5 Frequently Asked Questions About Testosterone

The endocrine system of the human body produces and distributes many types of hormones. These hormones regulate metabolism, fertility and sex drive, growth and development, heart rate, blood pressure, sleep, and even the production of other hormones. Since hormones regulate metabolism, hormone imbalances can trigger weight gain or weight loss. Thus, correcting hormone imbalances can aid in a personalized weight loss program.

One hormone that is often misunderstood is testosterone. Here are answers to five frequently asked questions about testosterone:

What is Testosterone?

Testosterone is a hormone produced by the testes in males, the ovaries in females, and the adrenal glands of both genders. In men, testosterone is regulated by two hormones. The gonadotrophin-releasing hormone is produced by the hypothalamus. In response, the pituitary gland produces the luteinising hormone which — along with a follicle-stimulating hormone — stimulates the production of testosterone. The regulatory process is a “negative feedback” process, as an increase in the gonadotrophin-releasing hormone causes the production of testosterone to fall and an increase in testosterone causes the production of the gonadotrophin-releasing hormone to fall.

In men, a portion of testosterone is converted into dihydrotestosterone. Endocrinologists believe dihydrotestosterone is at least partly responsible for triggering puberty since levels of dihydrotestosterone are low until puberty begins. Dihydrotestosterone is responsible for many of the “male” features that emerge during puberty.

In women, the majority of testosterone is converted into estradiol which, along with estrone and oestriol, makes up the three naturally occurring estrogens. Estradiol is the most potent of the three and is essential to female reproduction.

What Does Testosterone Do?

In men, testosterone signals the body to grow facial and body hair, develop “male” facial features, and produce sperm. In women, the ovaries convert testosterone into estrogen that plays an essential role in ovulation and implantation. In both men and women, testosterone signals the body to build and maintain muscle mass, bone density, and blood cells.

What are the Symptoms of High Levels of Testosterone?

Children with high levels of testosterone may experience a false growth spurt and early onset of puberty. Men with high levels of testosterone are rare and difficult to diagnose. However, men with high levels of synthetic testosterone due to the use of anabolic steroids can experience hair loss, acne, aggression, infertility, and decreased sex drive. Women with high levels of testosterone may experience acne, growth of facial hair and body hair, increased muscle mass, and a deepened voice.

What are the Symptoms of Low Levels of Testosterone?

Hormone levels naturally decrease around age 50. For example, most women begin to feel the effects of menopause at about the age of 51. Similarly, testosterone levels naturally and gradually decrease in men at this age. In addition to age, other risk factors for low testosterone include:

  • Genetic disease
  • Stress
  • Obesity
  • Injury, infection, or cancer of the testes
  • Certain medications, such as hormones and corticosteroids
  • Chemotherapy or radiation treatment
  • Alcoholism

The natural decline in testosterone with age is not necessarily a cause for concern. However, testosterone levels that are too low may be diagnosed as hypogonadism. Men with hypogonadism can experience:

  • Irregular sleep
  • Decreased sex drive
  • Infertility
  • Hair loss
  • Fatigue
  • Muscle loss or weakness
  • Depression
  • Weight gain

Low levels of testosterone have also been linked to osteoporosis. Endocrinologists diagnose hypogonadism by testing levels of testosterone and determining the seriousness of any symptoms.

How is Low Testosterone Treated?

Endocrinologists are careful in diagnosing hypogonadism, partly because of the natural decrease in testosterone in men over 50 and partly because of the risks associated with hormone replacement therapy. Typically, testosterone levels are tested at least two times on different days because testosterone levels can fluctuate.

After an endocrinologist diagnoses hypogonadism, they may prescribe hormone replacement. For young men who have been diagnosed with hypogonadism relating to fertility, the endocrinologist may give them injections of gonadotrophin. Gonadotrophin is the hormone produced by the hypothalamus to trigger testosterone production. Over time, gonadotrophin can increase testosterone levels and raise sperm count.

In other cases, doctors may implant testosterone pellets. These pellets slowly release testosterone into the body. These pellets are replaced about every three to four months.

The risks associated with hormone replacement therapy include breast growth and an increase in red blood cells. The most serious risk, particularly in older patients, is that testosterone replacement may cause an enlarged prostate.

In sum, testosterone is more than just a punchline. Testosterone is an essential hormone for health in both men and women.

Philip Rabito, MD

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