Inadequate sleep can result in fatigue and symptoms that resemble low testosterone levels. Dr. Jamin Brahmbhatt, a urologist and robotic surgeon at Orlando Health and an assistant professor at the University of Central Florida’s College of Medicine, addresses the issue. If you’re feeling abnormally tired, downcast, and disinterested in sex, you might be concerned about having low testosterone. However, these symptoms can also be experienced after a night out, a stressful work week, or simply a poor night’s sleep.
Dr. Brahmbhatt often begins the investigation by using the Androgen Deficiency in the Aging Male (ADAM) questionnaire with his patients. This survey aims to assess symptoms related to decreased libido, energy, strength, endurance, height, enjoyment of life, mood changes, and more. Answering affirmatively to certain questions may indicate low testosterone, according to the questionnaire. Nonetheless, these questions are just the starting point and do not provide definitive answers.
As a specialist in men’s health, Dr. Brahmbhatt frequently encounters patients who believe they have low testosterone based on symptoms alone, only to discover that their testosterone levels are within the normal range. Even he, as an expert, has rushed to have his testosterone checked, only to realize that his symptoms were actually due to poor sleep patterns rather than a hormone imbalance.
It’s important to note that diagnosing low testosterone can be complex, with a total testosterone level below 300 ng/dL serving as the cutoff for diagnosing testosterone deficiency, according to the American Urological Association guidelines. However, different labs may have varying definitions of normal testosterone ranges, leading to confusion. For instance, Quest Diagnostics and LabCorp provide different normal ranges, which means a testosterone level that is considered low by one lab may be deemed normal by another. Therefore, urologists typically rely on the AUA guidelines while considering each patient’s unique situation.
For the most accurate assessment of your testosterone levels, it is recommended to test them twice on separate mornings, ideally between 7 a.m. and 10 a.m. This timeframe is crucial because it aligns with the peak period of fluctuating testosterone levels in your body. The first peak occurs in the morning, followed by a second peak (though not as high) in the afternoon, with levels gradually decreasing towards the end of the day. Lab companies establish their reference ranges based on tests conducted during these specific morning hours.
When diagnosing testosterone deficiency, it is essential to consider both lab results and the presentation of symptoms such as low energy, reduced libido, muscle loss, or mood changes. Treatment typically aims to raise testosterone levels to around 450 to 600 ng/dL, known as the “middle tertile” in reference ranges. This range often provides relief from symptoms without risking adverse effects, but finding the appropriate dosage can take time.
Individual testosterone sensitivity, influenced by genetic factors like receptor sensitivity, can vary among men. This variation explains why two men with the same testosterone level may experience different symptoms. While there isn’t currently a test for testosterone sensitivity, ongoing research aims to personalize testosterone therapy in the future.
In some cases, symptoms resembling low testosterone may be attributed to lifestyle factors or other medical conditions rather than testosterone levels alone. Addressing these underlying issues is crucial, as not all symptoms can be solely attributed to low testosterone.
While testosterone replacement therapy has become more accepted due to newer research findings dispelling previous concerns, it may not be suitable for everyone. Additionally, other medical conditions mimicking low testosterone symptoms should be considered in the diagnostic process.
Chronic sleep deprivation, often caused by conditions like obstructive sleep apnea, can lead to fatigue, mood disturbances, and low libido, mirroring symptoms of low testosterone. Proper sleep is vital for hormone regulation and overall health. Treatment with CPAP machines can help manage sleep apnea and potentially improve testosterone levels.
Improving sleep quality, boosting testosterone levels, and alleviating symptoms have all been shown to make a significant impact. When I began using an activity tracker around the clock, it quickly pinpointed my sleep issues. Making simple changes like cutting out late-afternoon caffeine and swapping evening screen time for reading before bed made a noticeable difference in my sleep quality, energy levels, and overall mood – all without the need for hormone therapy. These small adjustments led to big improvements.
Factors like stress, lifestyle choices, and hormone levels are closely interconnected. Prolonged stress can give the impression of low testosterone levels. High cortisol levels, the body’s main stress hormone, can temporarily hinder testosterone production, leading to symptoms resembling testosterone deficiency, such as decreased libido and fatigue.
Diet and exercise are also key players in hormone balance. Research indicates a significant drop in testosterone levels among men in recent decades, which experts attribute to increasing rates of obesity, chronic stress, and sedentary habits. Many individuals have reported marked enhancements in energy, mood, and libido simply by shedding excess weight, adopting a healthier diet, and staying physically active.
Various medical conditions can mimic the symptoms of low testosterone. Conditions like low thyroid function or deficiencies in vitamins like D or B12 can cause fatigue, mood swings, and reduced libido. Diabetes or heart disease are common culprits of fatigue and sexual issues. Addressing these underlying medical conditions, rather than resorting to hormonal treatments, has led to substantial improvements in many patients initially believed to have low testosterone levels.
When it comes to erectile dysfunction, it’s essential to distinguish between the physical and psychological aspects. While some men may experience genuine erectile issues due to low testosterone, many mistakenly attribute their sexual concerns to hormone imbalances. In cases where testosterone truly is the issue, replacement therapy might offer relief, although focusing on treating ED directly with medications like tadalafil or sildenafil has proven to be a more effective approach for many men, restoring sexual confidence and performance.
There has been a concerning rise in testosterone testing and treatment among men, with a notable increase in prescriptions in recent years. However, the guidelines from the American Urological Association in 2024 highlight some worrisome trends. It’s revealed that a significant portion of men prescribed testosterone therapy haven’t undergone proper testing beforehand, and many do not have their hormone levels monitored regularly during treatment. Furthermore, a considerable number of men receiving testosterone therapy do not meet the clinical criteria for testosterone deficiency. As a result, many individuals who could benefit from hormone replacement therapy remain untreated due to unwarranted concerns about risks like prostate cancer or cardiovascular issues, which may not be as substantiated based on current evidence and research.
The article in the New England Journal of Medicine discusses how men who avoid regular health screenings or feel uncomfortable discussing their symptoms may miss out on necessary treatment and relief. Taking control of your health can feel like a dilemma – should men begin testosterone therapy to encourage better health habits, or should lifestyle and health issues be addressed first? These complexities emphasize the importance of having personalized discussions with your healthcare provider.
In my practice, I prioritize addressing lifestyle factors first. By focusing on aspects like quality of sleep, stress levels, physical activity, and personal relationships, many of my patients experience significant improvements without resorting to testosterone therapy. Stay informed about living well with the CNN Life, But Better newsletter, offering information and tools to enhance your well-being.
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