Male Hypogonadism = Low Testosterone
Intro
A study completed in 2020 showed that testosterone levels have been declining over the past 2 decades in adolescent and young males in America. Testosterone is a sex hormone that is primarily made in the testicles in males, and is responsible for fetal development, adolescent changes, libido, sexual function, mental and physical energy, and more. However, medical issues can start to arise when testosterone is low in males, such as low libido, male infertility, and more. Low testosterone in males is called male hypogonadism, and there are different types and different causes for male hypogonadism.
In this week’s blog post, I will be discussing:
Where & how testosterone is made
Symptoms of low testosterone in males
Causes of low testosterone in males
Integrative management options for low testosterone in males
Testosterone production
Where & how testosterone is made in males:
Testosterone is made in the Leydig cells, which are cells found in the testicles. Testosterone is made through a multi-step process in the mitochondria of the Leydig cells that starts off with cholesterol. Cholesterol starts to undergo transformation into testosterone when the Leydig cells get a signal from the brain, called luteinizing hormone (LH).
So, the process of testosterone production is:
LH is released from the brain, which then activates the Leydig cells.
Once activated, the mitochondrial in the Leydig cells transform cholesterol into testosterone.
Purpose of testosterone in males:
Supports healthy bone mass
Supports muscle mass and strength
Regulates sex drive/libido
Plays a role in the production of red blood cells
Regulates sperm production
Development of secondary sexual characteristics (facial and body hair growth, penile enlargement, voice deepening, etc.)
& more
Symptoms of low testosterone
Małe hypogonadism is diagnosed when labs revealed serum testosterone levels lower than 300 ng/dL in combination with 1+ clinical sign or symptoms. Symptoms of low testosterone in males include:
Loss of OR absence of secondary sexual characteristics
Anemia
Muscle mass loss/muscle wasting
Loss of bone mass
Sperm changes
Central fat gain around the abdomen
Sexual dysfunction (erectile dysfunction, low libido, difficulty attaining orgasm, etc.)
Reduced energy & stamina
Depressed mood
Increased irritability
Changes in cholesterol levels
& more
Causes of male hypogonadism
There are two different types of male hypogonadism, and each will have different root causes. The different types of male hypogonadism are:
Primary hypogonadism: This type of hypogonadism in males originates from a problem with the testicles, as the testicles are where testosterone is primarily produced.
Secondary hypogonadism: This type of hypogonadism in males originates from a problem with the hypothalamus or the pituitary gland, which are brain centers that are responsible for activating the testicles to produce testosterone.
Causes of primary hypogonadism:
Genetics
Infections
Hemochromatosis
Injury
Cancer treatment
Aging
Causes of secondary hypogonadism:
Kallmann syndrome
Inflammatory diseases
HIV/AIDS
Medications
Stress
Sleep issues/insomnia
Obesity
Environmental exposures, testosterone, & male fertility:
Scientific literature indicates that there is a connection between environmental exposures and low testosterone. Science has also shown that chemical contaminants can impact healthy cellular function, impair hormone production, and interrupt sperm production through pro-oxidant reactions.
Heavy metals have been connected to low testosterone levels, and exposure to various chemicals have been associated with low testosterone levels. Glyphosate is a chemical used in commercial farming that is used as an herbicide to kill weeds, and there is scientific evidence that shows the connection between glyphosate exposure to low testosterone in animal models. Literature has also shown that pesticide exposure in humans is connected to lower levels of testosterone.
In addition to glyphosate, scientific research has connected plastics to low testosterone. Phthalate is a plasticizer used in many products, and it has been connected to low testosterone and sperm changes in male subjects. Phthalates have also been connected to the development of insulin resistance in young male adults, and we know that there is a connection between insulin resistance and symptoms of low testosterone (as explained in my blog post on Male PCOS). On the bright side, science has shown that when phthalate exposure is reduced, changes to testosterone revert back!
Beyond phthalates, bisphenol-A (BPA) is another plasticizer that has been connected to changes in testosterone. In vitro studies show that when animal Leydig cells were exposed to BPA, it led to lower levels of testosterone, higher potential for Leydig cell death, & lower mitochondrial activity.
Integrative management
Integrative management of male hypogonadism is best completed when providers have a comprehensive set of labs that indicate sex hormone levels and potential root causes of low testosterone. Lab orders are personalized and differ from a case-to-case basis, and having an in-depth intake with a provider will help them understand what labs are best suited for that individual.
When labs indicate low testosterone and shed light on potential root causes, licensed naturopathic doctors (NDs) can recommend various integrative options to help their patients achieve optimal testosterone levels. Some options that a licensed ND may recommend are:
Lifestyle medicine
Reduce environmental exposure(s)
Mitochondrial health
Micronutrients, vitamins, & minerals
Herbal medicine
Hormone replacement
& more
Summary & Takeaways
The medical term for low testosterone in males is male hypogonadism, and is it diagnosed when someone has labs indicating low testosterone WITH 1 or more signs or symptoms of low testosterone.
In this blog post you learned:
Testosterone is made in the testicles. Leydig cells are the specific cells in the testicles responsible for the production of testosterone, and more specifically, the mitochondria in these cells transform cholesterol into testosterone through a multi-step process.
Testosterone in adult males is responsible for sex drive/libido, bone health and muscle mass, healthy sexual function, sperm production, blood health, and more. And, some symptoms of low testosterone include: low libido, low energy, depressed mood, changes in sperm quality, fat gain, muscle mass loss, and more.
There are different root causes of male hypogonadism, such as aging, genetics, medications, testicular injury, stress, and more. And, environmental exposures to heavy metals and chemicals have been connected to low testosterone.
Integrative management of low testosterone depends on severity of symptoms and lab markers, and licensed naturopathic providers could recommend natural options and pharmaceutical options to help patients optimize their testosterone levels
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