Testosterone

What it is

Testosterone is the main sex hormone in males, although it's also present in smaller amounts in females. It's primarily produced in the testicles in men and in the ovaries in women, with a small amount also made by the adrenal glands in both sexes. Think of it as a key player in many aspects of male health and development.

In men, testosterone is crucial for the development of male reproductive tissues, such as the testes and prostate, as well as promoting secondary sexual characteristics like increased muscle and bone mass, and the growth of body hair. It also plays a significant role in mood, energy levels, and sex drive.

The amount of testosterone in your body naturally fluctuates throughout the day, typically being highest in the morning. Levels also tend to decline gradually with age, usually starting from around age 30 or 40.

Why it matters

Testosterone levels are important for a wide range of bodily functions in men. Adequate levels are associated with:

• Muscle mass and strength: Testosterone helps build and maintain muscle.
• Bone density: It plays a role in keeping bones strong and healthy.
• Sex drive (libido): It's a key factor in sexual desire.
• Erectile function: While not the sole factor, it contributes to achieving and maintaining erections.
• Energy levels and mood: Many men report feeling more energetic and having a better mood when their testosterone levels are within the normal range.
• Red blood cell production: Testosterone can stimulate the bone marrow to produce red blood cells.

A blood test can measure the level of testosterone in your body. For adult males in the UK, a typical reference range for total testosterone is usually between 8.64 and 29 nmol/l. It's important to remember that these ranges can vary slightly between laboratories, and your GP will interpret your results in the context of your individual health and symptoms.

What can cause it to be high or low

Low Testosterone (Hypogonadism):

Several factors can lead to lower-than-average testosterone levels. These can be broadly categorised:

• Primary hypogonadism: This occurs when the testicles themselves aren't producing enough testosterone. Causes can include genetic conditions (like Klinefelter syndrome), undescended testicles, mumps infection affecting the testicles, or direct injury to the testicles.
• Secondary hypogonadism: This happens when the brain (specifically the pituitary gland or hypothalamus) doesn't send the right signals to the testicles to produce testosterone. This can be due to certain medications, obesity, chronic illnesses, significant stress, sleep apnoea, or tumours in the pituitary gland.
• Ageing: As mentioned, testosterone levels naturally decrease with age.
• Obesity: Being significantly overweight is strongly linked to lower testosterone levels.
• Chronic illnesses: Conditions like kidney disease, liver disease, or type 2 diabetes can affect testosterone production.
• Certain medications: Some drugs, including opioids and certain steroids, can lower testosterone.

High Testosterone:

It's much less common for men to have significantly high testosterone levels. When this does occur, it can sometimes be related to:

• Testicular tumours: Very rarely, tumours in the testicles can overproduce testosterone.
• Adrenal gland tumours: Similarly, tumours in the adrenal glands can sometimes lead to excess hormone production.
• Anabolic steroid abuse: The misuse of synthetic testosterone or related substances can lead to very high levels.

Lifestyle factors that may help

For men experiencing mildly low testosterone or wanting to support healthy levels, certain lifestyle adjustments may be beneficial. These are areas you might consider discussing with your GP:

• Maintaining a healthy weight: Losing excess weight, particularly abdominal fat, can have a positive impact on testosterone levels.
• Regular exercise: Engaging in regular physical activity, especially strength training and high-intensity interval training (HIIT), is often associated with better testosterone levels.
• Balanced diet: Ensuring your diet is rich in essential nutrients, including healthy fats, proteins, and micronutrients like zinc and vitamin D, is important for overall hormonal health.
• Adequate sleep: Getting enough quality sleep is crucial for hormone regulation. Aiming for 7-9 hours per night can be beneficial.
• Stress management: Chronic stress can negatively affect hormone levels. Finding effective ways to manage stress, such as mindfulness or relaxation techniques, may help.
• Limiting alcohol intake: Excessive alcohol consumption can impact testosterone production.

Questions to discuss with your GP

If you have concerns about your testosterone levels or are experiencing symptoms that might be related, it's always best to have a conversation with your GP. Here are some questions you might consider asking:

• What do my testosterone test results mean for my overall health?
• Are my testosterone levels considered low, and if so, what are the potential causes?
• What are the next steps for investigating my symptoms or test results?
• Are there any lifestyle changes you would recommend for me to consider?
• Could my current medications be affecting my testosterone levels?
• What are the potential benefits and risks of any further investigations or treatments?