UNDERSTANDING “LOW-T” IN YOUNG MEN

When the testicles do not produce enough of the male hormone testosterone, the condition is called testosterone deficiency or male hypogonadism.  Primary hypogonadism results from a testicular disorder, while secondary hypogonadism involves a malfunction in the hypothalamus or pituitary gland, parts of the brain that trigger testosterone production.

Substances like marijuana or cannabis may contribute to impotence among teenage boys.  Testosterone levels also may go down temporarily after exposure to cannabinoids in marijuana.  Marijuana, however, is not the sole contributor to testosterone deficiency in young men.

Hereditary Conditions
Some congenital conditions can cause low testosterone in younger men.  Klinefelter syndrome, for instance, results from an abnormality of the sex chromosomes.  Males normally have one X and one Y chromosome, but males with Klinefelter syndrome have two or more X chromosomes along with one Y chromosome.  The extra X chromosomes cause abnormal development of the testicles, resulting in low testosterone production.  Kallmann syndrome, in contrast, involves a defect in the hypothalamus, which controls the release of pituitary hormones and can cause low testosterone.  Other hereditary conditions that can result in low testosterone include Prader-Willi syndrome, in which the genitals are underdeveloped, and adult muscular dystrophy.

Toxic exposures such as radiation or chemotherapy may contribute to testicular failure that causes testosterone deficiency.  Endocrine deficiencies such as central hypothyroidism or secondary adrenal insufficiency contribute to testosterone deficiencies in young men.

Symptoms
Many studies have evaluated conditions that occur in young men with testosterone deficiency.  A deficiency is associated with lower strength and protein anabolism in young men. Metabolic processes like muscular growth and recovery require protein anabolism.  Young men with low testosterone levels experienced higher adiposity and lower fat oxidation. Adiposity refers to fat stores in the body and fax oxidation refers to the metabolic process that “burns” fat for energy. Other symptoms of testosterone deficiency in young men include impotence, loss of libido and inability or poor ability to concentrate.

How Do I Get a Proper Diagnosis?
Diagnosing testosterone deficiency in young men involves laboratory testing that evaluates hormone levels and tries to identify any contributing conditions.   A semen analysis and testicular biopsy may indicate testicular disorders.  Pituitary imaging can help identify pituitary abnormalities; studies may reveal genetic abnormalities that contribute to insufficient hormone production.

Available Treatments
Treatment for hypogonadism in young men involves testosterone replacement therapy. Replacement therapy may involve testosterone injections or pellets. Topical treatments may include testosterone patches or topical gel.  Gonadal stimulation therapy such as HCG therapy may benefit young men with testosterone deficiencies who are interested in fertility.