As men age, the natural level of male hormones (androgens), such as testosterone, starts to fall, and this can have negative physical and psychological effects. When your get-up-and-go has gone, and your sex drive isn’t what it used to be, a hormone imbalance such as low testosterone or high estrogen could be to blame. At Hayle Aldren, MD, MD(H), in Phoenix, Dr. Aldren has extensive experience in hormone replacement therapy and treatment of low testosterone, and offers a variety of treatment options to restore your health and sex life. To learn more, call Dr. Aldren to schedule your consultation today.


Testosterone and Hormones Q & A

  • What are the symptoms of low testosterone?
  • What causes low testosterone?
  • What are the ill effects of unbalanced or low hormones?
  • What is hormone replacement therapy?
  • Why consider hormone replacement therapy?
  • How does hormone replacement therapy work?

What are the symptoms of low testosterone?

Low testosterone levels can cause a host of symptoms affecting both your sexual health and overall health. Testosterone deficiency has been found to be a cause of scarring in the penis, which can contribute to erectile dysfunction (but testosterone alone will not reverse it). If you have ED, Dr. Aldren may recommend adding Shock Wave-Sound Wave Therapy or PRP to hormone treatment to improve penis function.

Low testosterone levels can cause a host of symptoms affecting both your sexual health and overall health. Testosterone deficiency has been found to be a cause of scarring in the penis, which can contribute to erectile dysfunction (but testosterone alone will not reverse it). If you have ED, Dr. Aldren may recommend adding PRP to hormone treatment to improve penis function.

Some of the most common symptoms of low testosterone include:

  • Changes in sexual performance and endurance
  • Decreased sex drive and low sexual desire
  • Low energy
  • Mood swings
  • Increased fat, low muscle mass and loss of strength
  • Joint aches and muscle pains
  • Slower healing of injuries
  • Loss of bone density (osteoporosis)
  • Poor sleep
  • Infertility
  • Low self-confidence and lack of motivation

The age-related decline in testosterone is called andropause, or male menopause. But you don’t have to necessarily be older to experience low testosterone levels, as even young adults (and some teens) can experience the untimely ill effects of low testosterone.

Although a gradual drop-off in testosterone production and availability is normal as men get older, some men age prematurely. Men lose testosterone at different rates, and the testosterone level at which a man will show symptoms varies greatly among individuals. Much like menopause in women, some men tolerate the change to andropause very well with few symptoms, while other men show much more severe and longer-lasting symptoms at an earlier age.

What causes low testosterone?

When testosterone levels fall below certain arbitrary levels on laboratory tests, it is called hypogonadism. In addition to the aging process, there are many other reasons why you might develop a testosterone deficiency. When the cause is something that directly damages the hormone-producing cells in the testicles (where most testosterone is made), it is referred to as primary hypogonadism. If the cause is somewhere else and only suppresses testicular function indirectly, it is called secondary hypogonadism. Aging is usually a combination of these two.

Primary hypogonadism

This type of testosterone deficiency is due to testicular damage of some kind. It could be from an undescended testicle or due to physical injury, radiation damage, or microwave exposure. It might be the result of a viral infection such as mumps. A ball of varicose veins inside the scrotum called a varicocele is another cause. Liver problems can cause atrophy and death of testicular cells. Cancer chemotherapy drugs can destroy the ability to produce testosterone, as can a hard-to-diagnose medical condition like hemochromatosis (a type of hereditary iron toxicity).

Some causes of testosterone deficiency may act at both the primary and secondary level. This includes various vitamin and mineral deficiencies, as well as a wide range of toxic pollutants known as environmental estrogens (xenoestrogens), also called hormone-disrupting or gender-bending chemicals.

Secondary hypogonadism

Secondary testosterone deficiency usually occurs when something interferes with the parts of your brain responsible for coordination and control of hormone production in the testes. Narcotic painkillers from the opiate (opioid) family are a very common cause, and so are performance-enhancing anabolic steroid drugs. Head injuries, brain surgery, and brain infections like meningitis can all be responsible. Other things which affect these brain areas include obesity, sleep disturbances, pituitary disorders, and certain medications.

Testosterone deficiency rarely occurs by itself, but typically presents in combination with other hormonal abnormalities, nutritional problems, and imbalances in body chemistry.

What are the ill effects of unbalanced or low hormones?

