The Risks of Low Testosterone in Men

Garrett Soames, PA-C, MMSc, CAQ-EM, ATC

It’s a commonly held belief that losing weight tends to be easier for men than it is for women.  While this subject will likely be up for debate, it is true that men have the benefit of having testosterone, which assists in maintaining proper body composition (more muscle, less fat).  Testosterone itself is a steroid (cholesterol based) hormone that is naturally produced by the testicles at a level averaging between 300 ng/dL and 1050 ng/dL (1, 2, 3).  Low testosterone in men has been correlated with increased abdominal fat deposition (central obesity) and decreased muscle volume (4).  Central obesity can also increase the risk of insulin resistance and type 2 diabetes, colorectal cancer, sleep apnea, premature death, and high blood pressure.   Men with low testosterone who begin testosterone replacement therapy in conjunction with proper diet and exercise, have actually been shown to decrease the above mentioned risks in addition to having improved well-being and libido.  

In the past, it was thought that higher testosterone levels increased the risk of cardiac events.  The general rule of thumb was that men develop heart disease on average 10 years prior to women, so it was assumed that the likely cause for this increased risk was many years of exposure to testosterone.  However, we know now from studies in patients receiving androgen-deprivation therapy for prostate cancer (which drops their testosterone levels to nearly zero), cholesterol levels actually rise significantly, and also seems to increase coronary artery arteriosclerosis (hardened arteries)[5].  It has also been revealed that even in men within the normal range, those with the lowest testosterone levels have been shown to have the highest cholesterol levels [6].  Lastly, a Mayo Clinic review of 30 trials of testosterone replacement therapy revealed no detrimental effect of testosterone replacement therapy[7, 8, 9].  

Free testosterone levels drop on average about 2% a year at or around age 40.  Following this logic, researchers now were able to make the reasonable conclusion that the heart disease we were seeing 10 years earlier in men was not due to testosterone.  Instead, it was thought that decreasing testosterone levels were actually the culprit.  So studies were now performed to see if this were true.  While more study is needed, it seems that testosterone may actually be cardio-protective, and definitely increases cardiac output and function.

Knowing all this, more and more doctors are screening for hypogonadism in men.  It is surprisingly common, and appears to be a strong contributor to the rising obesity epidemic in men.  Discuss the risks and benefits of testosterone replacement therapy with your doctor.   Having reviewed it’s benefits on weight loss and reducing risk factors, Rainier Medical Weight Loss is now offering testosterone replacement therapy for it’s patients who meet criteria for treatment.


*Garrett Soames, PA-C, MMSc, CAQ-EM, ATC is the newst provider to join Rainier Medical Weight Loss and Wellness and is now seeing patients in the University Place clinic on Tuesdays and Thursdays.  Call or email now if you would like to schedule an appointment with him to consult on your hormonal health. 

1.  Miner MM, Sadofsky R.  Evolving issues in male hypogonadism:  evaluation, management, and related comorbidities.  Cleveland Clin J Med.  2007;  7: S38-S46

2.  Dandona P, Rosenberg MT.  A practical guide to male hypogonadism in the primary care setting.  Int J Clin Pract.  2010;64: 682-696

3.  Corona G, Rastrelli G, Forti G, Maggi M.  Update in testosterone therapy for men.  J Sex Med.  2011;8: 639-654

4.  Kaufman JM, Vermeulen A.  The decline of androgen levels in elderly men and its clinical and therapeutic implications.  Endocr Rev. Oct 2005; 26 (6):  833-876

5.  Makhsida N, Shah J, Yan G, Fisch H, Shab-sigh R.  Hypogonadism and metabolic syndrome:  implications for testosterone therapy.  J Urol.  Sep 2005; (3):  827-834

6.  Kappor D, Malkin CJ, Channer KS, Jones TH.  Androgens, insulin resistance and vascular disease in men.  Clin Endocrimol (Oxf).  Sep 2005;  63 (3):  239-250

7.  Pitteloud N, Hardin M, Dwyer AA, et al.  Increasing insulin resistance is associated with a decrease in Leydig cell testosterone secretion in men.  J Clin Endocrinol Metab. May 2005;  90 (5):  2636-2641

8.  Sironi AM, Petz R, De Marchi D, et al.  Impact of increased visceral and cardiac fat on cardiometabolic risk and disease.  Diabet Med.  May 2012;  29 (5):  622-7

9.  Chakraborty D, Denham V, Bullar B, et al.  Fibroblast growth factor receptor is a mechanistic link between visceral adiposity and cancer.  Oncogene.  May 2017.  Published online

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