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Testosterone plays a vital role in male health, influencing various aspects of physical and mental well-being. Testosterone helps boys develop male features during puberty, such as deeper voices, facial and body hair, and muscle strength. As men age, their testosterone levels and muscle mass naturally decline. Low testosterone levels have been linked to muscle wasting, frailty, and physical dysfunction. Emerging research also suggests that testosterone deficiency can lead to muscle and joint pain, impacting overall quality of life. While the correlations and causal relationships between testosterone and muscle mass require further study, maintaining healthy testosterone levels, adequate protein intake, and proper exercise are crucial for muscle maintenance.
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What You'll Learn
Testosterone helps build muscle
Testosterone is a hormone that is primarily produced in the testicles of men and the ovaries and adrenal glands of women. It is essential for male growth and the development of masculine characteristics. Testosterone helps build muscle, and low testosterone can cause a loss of muscle mass.
Men with low testosterone may experience muscle wasting, or atrophy, as a late sign of the condition. This occurs because muscle cells have receptors for testosterone, called androgen receptors. When testosterone binds to these receptors, muscle fibres are maintained. However, without testosterone, the maintenance stops, and the muscle degrades.
Testosterone increases muscle mass by increasing muscle protein synthesis. Studies have shown that testosterone increased muscle protein synthesis in all subjects, with a 27% mean increase. Additionally, muscle mass estimated by creatinine excretion increased in all subjects, with a 20% mean increase.
Men can help build muscle mass by engaging in strength training exercises, even if their testosterone levels are declining. Adequate testosterone levels, proper exercise, and sufficient protein intake are essential factors in maintaining muscle mass.
Testosterone-based HRT can be a treatment option for those with low testosterone, potentially improving mood and increasing muscle mass. However, it is important to consult with a doctor before starting any hormone treatment, as side effects may occur.
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Low testosterone causes muscle wasting
Testosterone is a hormone present in males that plays a crucial role in muscle growth and maintenance. Typically, testosterone levels in men start to gradually decline from around the age of 40, decreasing by about 1 to 2% each year. This decline in testosterone levels can lead to muscle wasting, which is characterised by a progressive loss of skeletal muscle mass and strength.
The link between low testosterone and muscle wasting is supported by several studies. One study found that men with a 50% lower free testosterone concentration had 1.40 times higher odds of experiencing frailty, including weak grip strength and a slower walking pace. Another study on men receiving hemodialysis reported similar findings, associating low testosterone with frailty, muscle wasting, and physical dysfunction.
The mechanism behind muscle wasting in individuals with low testosterone involves the degradation of muscle fibres. Testosterone normally binds to androgen receptors on muscle cells, maintaining and stabilising the muscle fibres. However, when testosterone levels are insufficient, this maintenance process is disrupted, leading to muscle degradation and wasting.
Additionally, low testosterone levels can contribute to muscle wasting indirectly through increased inflammation, joint pain, and reduced physical activity. Over time, this can create a cycle of pain, fatigue, and inactivity that further weakens muscles and exacerbates existing musculoskeletal conditions.
While muscle wasting is a late sign of low testosterone, individuals may experience earlier indicators such as feeling weaker and less energetic. Addressing low testosterone levels through medical interventions and targeted exercise routines can help counteract muscle wasting and improve overall muscle health.
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Age-related muscle loss
Sarcopenia is a serious condition that can significantly impact an individual's quality of life. It increases the risk of falls and injuries and can lead to functional dependence and disability. People with sarcopenia may struggle with basic daily activities such as getting out of chairs, opening jars, or carrying groceries.
The development of sarcopenia is influenced by various factors, including hormonal changes, reduced physical activity, and inadequate nutrition. Ageing is associated with a decrease in certain hormones, such as testosterone, growth hormone, and insulin-like growth factor (IGF-1). Testosterone plays a crucial role in building muscle by generating proteins and increasing muscle strength. When testosterone levels are insufficient, muscle maintenance stops, and muscle degradation occurs.
