Testosterone – Function, Deficiency and Treatment
Testosterone is the primary male sex hormone, playing a key role in muscle strength, bone density, sexual function, and overall wellbeing in both men and women.
Things worth knowing about "Testosterone"
Testosterone is the primary male sex hormone, playing a key role in muscle strength, bone density, sexual function, and overall wellbeing in both men and women.
What is Testosterone?
Testosterone is a steroid hormone belonging to the androgen group and is the most important male sex hormone. It is produced primarily in the testes in men, and in smaller amounts in the ovaries of women and the adrenal cortex of both sexes. Testosterone influences a wide range of physical and psychological functions and is essential for the health of both men and women.
Functions of Testosterone
Testosterone performs numerous vital roles in the body:
- Sexual development: Driving the development of male secondary sex characteristics during puberty (e.g., voice deepening, body hair growth, genital development)
- Muscle growth: Stimulating protein synthesis and promoting muscle mass
- Bone density: Maintaining bone strength and helping prevent osteoporosis
- Libido: Regulating sexual desire in both men and women
- Sperm production: Supporting spermatogenesis (the formation of sperm cells)
- Mood and energy: Influencing motivation, concentration, and overall wellbeing
- Red blood cell production: Stimulating erythropoiesis (the production of red blood cells)
Normal Levels and Measurement
Testosterone levels are measured via a simple blood test, ideally taken in the early morning when hormone levels are at their peak. Normal ranges vary by age and sex:
- Adult men: approximately 12–40 nmol/L (350–1150 ng/dL)
- Adult women: approximately 0.3–2.4 nmol/L (10–70 ng/dL)
From around the age of 30, testosterone levels in men naturally decline by approximately 1–2% per year. This gradual process is often referred to as andropause or late-onset hypogonadism.
Testosterone Deficiency (Hypogonadism)
A testosterone level that is too low is called hypogonadism. This condition is classified as:
- Primary hypogonadism: A disorder originating in the testes themselves (e.g., due to Klinefelter syndrome, orchitis, or testicular torsion)
- Secondary hypogonadism: A dysfunction of the brain structures (hypothalamus or pituitary gland) that regulate hormone production
Symptoms of Testosterone Deficiency
- Reduced libido and erectile dysfunction
- Fatigue, lack of drive, and depressive mood
- Loss of muscle mass and increased body fat
- Bone loss (osteoporosis)
- Difficulty concentrating and memory problems
- Reduced body hair and testicular shrinkage
Elevated Testosterone Levels
Excess testosterone (hyperandrogenism) is less common but can also cause health issues. In women, it often presents as acne, increased body hair (hirsutism), menstrual irregularities, and infertility – frequently in the context of polycystic ovary syndrome (PCOS). In men, chronically elevated levels, such as those caused by anabolic steroid use, can lead to heart problems, liver damage, and infertility.
Diagnosis
Diagnosis involves a blood test measuring total testosterone and, where necessary, free testosterone (the biologically active fraction). Additional tests may include LH (luteinizing hormone), FSH (follicle-stimulating hormone), SHBG (sex hormone-binding globulin), and prolactin to help identify the underlying cause of any imbalance.
Treatment
Testosterone Deficiency
When hypogonadism is clinically confirmed, testosterone replacement therapy (TRT) may be prescribed. It is available in several forms:
- Gels (transdermal, applied daily)
- Injections (every 2–12 weeks depending on the preparation)
- Patches
- Implants (subcutaneous pellets)
- Oral tablets or capsules
Treatment should always be medically supervised with regular monitoring. Potential risks include impaired fertility, elevated hematocrit (increased blood thickness), and cardiovascular effects.
Lifestyle Factors to Optimize Testosterone Levels
Even without medication, testosterone levels can be positively influenced by the following measures:
- Regular strength training
- Adequate sleep (7–9 hours per night)
- Stress reduction (lowering cortisol levels)
- A balanced diet rich in zinc, vitamin D, and healthy fats
- Reducing alcohol consumption and maintaining a healthy body weight
References
- Bhasin S. et al. - Testosterone Therapy in Men with Hypogonadism: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism, 2018.
- World Health Organization (WHO) - Hormones and Health: Androgens and Male Reproductive Health. WHO Technical Report, 2021.
- Nieschlag E., Behre H.M. - Andrology: Male Reproductive Health and Dysfunction. Springer, 3rd Edition, 2010.
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