Hey guys, are you feeling sluggish, having trouble building muscle through your workouts or experiencing a slowdown in the bedroom? You could have low testosterone, or low T. Low T is a condition in which the male reproductive glands, the testes, don’t produce enough of the hormone testosterone.

When you think of testosterone, what comes to mind? Macho men? Aggressive, impatient, type A behavior? Road rage? Violence?

Testosterone is necessary for male development and sexual function. It’s also responsible for building muscle and bone mass in men as well as for sperm production and sex drive. In addition, testosterone has an effect on male fat distribution, bone density and red blood cell production.

In healthy men, testosterone levels peak during their early to mid-thirties, then they slowly decline as a normal part of the aging process. A man’s testosterone level typically declines by about one percent a year as he gets older.

Marginally lower testosterone levels are normal as men get older, but there are certain factors that can cause you to have a more significant underproduction or lack of production of testosterone. The causes low testosterone include:

• Injury or infection of the testes
• Chemotherapy for cancer
• Medications such as opioids, hormones to treat prostate cancer and steroids such as prednisone
• Acute or chronic illness
• Alcohol abuse
• Obesity or extreme weight loss
• Uncontrolled type two diabetes
• Severe hypothyroidism
• Previous anabolic steroid use

Among the most troublesome symptoms of low T are decreased sex drive and erectile dysfunction (ED). ED is the inability to achieve or maintain an erection suitable for sexual activity. There are other symptoms of low T that you may notice and some that are going on inside your body that you don’t notice. Symptoms of low T include:

• Decreased sense of wellbeing
• Depressed mood
• Difficulty concentrating and remembering
• Fatigue
• Moodiness and irritability
• Loss of muscle strength
• Decrease in body hair
• Breast development
• Changes in sleep patterns
• Decrease in hemoglobin in the blood
• Thinning of the bones
• Increased body fat
• Infertility

Your doctor can diagnose low T by taking a blood test to measure the amount of testosterone in your blood and correlating that with your symptoms. It may take several measurements of your testosterone level because levels change throughout the day. They tend to be highest in the morning, so your doctor will likely order the blood test to be performed at that time.

The treatment for low T is testosterone replacement therapy, or TRT. There are several methods for delivering the testosterone including intramuscular injections, transdermal patches, gels and pellet therapy.

TRT is typically effective at increasing bone density, providing greater muscle strength and physical performance, and improving mood and sense of wellbeing, sexual function and mental sharpness.

But TRT can result in some side effects as well. These include acne or oily skin, swelling of the ankles caused by mild fluid retention, urinary symptoms caused by stimulation of the prostate, breast enlargement or tenderness, worsening of sleep apnea, overproduction of red blood cells, decrease in testicle size and skin irritation.

In January, the American College of Physicians (ACP) released new clinical guidelines for providing TRT to adult males with age-related low T. The evidence-based recommendations, which were published online on January 6 in Annals of Internal Medicine, highlight data from a systematic review of evidence on the safety and efficacy of TRT in that population.

The ACP recommendations suggest that clinicians should initiate TRT in adult males with age-related low T to help them improve their sexual function. The ACP also recommends that clinicians should avoid prescribing testosterone for any other concern, including depressive symptoms, low energy and decreased vitality.

In addition, the ACP recommends that clinicians reassess men’s symptoms within 12 months of initiating testosterone treatment, with regular re-evaluations during subsequent follow-up appointments. They should discontinue TRT if sexual function fails to improve.

For the most part, the ACP’s recommendations mirror the guidelines proposed by the Endocrine Society and the American Urological Society.

In any case, you should discuss the risks and benefits of TRT with your physician before beginning treatment. And it’s critically important that you be honest with your provider about your symptoms. Don’t be embarrassed. There’s help for you, but you have to open up to your provider. Do it today!