterone#signs-in-people-with-vulvas
16. https://pubmed.ncbi.nlm.nih.gov/22234399/
17. https://pubmed.ncbi.nlm.nih.gov/15204068
18. https://www.ncbi.nlm.nih.gov/pubmed/1705137
19. https://www.healthline.com/nutrition/8-ways-to-boost-testosterone#2.-Eat-Protein,-Fat-and-Carbs
20. https://www.ncbi.nlm.nih.gov/pubmed/21154195
21. https://www.ncbi.nlm.nih.gov/pubmed/17520786
22. https://www.ncbi.nlm.nih.gov/pubmed/21632481
23. https://pubmed.ncbi.nlm.nih.gov/9349750/
24. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312212/
25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897047/
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