Testosterone deficiency in old age, often mistakenly referred to as andropause, represents a significant change in a man's life. Characterized by a gradual decline in testosterone production, usually beginning in the mid-thirties, this condition can have far-reaching effects on physical health, emotional well-being, and sexual function ( Morales et al., 2000 ). It is a form of male hypogonadism, known as late-onset hypogonadism. This article addresses this important topic to raise awareness and understanding of age-related testosterone deficiency and to help men proactively manage their hormonal health.
Testosterone deficiency in old age brings with it a host of challenges, including reduced energy, mood swings, decreased muscle mass, and declining libido. These symptoms can significantly impact daily life and quality of life. While the gradual decline in testosterone production is a natural part of the aging process, it is important for men to recognize the associated changes and take steps to maintain their health and vitality.
Hormone replacement therapy, particularly testosterone replacement therapy (TRT), plays a crucial role in the treatment strategy for symptoms of age-related testosterone deficiency ( Hijazi & Cunningham, 2005 ), and Adon Health focuses on this form of therapy with corresponding expertise. The goal is to improve and maintain the quality of life and health of men in this phase of life through targeted testosterone supplementation. In this article, based on current research and expert opinions, we aim to provide men with the necessary knowledge to proactively manage their hormonal health and meet the challenges of aging.
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What is testosterone deficiency in old age?
The decline in testosterone production with age represents a significant change in a man's life, typically beginning between the ages of 35 and 55 ( Matsumoto, 2002 ). During this period, men experience a marked decline of approximately 1-2% per year ( Stanworth & Jones, 2008 ). Overt testosterone deficiency is far more common than often recognized. Studies indicate that between 10% and 40% of all men suffer from a deficiency ( Mulligan et al., 2008 ).
Testosterone is a hormone essential for a wide range of bodily functions. This decline in testosterone levels is an aging process, similar to menopause in women. However, this hormonal change differs in men in that the decline in testosterone occurs gradually and over a longer period.
Symptoms of testosterone deficiency
A testosterone deficiency can lead to a range of changes, both physical, sexual, and psychological, including:
Sexual symptoms:
- Reduced libido: One of the most noticeable signs or symptoms of testosterone deficiency is a decreased interest in sexual activity ( Hintikka et al., 2009 ).
- Erectile problems: Testosterone stimulates receptors to produce nitric oxide, a molecule that helps trigger an erection. A deficiency can therefore lead to difficulties in achieving or maintaining an erection ( Wang et al., 2000 ) .
- Reduced sperm production: Testosterone plays a key role in sperm production. A deficiency can lead to a reduced sperm count and potentially to infertility ( Loma Linda University , 2017 ).
Physical symptoms:
- Loss of muscle mass: Testosterone helps build and maintain muscle mass. A deficiency can therefore lead to the breakdown of muscle tissue ( Bhasin et al., 1997 ).
- Increased body fat: An imbalance between testosterone and estrogen can lead to an increase in body fat in men, particularly in the abdominal area ( Wittert et al., 2003 ) .
- Changes in bones: Long-term testosterone deficiency can reduce bone density, increasing the risk of osteoporosis and bone fractures ( Fink et al., 2006 ).
Psychological symptoms:
- Fatigue and lack of energy: Men suffering from testosterone deficiency often report general fatigue and a lack of energy ( Wang et al., 2000 ).
- Mood swings: Testosterone influences mood. Low levels can lead to irritability, anxiety, and depression ( Hintikka et al., 2009 ) .
- Concentration problems: Men with low testosterone may have difficulty concentrating and thinking clearly ( Smith et al., 2018 ).
Testosterone deficiency in old age: Identifying causes and the right age
Age-related testosterone decline is a gradual process without a clear onset, resulting in significant individual variation in the age at which symptoms appear. While some men notice signs as early as their mid-thirties, others may not experience symptoms until their late fifties or even later ( Matsumoto, 2002 ). The onset of symptoms is often subtle and can easily be mistaken for general signs of aging. Comorbidities such as diabetes or cardiovascular disease can accelerate this condition and intensify symptoms ( Putta et al., 2017 ).
