Low Testosterone: What Causes Symptoms in Young Males 20 and Up?
Medically reviewed by Isabel Casimiro, MD, PhD
Low testosterone, also called hypogonadism, naturally begins in a man's 30s. However, younger men can also experience low testosterone, which tends to be related to underlying conditions or injury to the testes.
This article will discuss the causes of low testosterone levels in young males, along with treatment options.
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What’s Considered Young for Low Testosterone Levels?
Testosterone levels naturally decrease as someone ages. It's normal for levels to start decreasing at 30 years old.
When levels decrease earlier than 30 years, which is considered young, and it may be due to a condition called hypogonadism. This condition can affect people at any age, but when it affects young people it is likely related to a congenital (at birth) or acquired condition that interferes with testosterone production in the testes or the signal from the hypothalamic-pituitary-gonadal axis.
Causes of Low Testosterone in Younger Males
The causes of low testosterone in younger males can be broken down into two categories: primary or secondary hypogonadism.
Primary hypogonadism is when there is a problem within the testicles. Secondary hypogonadism is a problem with the signaling in the brain.
Primary Causes of Low Testosterone Levels in Younger Males
Primary hypogonadism is caused by an issue within the testes. It is identified by having decreased or absent testosterone levels and increased gonadotropin levels. Below are the primary causes of low testosterone in younger males.
Congenital
Congenital primary hypogonadism means there is a problem within the testes since birth. Congenital conditions that can cause hypogonadism are:
Undescended testes (cryptorchidism)
Acquired
Acquired primary hypogonadism refers to conditions affecting testicular function that you're not born with but which occurred later in life. Causes, which include medications that may lead to testicular injury, are:
Medications (alkylating agents, ketoconazole, glucocorticoids)
Testicular injury
Chronic conditions, including human immunodeficiency virus (HIV) and kidney failure
Secondary Causes of Low T Levels in Younger Males
Secondary hypogonadism is caused by an issue within the hypothalamus and/or the pituitary gland. It is identified by the decreased or abnormal gonadotropin levels along with low total testosterone levels. Below are the secondary causes of low testosterone in younger males.
Obesity
The increase in people having obesity may be leading to secondary acquired hypogonadism. A 2019 journal article discussed how 73% of men with low testosterone were overweight or obese. It is not exactly known how extra weight and hypogonadism are related, but it is thought that there is a pituitary inhibition that causes decreased testosterone and, as a result, decreased sperm counts.
Type 2 Diabetes
Another cause of secondary acquired hypogonadism is type 2 diabetes. Type 2 diabetes has been on the rise in recent years with approximately 1 in 10 people diagnosed with the condition.
Low testosterone levels are common in those with type 2 diabetes. A 2020 journal article reports that about 33% of men with type 2 diabetes have low testosterone. Researchers have found that type 2 diabetes minimizes pituitary gonadotropin release. This can lead to hypogonadism.
Recreational Drug Use
Chronic recreational drug use (drugs are taken for enjoyment or their psychoactive effects, not for medical reasons) is another cause of secondary acquired hypogonadism. Research has found that people who take drugs like fentanyl and morphine have a high incidence of androgen deficiency.
Anabolic steroids were another type of drug that was found to cause hypogonadism in conjunction with smaller testicular size and decreased sperm count.
Environmental Toxins
Exposure to several environmental toxins has been shown to contribute to hypogonadism. These toxins include:
Tobacco smoke: Tobacco contains carcinogens (cancer-causing substances) and has been found to hinder sperm function.
Pesticides and herbicides: Research has found those with high consumption of pesticide containing fruit and vegetables had lower sperm count than those who did not.
Heavy metals: Mercury and lead have been associated with male infertility.
How to Find Out What’s Causing Low T Levels
To diagnose what's causing low testosterone levels, a healthcare provider would look at a person's medical history. Many times, it is an underlying health condition that has caused the low testosterone.
Testing is done with blood work. The blood test should be taken between 7 a.m. and 11 a.m., or within three hours of waking up. The person should be fasting as well.
According to the Centers for Disease Control and Prevention (CDC), a testosterone level of less than 264 nanograms per deciliter (ng/dL)l in males not experiencing obesity is considered low. If the test is low, there will be additional blood testing to determine if it is primary or secondary hypogonadism.
Effects of Low Testosterone in Younger Males
Testosterone in males works in several different ways. Here is what the hormone helps with:
Making sperm
Keeping muscles and bones strong
Making red blood cells
Managing energy
Hair growth
Libido
Symptoms of Low Testosterone
It can be difficult to diagnose low testosterone in younger males because the symptoms are vague.
Older men may experience erectile dysfunction or decreased libido (sex drive). However, younger men generally do not have these symptoms and experience low energy.
Low Testosterone Treatment in Younger Males
Younger males who find out that they have low testosterone may consider treatment. They may choose to use hormone or non-hormone treatment options.
It is important to note that in people with primary hypogonadism, sperm formation is usually not responsive to hormone therapy. Whereas sperm formation in people with secondary hypogonadism is typically responsive to hormone therapy.
Testosterone Replacement Therapy and Fertility
Testosterone replacement therapy will suppress sperm formation and decrease fertility. The benefits and risks of using testosterone replacement therapy need to be heavily considered before treatment begins.
Hormone Medications
Testosterone replacement therapy is available in several forms like a topical gel, injection, or oral medication. Gels and injections tend to be the most popular routes.
Topical gels should be applied to the arms, shoulders, or abdomen. Injections are given either every week or every other week.
One of the primary risks of hormone replacement therapy is that it imitates the testosterone the body normally produces. As a result, the body then decreases its own production of intratesticular testosterone which impairs sperm production and can result in infertility.
Non-Hormone Options
In cases where someone has low testosterone due to a modifiable underlying condition, one of the first steps would be to treat or manage that condition.
People with low testosterone due to obesity or poorly controlled type 2 diabetes should work with a healthcare provider to manage their condition.
Another way to treat low testosterone without hormones is to improve sleep quality. Research has shown that poor sleep quality has been associated with low testosterone levels.
There are several natural testosterone boosters on the market. Make sure to check with a healthcare provider before beginning a new supplement or medication.
Summary
Testosterone levels tend to decrease when a man reaches 30 years of age. However, low testosterone in younger males is typically due to an underlying health condition or an injury. There are hormone and non-hormone treatment options available that a healthcare provider should oversee.
Read the original article on Verywell Health.
