Men and Low Testosterone

As the years go by, men’s bodies go through certain changes — some of them visible, and some of which can only be felt. When a man passes 40 years of age, one of these changes is likely to be a gradual reduction in testosterone production. Most men are loath to talk about it, and they may not even know what’s happening to them. But they may complain of having lower strength, gaining weight, and “not feeling like myself.”

While the interaction between diabetes and testosterone is a topic that could use more studying, existing research makes clear that men with diabetes are more likely to have low testosterone — and men with low testosterone are more likely to have diabetes. This article examines the factors that may lead to low testosterone, and outlines some steps you might be able to take to help reverse this process.

Fast arrival, slow exit

Testosterone is the hormone that turns boys into men. It gives you facial hair, puts muscle on your frame, and changes the pitch of your voice. It speeds up the muscle recovery process and creates a sense of strength — it’s probably part of the reason why some men in their 20s feel like they can get away with anything. It’s critical to male sexual behavior and reproduction, with additional beneficial effects on bone density and emotional well-being.
Unlike women, men do not experience a sudden drop in hormones as part of the aging process. Testosterone declines gradually, generally starting after age 40. According to a study published in the European Journal of Endocrinology, once this process starts, the typical rate of decline is between 0.5% and 2% per year. This gradual decrease in testosterone can leave men with less energy and a lower libido.

Certain lifestyle habits and physical conditions can speed up the decline in testosterone — and one condition that is linked to low testosterone is diabetes. A third of American men over age 65 have Type 2 diabetes, and roughly the same proportion has low testosterone — with a significant overlap between the two groups. A review article published in the Journal of Endocrinology reports that half of older, obese men with diabetes have low testosterone levels. At this point, the scientific community can’t say whether diabetes or low testosterone is more likely to cause the other — it’s a classic chicken-or-egg question. Either way, the connection is too strong to ignore.

Though the debate about cause and effect continues, some researchers think low testosterone is a strong predictor of insulin resistance, a hallmark of Type 2 diabetes. If that’s true, reduced testosterone may gradually increase the risk of diabetes. But other than age, what factors are associated with lower testosterone production? Knowing the answer to this question can support lifestyle choices that might help raise your testosterone levels and, at the same time, make it easier to manage your diabetes.

One quick note: You might think that simply taking a testosterone replacement can reverse the effects of low testosterone. If so, you would be right. Testosterone replacement has been shown to improve insulin sensitivity, among other effects of low testosterone. But as with any hormone replacement therapy, there’s always a risk of side effects — the jury is still out on whether testosterone replacement therapy is safe and effective. And replacement doesn’t address the underlying reasons why testosterone is low in the first place. The rest of this article examines some common causes of low testosterone.

Lack of sleep

In our busy lives, a good night’s sleep is sometimes thought of as a luxury. However, lack of sleep deprives your body of something it needs, so it should be no surprise that a chronic sleep deficit can wreak havoc on your health. Lack of sleep can also disrupt glucose metabolism — in fact, it may be a better predictor of diabetes than obesity is, according to a study published in the journal The Lancet. Getting more sleep could be a simple solution for people with low testosterone and diabetes.

How are sleep and testosterone related? A large testosterone release happens during the last stage of the sleep cycle, a deep sleep during which the body repairs and rebuilds tissues, including bone and muscle, and the immune system. If your sleep is disrupted, and especially if you suffer from sleep apnea (a disorder in which breathing is disrupted during sleep), you won’t get enough restful sleep — and studies show a direct link between lack of restful sleep and low testosterone. In one study, when participants’ sleep time was reduced from 8 to 5 hours per night, their daytime levels of testosterone dropped by 10% to 15%. This result was seen in men in their 20s after only one week of sleep reduction — just imagine the effect that decades of sleep deprivation might have.

If you suspect that you have sleep apnea, contact your health-care provider or a sleep study clinic. Symptoms of sleep apnea can include loud snoring, abrupt waking while experiencing shortness of breath, bouts of not breathing during sleep that another person witnesses, difficulty sleeping at night, and daytime sleepiness.

Don’t stress about it

Ongoing stress may be another cause of reduced testosterone. Men entering their 40s tend to have more responsibilities than earlier in their life, which tends to increase their overall stress level. Studies have shown that if men are constantly under a lot of stress, their bodies will produce cortisol (often called “the stress hormone”) at the expense of testosterone.

Cortisol works to raise blood glucose, suppress the immune system, and aid in metabolizing fat, protein, and carbohydrate. A certain level of cortisol is necessary for the body to function properly. When the body overproduces cortisol, though, testosterone production slows down. That’s partly because both hormones are built from the same raw chemical material — but in an interesting twist of nature, cortisol production gets priority. So high stress means high cortisol production, which doesn’t leave much room for testosterone production.

When discussing stress, it’s important to mention the role nutrition plays. Eating overly processed, additive-filled foods adds to the body’s stress load, and malnutrition or undernutrition leaves the body without the building blocks it needs to function. The end result is a body that is not ready to face the demands of daily life. So even if you can’t get rid of the pressures you face in your life, you may be able to reduce the impact of stress on your body by following a balanced, nutritious diet.