Lifestyle also has a significant impact on the onset and progression of testosterone deficiency. A healthy diet, regular physical activity, and effective stress management can support hormonal balance and stabilize testosterone levels. Sufficient sleep is equally important, as sleep deprivation can negatively affect testosterone levels ( Agrawal et al., 2022 ).
There are scientific studies indicating that the decline in hormone levels with age is not necessarily a natural process, but rather due to an increase in so-called comorbidities ( Huhtaniemi, 2014 ). This research suggests that factors such as being overweight ( Kelly & Jones, 2015 ), cardiovascular disease, and diabetes can influence testosterone levels. For example, a study published in the Journal of Clinical Endocrinology & Metabolism shows that being overweight and obese are significantly associated with lower testosterone levels ( Laughlin et al., 2008 ). Such findings contribute to a more nuanced understanding of age-related testosterone deficiency and emphasize the importance of preventative healthcare measures. For detailed information on the link between the common disease type 2 diabetes and testosterone deficiency, you can read our article: " Why Diabetics Should Absolutely Keep an Eye on Their Testosterone Levels ."
Diagnosis of testosterone deficiency
Diagnosing testosterone deficiency, also known as hypogonadism in men, requires a careful evaluation of both clinical symptoms and hormone levels. Here are the key steps to diagnosis:
- Medical history and symptom assessment: The first step is a detailed medical history, in which the doctor asks about specific symptoms. These include reduced libido, loss of energy, mood swings, sleep problems, decrease in muscle mass and bone strength, and changes in sexual function ( Hintikka et al., 2009 ).
- Clinical-visual examination: A thorough examination can provide further indications of testosterone deficiency, such as reduced body hair, changes in fat distribution or reduced muscle mass ( Bhasin et al., 1997 ).
- Blood tests: To confirm the suspected diagnosis, blood tests are performed to measure testosterone levels. This usually includes measuring total testosterone, often supplemented by determining free testosterone. Since testosterone levels can fluctuate throughout the day and vary from day to day, two independent measurements are usually taken in the morning ( Brambilla et al., 2009 ).
- Exclusion of other conditions: Since symptoms of testosterone deficiency can also occur in other diseases, it is important to rule out other possible causes. These can include conditions such as hypothyroidism, depression, or other hormonal disorders.
- Health assessment: The doctor will also assess other health factors that can affect testosterone levels, including medication use, lifestyle factors, and the presence of comorbidities. A comprehensive assessment that considers both physical and mental aspects is crucial for an accurate diagnosis and the development of an effective treatment plan.
At Adon Health, we place great importance on thorough diagnostics that go beyond simply measuring testosterone levels. Our collaborating physicians consider both clinical symptoms and laboratory test results to gain a holistic understanding of each patient's health. This approach allows for precise diagnoses and the development of individually tailored treatment plans to effectively support men on their path to better health.
What helps with testosterone deficiency?
A holistic approach is crucial for effectively alleviating the symptoms of a deficiency. At Adon Health, we emphasize that every treatment should be individualized. Open communication with your doctor about symptoms, medical treatment options, and lifestyle changes is essential to receiving the best possible support.
Medical treatment options
One of the main treatment options for age-related hypogonadism is medication, specifically testosterone replacement therapy (TRT) ( Hijazi & Cunningham, 2005 ). At Adon Health, our goal is to offer safe, effective, and personalized TRT that meets each man's specific needs and health goals. Here are some key aspects highlighted at Adon Health:
- Goal of TRT: The main goal of testosterone replacement therapy is to normalize testosterone levels in the body. This can help alleviate typical symptoms of deficiency, such as loss of energy, mood swings, decreased libido, and muscle weakness ( Haider et al., 2024 ).
