Testosterone is the predominant male hormone and plays a major role in a man’s health and well-being. It is a source of energy and vitality, helping build a man’s muscle mass and bone strength, maintain his sexual function, sharpen his memory and concentration, and keeping his mood under control.
 
The bad news is, testosterone levels decline as a man ages. After typically peaking in the late 20s, testosterone begins to decline at the rate of about 1% per year for a healthy male. By the time a man turns 80, he is likely to have only about 20% of the testosterone he had at age 25.
 

Testosterone Deficiency (TD) Explained

Hormone levels, including testosterone, fluctuate frequently for a host of reasons. When we are sick or suffer a physical injury, hormone levels can rise and fall. Doctors typically consider a normal testosterone level to be in the range of a minimum 300 nanograms per deciliter (ng/dL) up to a maximum of 1,000 ng/dL.
 
A man with an average testosterone level below 300 ng/dL is classified as having low testosterone (low-T) — a condition affecting more than 1 in 3 men over 45. Having an average testosterone level at least 20% below the 300 ng/dL normal minimum is termed testosterone deficiency (TD). That is what is sometimes referred to as andropause or male menopause, but the term testosterone deficiency is a more precise way of describing the same condition.
 

Physical Changes, Rising Health Risks

Declining testosterone levels can produce a wide range of unwanted physical and emotional changes — reduced energy levels, mood swings, increasing body fat, reduced sex drive and erectile dysfunction, declining bone mass, hair loss, and more. The decline can also affect a man’s ability to cope with stressful situations and cause him to become socially withdrawn as he gets older.
 
The changes can impact nearly every aspect of life. The reduced energy and drive caused by declining testosterone can lead to lower productivity at work. Impatience and irritability can strain relationships with colleagues and employees, while causing rifts with family members and friends.
 
Beyond the physical and emotional changes, the hormonal decline raises the risk of a variety of chronic diseases and major health threats. Men with lower levels of testosterone are at greater risk of cardiovascular disease, cancer, diabetes, osteoporosis and dementia. They are also more prone to depression, fatigue, bone fractures, obesity and cognitive decline.
 

What can be done to avoid this?

The good news is, there are proven ways to slow the decline and restore hormones to their optimal levels, i.e. the level of hormones at age 25. Lifestyle changes can make a significant positive impact on hormone levels. Diet, exercise and sleep form the foundation of health and well-being. You have to change your diet, incorporate more foods that promote hormone production and maintain a healthy body weight. Along with extensive health benefits, exercise stimulates the production of hormones. You will need to exercise up to four to five times per week, ideally with a combination of aerobic exercise and resistance (weight) training.
 
Sleep quality is the third critical lifestyle element. Sleep has a direct effect on hormones. Studies have shown that cutting back on sleep, even among young adult males at “peak testosterone” age, can produce a quick and drastic decline in hormone levels, further adding to the decline that comes with normal aging. Understanding the connection between male hormones and the body’s biological clock underscores sleep’s important role.

Biological Clock & Sleep

The body’s circadian biological clock is the physiological control center that regulates sleep, body temperature, metabolism, and the release of hormones. While it is important to go to sleep at the same time every day and to get a consistent 7–8 hours of sleep each night, that is not enough to slow the decline in hormones.
 
You need to be asleep at the time the body produces hormones, which means you need to sleep well before midnight, because around midnight is the peak time for hormone production, which ensures you will wake up in the morning with hormones at their peak levels for the day. Going to sleep at 2 a.m. — even if you plan to sleep for 8 solid hours — interferes with the hormone production process, resulting in reduced hormone levels.

Bio-identical Hormone Therapy

If lifestyle changes do not achieve enough of an improvement, the next best option to consider is usually bio-identical hormone therapy. The therapy uses one or more bio-identical hormones to achieve optimal hormone levels, i.e. the level seen at age 25. Bio-identical means completely natural and identical in structure to the body’s own hormones. These are not steroids or synthetic hormones. Bio-identical testosterone comes from Mexican yams (sweet potatoes). Other plants yield other bio-identical hormones.
 
Before any recommendations can be made, your doctor will measure various hormone levels, which is usually accomplished through a simple blood test. There are a number of methods available for taking the replacement hormone, including tablets, gels, creams, patches, injections and time-release implants. The goal is to have the hormone absorbed fully and consistently, to avoid spikes in levels. Gels tend to be the most effective and most popular method. Periodic blood tests will help your doctor monitor the changes in your hormone levels over time.
 
Men who begin testosterone replacement therapy usually notice a difference almost immediately in terms of feeling more energetic and vital. That is not to say that the therapy is a cure for every male problem, and the results vary by individual.
 

A New Perspective on Aging

There are effects caused by aging that are inevitable and beyond our control. But losing vitality and energy is not something that aging men have to accept as their fate. If you are experiencing symptoms similar to those described earlier, talk to your doctor, first to rule out other possible causes, and be sure to ask about having your hormone levels checked.
 
 

By Asst. Prof. Dr. Pansak Sugkraroek, a board-certified OB/GYN specializing in Menopause and Reproductive Medicine at Bumrungrad International Hospital