Androgens are a group of steroid hormones typically associated with male sexual development, but they also play an important role in women's health. Beyond their well-known role in reproductive function, androgens support bone health, muscle development, and mood.
There are negative implications of androgen deficiency on human health. This is more common than you may think. According to one study, nearly one-quarter of men have low testosterone levels, a number projected to continue to climb in the future.
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What Are Androgens?
Androgens are a group of hormones primarily responsible for male sexual development and function. They are present in females in smaller quantities. Testosterone is the most well-known androgen, but others include dehydroepiandrosterone (DHEA), dihydrotestosterone (DHT), and androstenedione.
In men, androgens are responsible for the development of the testes and prostate gland and secondary sexual characteristics like facial hair, deep voice, and muscle mass. Testosterone also supports sperm production and libido. (4, 20)
In women, the ovaries and adrenal glands produce androgens, which are responsible for the growth of pubic and underarm hair, maintaining bone density and muscle mass, and encouraging a healthy libido, energy levels, and a happy mood. (4, 20)
Signs of Androgen Deficiency
Nearly 6% of men aged 30-79 experience symptomatic androgen deficiency (1). Symptoms indicative of low androgen levels in men include:
- Low libido
- Erectile dysfunction
- Fatigue
- Low muscle mass and strength
- Increased body fat
- Depressed mood
- Decreased bone density
- Memory loss
When women have low androgens, they may experience the following symptoms:
- Fatigue
- Insomnia
- Low motivation and self-esteem
- Sexual dysfunction
- Decreased bone density
- Thinning pubic hair
Androgen Deficiency in Older Men
Andropause is the gradual decline in testosterone levels in aging men. This hormonal transition is comparable to menopause in women. Typically beginning in the fourth or fifth decades of life, testosterone production naturally declines, leading to a wide range of symptoms:
- Decreased libido
- Erectile dysfunction
- Fatigue
- Mood changes
- Reduced muscle mass
- Increased body fat
- Decreased bone density (6)
Androgen Deficiency in Boys
Hypogonadism is a condition where the body does not produce enough male sex hormones. This is classified as primary (testicular failure) or secondary (due to dysfunction within the hypothalamus or pituitary). In infants, symptoms may include underdeveloped genitalia and delayed puberty. During childhood and adolescence, common signs include:
- Delayed or absent puberty
- Slowed growth and development
- Short stature
- Decreased muscle mass and strength
- Impaired cognition
- Depressed mood (8, 21)
Causes of Androgen Deficiency
Androgen deficiency in both men and women can arise from a variety of causes, ranging from natural aging processes to underlying medical conditions or lifestyle factors.
Causes of Androgen Deficiency in Men
- Aging: Beginning in their 50s, men's testicular function decreases by 1-2% every year.
- Hypogonadism
- Testicular disorders: Klinefelter syndrome, undescended testicles, or testicular injury
- Chronic diseases: obesity, diabetes, or chronic kidney or liver disease
- Medications: statins, steroids, and opioids
- Alcohol and marijuana use
- Genetic disorders like Kallmann syndrome
Causes of Androgen Deficiency in Women
- Aging: Testosterone levels naturally decline by 50% between the ages of 20 and 45
- Adrenal insufficiency: a condition in which the adrenal glands fail to produce sufficient levels of hormones
- Hypopituitarism: a condition in which the pituitary (a gland in the brain) fails to produce sufficient hormones to stimulate ovarian and adrenal-mediated hormone production
- Use of certain medications, such as hormonal contraceptive pills or statin drugs
Diagnosing Androgen Deficiency
Screen patients at risk of androgen deficiency by collecting a comprehensive health history. Androgen deficiency may be suspected when certain symptoms (as described above) are present. Certain preexisting medical conditions or the use of some medications can also increase the likelihood of androgen deficiency. (10)
While performing a physical exam, look for symptoms associated with androgen deficiency, such as decreased muscle mass, increased body fat, or reduced testicular size. (10)
Total and free testosterone levels should be measured to diagnose testosterone deficiency. In the presence of androgen deficiency symptoms, total testosterone less than 300 ng/dL and free testosterone (the portion of unbound testosterone) less than 5 ng/dL are diagnostic for symptomatic androgen deficiency. Serum testosterone should be measured in the morning when testosterone levels are at their highest. (1)
Measuring luteinizing hormone (LH) and follicle-stimulating hormone (FSH) can illuminate the cause of deficiency.
Elevated levels of LH and FSH suggest primary hypogonadism. As the next step, rule out Klinefelter syndrome with genetic testing.
Low or normal levels of LH and FSH suggest secondary hypogonadism. Further blood testing can include prolactin to detect hyperprolactinemia, an iron panel to diagnose hemochromatosis, and TSH to screen for other pituitary hormone deficiencies.
Other helpful labs to better understand endocrine pathways and hormonal balance include sex hormone-binding globulin (SHBG), DHEA-S, estradiol, and progesterone.
Treating Androgen Deficiency
To alleviate symptoms and restore hormonal balance, testosterone replacement therapy (TRT) is recommended for men and women with testosterone deficiency.
Uses of Androgen Therapies
TRT is the administration of testosterone by intramuscular injections, transdermal patches, topical gels, or pellets to replace insufficient levels. The route of administration is decided upon based on individual preference, cost, potential side effects, and patient response. Doctors should assess treatment success and safety by monitoring patient symptoms and repeating blood tests. (17)
Why Shouldn't You Self-Prescribe?
Self-prescribing testosterone can have serious consequences and is strongly discouraged for several reasons. Without proper medical supervision, individuals may inadvertently misuse testosterone, leading to complications such as cardiovascular issues and infertility.
Testosterone is a controlled substance. Self-prescribing testosterone without a medical license is illegal. Concerns regarding the quality and source of testosterone arise when a medical doctor does not prescribe it.
Side Effects of Treating Androgen Deficiency
While TRT can alleviate symptoms, it does come with the risk of potential side effects, which include:
- Acne
- Fluid retention
- Increased risk of cardiovascular events, including heart attacks and strokes
- An abnormally high level of red blood cells
- Sleep apnea
- Prostate enlargement, which can worsen benign prostatic hyperplasia (BPH) symptoms and increase the risk of prostate cancer
- Enlarged breasts
- Mood swings and irritability
- Infertility
- Skin irritation at the application or injection site
When to Contact Your Healthcare Provider
Men and women of all ages should be aware of the signs and symptoms of androgen deficiency and speak with a doctor if they have health concerns. Unexplained causes of delayed growth and development, fatigue, sexual dysfunction, osteoporosis, or other hormonal symptoms warrant medical evaluation.
Patients who are on TRT and experience unwanted side effects should also speak with their doctors to modify therapy.
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Key Takeaways
Androgens are hormones that play significant roles in reproductive function, bone health, muscle mass, and mood for men and women. Androgen deficiency is a state of insufficient levels of these hormones, leading to many symptoms that can affect growth and quality of life.
Testosterone replacement has become standard practice for treating symptomatic androgen deficiency. TRT restores testosterone levels to optimal levels to alleviate symptoms of hormonal imbalance. Patients who believe they are struggling with androgen deficiency are encouraged to discuss diagnostic labs and testosterone replacement with their healthcare provider.
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