- Individual assessment: Before starting TRT, we at Adon Health conduct a comprehensive medical examination. This includes hormone analyses and an assessment of your overall health, including ruling out contraindications, to ensure that testosterone replacement therapy (TRT) is the appropriate treatment option.
- Different forms of TRT: Testosterone can be administered in various ways, including injections, skin patches, gels, or tablets. The choice of administration method depends on several factors, including patient preference, lifestyle, and individual health risks ( Sizar et al., 2023 ).
- Monitoring and adjustment: Regular monitoring is necessary during TRT to control testosterone levels and minimize side effects. This allows the dosage to be adjusted as needed and ensures the therapy is effective.
- Side effects and risks: Like any medical treatment, TRT can cause side effects such as acne, mood swings, and worsening of sleep apnea. The physicians collaborating with Adon Health openly discuss these risks with patients and implement preventative measures to minimize them .
- Long-term care: TRT is often a long-term approach. Therefore, we emphasize the importance of continuous care and regular check-ups to ensure the effectiveness and safety of the treatment and to support the patient's long-term health.
Lifestyle changes: how you can actively participate
Lifestyle adjustments are crucial for effectively managing testosterone deficiency and improving overall well-being. Therefore, it's especially important that, alongside testosterone replacement therapy, you also reflect on and adjust your daily lifestyle habits to naturally support your testosterone levels. These holistic approaches are an integral part of the treatment plan at Adon Health, helping men actively address these challenges and improve their quality of life.
- A balanced diet: A diet rich in vitamins, minerals, and essential nutrients supports hormonal balance ( Allen & Key, 2000 ). Omega-3 fatty acids, zinc ( Netter et al., 1981 ), and vitamin D are particularly important. These nutrients are found in foods such as fish, nuts, seeds, and leafy green vegetables. They help stabilize testosterone levels and promote overall well-being.
- Regular exercise: Physical activity, especially strength training and endurance exercises, not only increases testosterone levels but also strengthens muscle mass, improves heart health, and promotes mental stability. Regular exercise is therefore a key element in combating the symptoms of testosterone deficiency ( Riachy et al., 2020 ).
- Stress management: Chronic stress has a negative impact on hormone balance ( Xiong et al., 2021 ). Stress reduction through techniques such as meditation, yoga, or regular relaxation breaks is therefore essential. These practices help lower cortisol levels and contribute to a balanced hormone level ( Gothe et al., 2016 ).
- Psychological support: The emotional and mental aspects are equally important. Counseling sessions, either in individual therapy or in self-help groups, can be supportive and help men to come to terms with their experiences and develop strategies for dealing with emotional challenges.
- Healthy sleep: High-quality and regular sleep is fundamental for hormonal balance ( Agrawal et al., 2022 ). Good sleep hygiene, including a quiet sleep environment and a consistent sleep schedule, is essential. Avoiding screen time before bed and establishing a relaxing evening routine can also be helpful .
- Avoiding harmful substances: The consumption of alcohol and nicotine can worsen the symptoms of testosterone deficiency. Moderate consumption, or better yet, complete abstinence, can bring significant health benefits and contribute to symptom improvement ( Smith et al., 2023 ).
For more information on how healthy habits can help you maximize your therapy results and naturally boost your testosterone, read our article: “ Top 8 Ways to Boost Testosterone Naturally: Maximizing Therapy Results Through Healthy Habits .”
Our conclusion, your knowledge
While a decline in testosterone levels may present challenges, it's a natural and manageable part of aging. With sound knowledge and appropriate support, you can proactively and positively navigate this phase of life. It's important to remember that you're not alone in this process. A variety of support services are available, from medical care and lifestyle management to psychological counseling. At Adon Health, we're committed to equipping you with the tools you need to understand and manage your hormonal health. Our goal is to strike a balance between modern treatment methods and a healthy lifestyle to help you maintain and enhance your vitality and quality of life.
