Health Check: hypogonadism

6 mins
31 Jan 2023
Health Check: hypogonadism

Battling misinformation and bringing you expert advice this is EYKTK about hypogonadism aka low testosterone

image Team Woo

words Ryan Cahill

Trigger warning: eating disorders.

Testosterone is a hormone that is essential for the development of secondary sex characteristics that are perceived as "masculine". Testosterone levels are higher in people assigned male at birth. It’s typically produced in the testes, but also produced in small quantities in the ovaries. It can promote the growth of muscles and bone mass, body hair, and also has a significant impact on mood, behaviour and fertility.

The prevalence of low T does increase with age, but individuals seeking treatment is increasing, which is a sign that there is a greater awareness surrounding the condition.

What is hypogonadism?

Having low testosterone (hypogonadism) occurs when the body isn’t producing testosterone levels which are consistent with what is expected for men or those assigned male at birth. In this instance, you may have to seek alternative methods to ensure that your testosterone levels are not too low or too high, as either of these can cause issues, both short-term and long-term.

According to InterACT, an organisation advocating for intersex youth, hypogonadism can be related to intersex variations and may be linked to Klinefelter Syndrome or Turner Syndrome.

Having low testosterone is not something that you need to change unless it is posing personal problems to you or you dislike the way it feels. Everyone has different ideas of what feels right in their bodies.

Hypogonadism signs and symptoms

There are a variety of signs and symptoms that come with low testosterone, but these are often things you might experience in everyday life and not consider the result of having low testosterone. Some of these include mood changes, lack of energy, fatigue, difficulty sleeping and poor concentration.

The signs that might be a little less expected, at least if you’re below the age of 40, are erectile dysfunction, low sex drive, difficulty exercising and some loss of body hair. Another sign might be being more prone to injury than the average person, for example, from exercise or sports. This could be due to reduced bone density or muscle mass caused by low testosterone.

"The number of individuals seeking treatment for hypogonadism is increasing"

Low testosterone diagnosis

If you think you might have low T, your GP will assess your symptoms before sending you for multiple blood tests. Testosterone levels typically fluctuate throughout the day, and are often at their highest in the morning. Due to this, your GP will likely order you to have your bloods taken at different times during the day so that a proper assessment can be made.

Hypogonadism causes

There are a variety of reasons why an individual might have low testosterone. In some instances, it might be caused by a genetic disease, or a treatment like radiotherapy or chemotherapy. However, the most likely causes are linked to diet and mental health issues, such as anxiety, and depression.

Low T treatments

If you’re found to have low T, medical professionals will likely put you on Testosterone Replacement Therapy (TRT) or Hormone Replacement Therapy (HRT). On the NHS, this treatment is typically prescribed as either an injection or a gel. For the gel, you may want to rub this on your upper arm or thighs.

Some companies offer “testosterone boosters” in tablet form, which are available online. It’s recommended that you check you have low testosterone levels before investing in an over-the-counter treatment. There’s a chance you could end up producing too much testosterone, which can lead to acne, male pattern baldness, increased irritability and infertility.

Battling misinformation and bringing you expert advice

Health Check

What it feels like to have low testosterone

Low testosterone will affect individuals in different ways depending on their hormone levels. But Adam, a 26-year-old based in South Cumbria, first realised that he had low testosterone in his late teens. “I didn’t grow at all or develop between the ages of 12 and 15. I never knew why but I now know that’s due to low T.” He explains. “The actual diagnosis came after I realised that I likely had low T. I went to the GP and they did a blood test to confirm that I had no detectable levels of testosterone.”

Adam was referred to endocrinology (a type of medicine specialising in hormones) who prescribed him with TRT, as well as performing some tests to determine whether his low testosterone was being caused by his eating disorder. After confirming that it was likely linked to his ED, he began treatment. “I started on gel and it gave me quite bad anxiety. I then tried the injections but the fluctuations in testosterone levels were too severe and I was getting really bad depression during the periods when the testosterone levels would dip.” He says that while the treatments may be effective for others, it’s taken years of adequate nutrition for him to start producing testosterone naturally.

When asked whether he feels a sense of relief at having his testosterone levels restored, he’s unsure. “To be honest, the damage has been done. I’m not sexually active so it never affected that. I’m glad that any long term-effects, such as osteoporosis, can now be avoided, but the delay in diagnosis has already done the damage.”

His outlook means he’s keen to advise people to get their testosterone levels checked if they have any of the symptoms. “Go and see your GP as soon as possible. It’s a simple test and the treatment really isn’t bad at all. You can avoid so many long-term effects by getting diagnosed and treated early.”

"You can avoid so many long-term effects by getting diagnosed and treated early.”
Adam, 26

The low testosterone taboo

Adam says that he believes some individuals may not seek help for suspected low t because of the taboo that comes with having it. He feels that some of the topics linked to low T, specifically erections, orgasm, reduced muscle mass, anger and anxiety, are things that some individuals may feel uncomfortable discussing. Health professionals will have experienced many different conditions, and the symptoms that come with low t will be topics that they’ve discussed in detail on numerous occasions.

The term “low t” or “low testosterone” may also be used as a derogatory term. You only have to have a quick browse of Twitter to see that low testosterone is used as a way of describing people as “weak”. It’s important to realise that there’s absolutely no shame in having low t, and even less shame in getting help to address it if you are so inclined.

Further resources

To read more about low testosterone, the NHS website is a great place to find straight-forward information, including useful guides about TRT. The Men’s Health Clinic website is also a great resource for information relating to low testosterone. It also includes questionnaires and FAQ sections that may help you learn more about having low testosterone.

This is not a diagnostic tool - if you are experiencing symptoms of hypogonadism/low testosterone, book an appointment with your GP.

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