Additionally, ageing individuals may experience a reduction in basal muscle protein synthesis, leading to a progressive reduction in muscle mass. Lower physical activity levels and an inadequate intake of protein can further contribute to muscle loss.
While sarcopenia is a natural consequence of ageing, it can be managed and slowed down through lifestyle interventions. Strength training exercises, such as progressive resistance training, can help build muscle mass, increase metabolism, and improve strength. Adopting a healthy diet, particularly one rich in protein, can also aid in reversing muscle loss.
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Hypogonadism and low testosterone
Hypogonadism is a condition in which the body does not produce enough testosterone, the hormone responsible for typical male characteristics, such as facial, pubic, and body hair, as well as muscle mass. Male hypogonadism can be present from birth or develop later in life, often due to injury or infection. It can also be caused by testicular disorders, pituitary gland dysfunction, or hypothalamic issues.
Primary hypogonadism originates in the testes, specifically in the Leydig cells, where testosterone is synthesized. Disorders or injuries affecting the testes can lead to insufficient testosterone production. Secondary hypogonadism, on the other hand, arises from the hypothalamus or pituitary gland, which are responsible for signalling the testes to produce testosterone. Conditions like Klinefelter syndrome, mumps orchitis, hemochromatosis, and cancer treatments can also contribute to secondary hypogonadism.
The symptoms of hypogonadism in males include decreased muscle mass, erectile dysfunction, reduced libido, fatigue, infertility, loss of body hair, and weaker bones. These symptoms can vary between individuals, and the specific symptoms depend on when hypogonadism develops and the testosterone levels present.
Diagnosing hypogonadism typically involves multiple early morning blood tests to measure testosterone levels, along with assessing symptoms indicative of low testosterone. Treatment options include testosterone replacement therapy, which can improve symptoms associated with testosterone deficiency, including muscle loss. However, addressing reversible conditions, such as obesity, that contribute to hypogonadism should be considered before testosterone therapy.
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Testosterone replacement therapy
Testosterone is a hormone present in males that helps build muscle by generating proteins, which then increases muscle strength. As men age, their testosterone levels and muscle mass naturally decline. Low testosterone can cause loss of muscle mass, also known as muscle wasting. This loss of muscle is a late sign of low testosterone—men may first notice symptoms such as fatigue and reduced energy levels.
TRT is available in several different forms, including skin gels, intramuscular injections, subcutaneous injections, patches, and pellets. Skin gels are applied daily to clean, dry skin and are one of the most common forms of TRT in the U.S. Intramuscular injections are given into a muscle every one to two weeks, while some long-acting formulations can be administered every 10 weeks in a medical office. Subcutaneous injections are given under the skin weekly. Testosterone patches are applied daily and rotated in location to avoid skin reactions. Pellets are implanted under the skin every three to six months.
While TRT can provide benefits such as increased energy, mental sharpness, and improved sexual function, there are also legitimate safety concerns and side effects associated with its use. Some men may experience acne, disturbed breathing during sleep, breast swelling or tenderness, and ankle swelling. TRT may also increase the risk of high red blood cell counts, which can elevate the chances of clotting. Long-term testosterone use has been suggested in older observational studies to increase the risk of cardiovascular disease and stimulate the growth of existing prostate cancer.
Men experiencing symptoms of low testosterone should consult their doctors to determine if TRT is a safe and suitable option for them. It is important to address other potential causes of fatigue and low sex drive, such as diet, exercise, and sleep habits, before considering TRT.
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Frequently asked questions
Testosterone is a hormone present in males that helps build muscle by generating proteins, which then increases muscle strength. Testosterone levels generally decrease with age, so older men tend to have low testosterone levels.
Testosterone helps maintain muscle fibres. Without testosterone, the maintenance stops and the muscle is degraded. Low testosterone levels can also lead to muscle and joint pain, which can cause fatigue and reduced physical activity, further weakening the muscles.
Strength training can help build muscle mass and increase metabolism, making it easier to burn fat. Dietary adjustments, supplements, and testosterone replacement therapy can also be used to treat low testosterone and its symptoms.
