Menopause and low testosterone

What is low T?

While lower testosterone levels are a natural part of aging for people with testes, low testosterone (low T) is a medical condition in which testosterone levels drop to a point that negatively affects a person’s health and/or quality of life.

Just as menopause symptoms can be disruptive in the workplace, low T symptoms can also impact productivity. Ensuring that employees of all ages feel supported, informed, and empowered in their health is critical in creating a positive, inclusive work environment. But unlike menopause, awareness around low T symptoms is less common. Providing access to accurate information about low T and a straightforward way to access quality care can help more people find the right treatment options for them.

What is low T?

Testosterone is a hormone responsible for many important functions, including bone and muscle development, emotional regulation, red blood cell production, sex drive, and sperm production. In people with testes, testosterone levels increase dramatically during puberty but gradually decrease in mid-adulthood as a part of the aging process. Testosterone levels decline on average about 1% a year after age 30.

Most have testosterone levels within the normal range. However, by age 70, 30% of males will meet the definition of low T, and by age 80, this increases to 50%. Young people can also experience low T, with one study finding that 20% of those between the ages of 15-39 had a testosterone deficiency.

Low T can be categorized a few ways:

  • Primary low T is a problem with the testes that prevents them from responding to the hormones released from the brain to trigger testosterone production.
  • Secondary low T involves problems in the regions of the brain (pituitary gland and hypothalamus) that produce the hormones that trigger testosterone production.
  • In some cases, low T is caused by a combination of problems in both the testes and the brain.

Low T may also be caused by:

  • Chronic conditions (e.g., diabetes, cardiovascular disease, obesity)
  • Physical damage to the testes
  • Use of certain medications, such as some antidepressants or high blood pressure medications
  • Injury or disease of the hypothalamus or pituitary gland — regions of the brain that drive testosterone production in the testes

Symptoms of low T can impact people differently across their lifespan. Fatigue, low energy, insomnia, depressed mood, and irritability may interfere with daily life and work performance. In addition, fertility issues are also common with low T. Those trying to grow their family through intercourse may experience challenges such as reduced sex drive, decreased sperm production, and/or difficulty maintaining an erection.

When to speak to a provider

Diagnosing low T can be challenging because many symptoms can also be caused by other health conditions. It’s important to speak with a healthcare provider with significant experience and training in treating low T and related conditions. Whether you consult with a primary care physician or later a reproductive urologist, disclose any family-forming goals and share what symptoms are impacting your daily life — whether that’s day-to-day activities, work performance, or mental health. In order to diagnose low T, a provider will take a health history, do blood tests, and conduct a physical exam.

Health history

A provider will discuss signs and symptoms as well as ask questions related to the use of medications and supplements, injury or infection to the testes, history of chemotherapy, and more. Being open and honest about any type of testosterone replacement or boosters — prescribed or over-the-counter — is critical in diagnosing and treating low T.

Blood tests

A simple blood test can measure testosterone levels. Because testosterone levels peak in the early morning and decrease throughout the day, two blood draws will be done early in the morning on different days.

Physical examination

Your provider will also complete a physical examination which includes inspection of bodily hair patterns, examination of scrotum and testes, measuring body mass index and waist circumference, and checking for enlarged breasts.

After testing, your provider may diagnose low T and determine whether it’s considered primary low T, secondary low T, or a combination of both.

How is low T treated?

Treating low T has both potential benefits and risks and can be managed with a combination of lifestyle changes and medical treatments. A provider may recommend maintaining a healthy weight, getting enough sleep, reducing stress, maintaining a balanced diet, increasing physical activity, and avoiding heavy alcohol consumption.

Testosterone replacement therapy has also become an increasingly popular option to treat low T. Before starting testosterone replacement therapy, a provider will conduct screenings and exams to determine if this treatment option is safe and appropriate. Testosterone replacement therapy is available in different formulations ranging from injections, skin patches or implants, nasal gels, or pills. Continuous follow-up including regular blood work is a routine component of safe testosterone replacement therapy.

While not advised by medical experts, another treatment option gaining attention and popularity is the use of testosterone boosters or supplements. With celebrity endorsements, over-the-counter testosterone supplements have become widely available and can be found in some sports clinics or vitamin stores with the promise of more energy and bigger muscles.

While taking exogenous testosterone — testosterone not made in the body — may manage symptoms, it can negatively impact fertility. Exogenous testosterone can actually lower hormone levels involved in sperm production, including naturally produced testosterone. This can then drive down sperm production and may result in either no sperm or greatly decreased sperm count. With guidance from organizations like the European Association of Urology and the American Urological Association, it’s recommended that people interested in growing their family through intercourse consider other types of treatment.

Misinformation about testosterone boosters and supplements

In the U.S., supplements are not regulated by the Food and Drug Administration (FDA) and can vary widely in quality and ingredients. While supplements may improve symptoms of low T, there’s little data to confirm the effectiveness of over-the-counter supplements. It’s important to be aware of the misinformation surrounding over-the-counter testosterone supplements and talk with a provider before starting any testosterone treatment.

Why should low T matter to employers?

Employers have a unique opportunity to provide resources that help ease some of the challenges associated with hormonal aging and empower employees to continue enjoying their careers. Providing access to the right specialists can also help prevent employees from pursuing non-regulated treatments associated with challenging side effects.

How can Carrot help?

Carrot is filling in gaps in access to high-quality care and support for low T by building community, providing clinical education, and improving access to care.

  • Building community: Carrot brings members together through intimate, virtual, expert-led group sessions on low T and managing symptoms. Led by medical experts, these groups foster a sense of community by normalizing discussions about this taboo topic while providing trustworthy, high-quality information.
  • Personalized clinical education: Members have unlimited access to 1:1 chats with medical experts who can answer their questions and provide educational resources. They also can explore interactive guides and clinically-reviewed content — allowing them to learn at their own pace.
  • Access to care: Through Carrot’s vetted network of providers, Carrot helps connect members to expert providers specializing in low T, so members can receive the right care.

‍If you’re an HR leader ready to support your employees through hormonal aging, get in touch with us to learn more about how Carrot can help.

Continued reading

Menopause in the workplace 2023: A report from Carrot Fertility

Redefining hormonal therapy

Does low testosterone impact fertility?

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