Waist management

In recent years, a scientific truth has become apparent: Body weight is a worse predictor of long-term health than waist circumference is. The weight that many men carry around their middles is problematic. The scientific community used to think that abdominal fat was just stored energy, but it turns out to be more than just that. Fat tissue is very active and secretes numerous substances, and fat stored in the midsection acts as a pro-inflammatory agent. This seems to have a negative effect on testosterone production.

The inflammation caused by abdominal fat can also damage your blood vessels, leading to a host of cardiovascular problems, including erectile dysfunction. Combined with weakened sexual desire from low testosterone, this can have an adverse effect on men’s sex lives.

It may also be true, however, that reduced testosterone production leads to bigger waistlines. In this case, raising testosterone levels by getting enough sleep and limiting stress may allow you to shed a few inches, which can have enormous cardiovascular and blood-glucose-lowering benefits.
The good news is that a small change in your waistline can have a significant effect — losing only five pounds of extra fat will have measurably positive results. Ideally, waist circumference (right above your hip bones) should be no more than 50% to 55% of height. If a man has a little extra around the middle, it’s not the end of the world — just make sure to maintain a good fitness level and try not to let your waistline grow.

Low physical activity

The body is built for movement, and low testosterone has been linked to low physical activity. You don’t have to exercise like a pro athlete to get the benefits of activity. Regular moderate cardiovascular exercise, such as brisk walking or light jogging, is a great way to improve blood glucose control while also controlling your waistline. These two benefits — blood glucose control and weight control — directly affect testosterone production.

As we age, muscle tissue tends to waste away. Along with experiencing with a decline in testosterone, men with Type 2 diabetes tend to lose muscle at a faster rate than other men. Maintaining muscle mass is important to long-term health and mobility, and muscle tissue plays an important role in blood glucose control. Exercise tends to increase or maintain muscle mass.

Cardiovascular exercise is important, but resistance training may be the most effective way to maintain or increase muscle mass and testosterone production. Several studies have looked at the effects of resistance training on testosterone production and body weight; most have found that testosterone production goes up and body weight goes down as a result. Interestingly, one study found no change in body weight but did report a significant reduction in abdominal fat among participants. This result demonstrates that loss of harmful fat can be paired with an increase in muscle mass — two positive outcomes, even as body weight stays the same. For this reason, body-mass index (BMI) is sometimes a flawed measure of health; it doesn’t take the type of tissue you’re carrying into account. If you’re not losing weight but your pants are getting looser, you’re on the right track.

Testosterone and muscle are the best of friends, so including resistance training in any exercise routine goes a long way for most men. Working with weights to improve strength and build muscle mass will trigger an increase in testosterone production, which the body then uses to build muscle — a virtuous circle. Challenging the body gives it a reason to produce more testosterone. After a muscle has been used in resistance training, muscle fibers are broken; those fibers need to be repaired and made stronger. The body responds by producing testosterone, which triggers muscle cells to manufacture the proteins they need to make these repairs. Studies show that testosterone is elevated immediately after a bout of heavy resistance training.

Muscle tissue is a great example of the phrase “use it or lose it.” If you don’t put muscles to regular use, they tend to waste away. As people age, they may think of this process as natural and wonder if they’re too old to benefit from resistance training. Think again: Just 12 weeks of strength training has been shown to reverse age-related testosterone decline in older men. It’s never too late!

Metabolic syndrome

Most of us have heard a lot about metabolic syndrome. It’s a cluster of conditions — elevated blood pressure and blood glucose, excess body fat around the waist, and abnormal cholesterol levels — that, together, increase your risk of heart disease, stroke, and diabetes.

A review article published in Therapeutic Advances in Endocrinology and Metabolism notes that the drop in testosterone every man experiences is more pronounced in men with metabolic syndrome. Chronic elevated blood glucose is associated with lower testosterone, and — while the reasons aren’t known — research has shown that testosterone improves insulin sensitivity. A healthy level of testosterone is linked to a higher level of HDL (high-density lipoprotein, or “good”) cholesterol, which acts as an antioxidant and protects the lining of the blood vessels. Low testosterone reduces HDL cholesterol, thus increasing the risk of hypertension (high blood pressure) and atherosclerosis (hardening and narrowing of the arteries).

Taking action

The relationship between low testosterone and Type 2 diabetes isn’t simple; it involves a number of factors. Researchers haven’t figured out all the ways the two conditions are related, but it’s abundantly clear that almost everyone with both conditions would benefit from losing some abdominal fat and keeping blood glucose levels under control. Solutions as simple as getting more sleep and exercising regularly can result in renewed energy and even a better sex life.

If you suspect that you have low testosterone, talk to your health-care provider to learn about your options. Simply applying a gel or a patch can be an attractive solution because it’s easy, but the risks and rewards of testosterone replacement are still being debated. A gel or patch can’t address the underlying conditions that often lead to low testosterone, and introducing testosterone from the outside might reduce natural production of the hormone.
A good first step may be to adopt lifestyle changes that can raise your testosterone level naturally, and come with many other health benefits. Why not give your body a chance to be at its best?

Want to learn more about diabetes and men’s health? Read “Erectile Dysfunction (ED) Common in Young Men With Type 1 Diabetes, Study Finds” and “Viagra May Reduce Heart Attack Risk in Men With Type 2 Diabetes.”