Low Testosterone In Your 50s? Your Age May Not Be The Whole Story
If you're in your 50s and feeling more tired, carrying more weight around your middle, or noticing a dip in your sex drive, it's easy to blame aging. But testosterone changes aren't always as simple as getting older.
A recent review of the research looked at what drives low testosterone in older men and found that several factors beyond age can influence levels.
About the review
Testosterone naturally declines with age, but researchers have debated how much of that change comes from aging itself versus health conditions that become more common later in life.
The review examined research on male hypogonadism, meaning consistently low testosterone, as well as obesity, diabetes, metabolic syndrome, chronic illness, and testosterone treatment.
Metabolic health may play a bigger role than age
The review found that low testosterone in older men is often functional hypogonadism, meaning another health issue is affecting testosterone rather than aging alone.
Body fat around the waist appears to be particularly important. In one study included in the review, 44% of men with a waist circumference of at least 110 centimeters (about 43 inches) had biochemically low testosterone.
The relationship can also run both ways. Low testosterone can make it harder to maintain muscle and easier to gain fat, while excess body fat can further suppress testosterone.
Age still plays a role for some men. The review notes that those over 65 to 70 may experience a more lasting decline as the testes become less efficient at producing testosterone.
How to know if testosterone is actually low
Fatigue and low mood can occur with low testosterone, but they're not specific enough to tell you much on their own.
Sexual symptoms, including lower libido, fewer spontaneous erections, and erectile dysfunction, are more closely associated with low testosterone.
Testing matters, too. One low reading isn't enough to confirm a problem because testosterone levels fluctuate throughout the day. Guidelines generally recommend a fasting morning blood test between 7 and 11 a.m., followed by a second test to confirm the result.
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What to do if your levels are low
If your tests show consistently low testosterone, here's what the review suggests discussing with a clinician:
- Look for the underlying cause: Medications, chronic health conditions, excess weight, and metabolic problems can all affect testosterone.
- Address metabolic health: In the studies reviewed, losing 5 to 10% of body weight was linked to a small rise in testosterone that was enough to matter for some men. Bariatric surgery was linked to much larger increases, and a better chance of reversing low testosterone tied to obesity.
- Confirm before treating: Testosterone therapy is generally considered for men who have persistent symptoms and repeatedly confirmed low levels.
- Know the trade-offs: Testosterone therapy appears to help most consistently with sexual symptoms. In a large trial, it wasn't linked to a higher overall risk of heart attack or stroke, but atrial fibrillation, an irregular heart rhythm, was slightly more common in men taking testosterone than in those taking a placebo, as were blood clots in the lungs.
The takeaway
Low testosterone can be a clue, not just a number to chase. Before reaching for hormone therapy, make sure you know what's driving the change.
