High and Low Testosterone Levels in Men
Charles Patrick Davis, MD, PhD
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Steven Doerr, MD
Steven Doerr, MD
Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.
Testosterone is considered to be the "male hormone" that's produced by men in the testes. Although women's ovaries produce some testosterone, the hormone is produced in much higher concentrations in men and it is responsible for many of the secondary sex characteristics seen in men such as a deeper voice and hair on the chest, in addition to contributing to a healthy libido, building muscle mass, and maintaining energy levels. In general, the normal range in males is about 270 to 1070 ng/dL with an average level of 679 ng/dL. A normal male testosterone level peaks at about age 20, and then it slowly declines. Testosterone levels above or below the normal range are considered by many to be out of balance. Moreover, some researchers suggest that the healthiest men have testosterone levels between 400 - 600 ng/dL.
Men who have testosterone levels that are higher than average may experience both benefits and drawbacks. The benefits, which are modest, include normalizing blood pressure and lowering the likelihood of obesity and heart attacks. However, there is a tendency for such men to consume more alcoholic beverages, and they are more likely to smoke, and more likely to get injured. According to some researchers, the higher the testosterone level, the more likely men are to participate in risk-taking behavior (sexual, injury risk, and even criminal activity). The problems associated with high testosterone levels are infrequent and rare in middle-aged and elderly men who are not receiving testosterone treatments. When the testosterone level becomes out of balance, it usually becomes too low rather than too elevated.
The most common "out of balance" testosterone levels are found to be on the low side of normal; this occurs because a male's highest testosterone level usually peaks at about age 20, and then it decreases slowly with age. It has been suggested that a 1% decrease in testosterone levels per year is not unusual for middle-aged (30 to 50 years old) and older males. While this decrease may not be noticeable in some men, others may experience significant changes starting in their middle-aged years or more commonly at age 60 and above. This drop in testosterone levels is sometimes termed hypogonadism, "male menopause" or andropause. Low testosterone levels may result in a decline in physical energy, strength, stamina, and diminished mental aggressiveness. Moreover, men may experience more aches and pains in the bones and joints and they may also have a decline in libido and erections. There is treatment available, however, for this imbalance of low testosterone levels. Doctors may use injections, patches, or topical creams or gels that contain testosterone. However, not all men may be candidates for this type of treatment. Testosterone should not be used in men with suspected or known prostate cancer or breast cancer. In addition, the testosterone may put a male that has kidney, liver, or heart problems at higher risk for complications of these diseases. Before testosterone therapy is initiated, it is very important to check with your doctor to determine what treatment, if any, is right for you.
So, how does one ensure that testosterone levels remain in balance? Some physicians suggest that monitoring testosterone levels every five years, starting at age 35, is a reasonable strategy to follow. If the testosterone level falls too low or if the individual has the signs and symptoms of low testosterone levels described above, testosterone therapy can be considered. However, once testosterone therapy is initiated, testosterone levels should be closely monitored to make sure that the testosterone level does not become too high, as this may cause stress on the male, and it may result in some of the negative problems seen in men with high testosterone levels. Finding the appropriate balance of testosterone is possible through discussions with your doctor, and it requires your willingness to have testosterone levels checked before the initiation of therapy and then routinely in the future.
Last Editorial Review: 4/14/2014