There are 2 main systems in the body that coordinate between different organs and keep bodily functions running smoothly. One is the nervous system, and the other is the hormonal (endocrine) system. When hormones get out of balance for any reason, either too high or too low, the resulting disorder can affect every part of life, not just sex. Since the symptoms of a hormone imbalance can occur from other medical conditions, it’s important to receive a proper diagnosis before starting testosterone treatment, particularly as you grow older.

Hormones are a large family that includes more than just sex hormones, but all hormones can affect sex. Contrary to popular belief, not all male sexual or hormonal problems can be blamed on low testosterone. Because hormones also act on each other, all hormones should be taken into account when diagnosing and treating hormonal problems in men, not just testosterone. This includes the estrogens, which start creeping up as men age.

Sometimes treatment with hormones like testosterone can cause the hormonal system to become more unbalanced if the testosterone is allowed to be transformed by the body into too much estrogen. Hormone treatment that is not personalized, or is not regularly monitored with  the right kind of laboratory tests, can actually worsen sexual problems and cause other medical complications.

As an example, men in poor health who have pre-existing heart disease are at higher risk of further heart problems during the first 90 days if put on inappropriately high doses of testosterone without first treating their underlying medical condition and looking at overall hormone balance.

However, it is also well known that testosterone is essential for heart health in men, and that low testosterone is a risk factor for men to get heart disease. Replacement of testosterone to normal levels is beneficial to heart health for most men, and this is a reversal of the outdated and disproven opinion that it was always bad.

What is hormone replacement therapy?

There are different medical philosophies for hormone replacement therapy (HRT), which is designed to restore your hormone levels to a previous state or toward normal. The integrative medical approach to HRT favored by Dr. Aldren emphasizes using bio-identical hormones, which are identical copies of your body’s own natural hormones. Dr. Aldren will recommend accurate types of lab tests to diagnose unbalanced, excessive, or low hormones, and develop a personalized treatment plan for your optimum hormonal health and well-being.

Sometimes hormones can be balanced without actually providing any hormones, using nutritional supplements or herbal tonics. The body can often be stimulated to make more of its own testosterone. This is necessary when the patient competes in a sport where all hormones are banned and testing is required. In some cases, if hypogonadism is severe, a waiver can be sought to allow the athlete to return to competition and take his hormones.

Why consider hormone replacement therapy?

You might need treatment if hormone levels drop to the point where you experience disruptive side effects. This could either be due to a medical condition like hypogonadism or because you are dissatisfied with the effects that natural age-related hormone loss is having on your bodily functions and happiness. Different men react to hormonal changes differently, so even if your testosterone levels are not out of the ordinary, you might still benefit from a comprehensive hormonal evaluation with a men’s health expert to diagnose and treat any hormone imbalances.

Testosterone does not work in a vacuum, and it may be possible to increase the effects of the testosterone you have without necessarily prescribing more. By optimizing the activity of existing testosterone, it could also be possible to use a lower dose of testosterone for hormone replacement. This could reduce some of the possible (but treatable) side effects of too much testosterone, such as acne, hair loss, thickened blood (high red cell count), testicular shrinkage, lower fertility, and potential aggravation of certain prostate issues.

Some of the benefits of testosterone optimization or testosterone replacement include:

  • More energy
  • Improved mood
  • Better stress management
  • Improved sleep
  • More mental alertness
  • Better sex
  • Decreased pain perception and less need for pain pills

How does hormone replacement therapy work?

If you’re experiencing numerous symptoms related to low testosterone or a related hormone imbalance, Dr. Aldren may recommend individualized hormone testing to see if hormone replacement therapy might be the best course of action. Testing options include blood tests, urine tests, or saliva tests. Dr. Aldren can help pick out the right tests for your particular needs.

Having the right lab tests done at the right time is absolutely critical for success. Many common hormone panels use outmoded or less accurate methods of testing. The results of tests like that can be useless or downright misleading and could take you down the wrong path into a worse condition while wasting months or years of your life.

If Dr. Aldren recommends hormone therapy, you have several options for receiving treatment, including injections, transdermals (patches, creams, or gels applied to the skin), nasal sprays and ointments, or pellet implants inserted under the skin. Although testosterone is never given by mouth, oral medications or supplements may be used to control the way your body uses testosterone.

Other hormones, such as hCG or oxytocin, may have a place in some treatment programs. Peptides and hormone precursors may sometimes be used in certain situations.

No matter the type of treatment you receive, you’ll need regular checkups and lab tests with Dr. Aldren to ensure you’re not experiencing any possible side effects and that the therapy is producing the intended results.