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Testosterone levels and the impact it has on overall health and injury management

Dr. Chris Greyling, an endocrinologist at Mediclinic Durbanville, explains that men’s testosterone levels naturally decline by 1-2% per year from around age 40. However, conditions such as obesity and type 2 diabetes can accelerate this process, increasing the risk of testosterone deficiency. By age 70, nearly a third of men may experience significant hypogonadism, where the body produces insufficient testosterone or sperm.

Listed are three main causes of testosterone deficiency, as outlined by Dr. Greyling:

  1. Primary hypogonadism – triggered by testicular issues such as trauma or infections.
  2. Secondary hypogonadism – linked to pituitary dysfunction, often due to obesity or chronic diseases.
  3. Tertiary hypogonadism – results from hypothalamic abnormalities, such as tumours or genetic conditions such as Kallmann syndrome, which can lead to reduced libido, erectile dysfunction, and muscle weakness.

How does testosterone deficiency affect a man’s health?

Testosterone deficiency, clinically known as hypogonadism, can lead to numerous health concerns. Dr. Greyling notes that common symptoms include persistent fatigue, mood changes such as anxiety and depression, unexplained weight gain, and loss of muscle mass. Some men may also experience diminished facial and body hair growth.

Low testosterone levels can also affect overall vitality, leading to decreased motivation and energy levels. Additionally, it may impact reproductive health and overall physical performance.

One of the most serious risks is reduced bone density, which can lead to osteoporosis and an increased possibility of fractures. Weakening bones make men more vulnerable to debilitating injuries.

Causes of Primary Hypogonadism

Congenital conditions (present at birth):

  • Anorchia – Lack of testicles at birth.
  • Cryptorchidism – Undescended testicles.
  • Leydig Cell Hypoplasia – Underdeveloped Leydig cells in the testicles.
  • Klinefelter’s Syndrome – A genetic condition where an extra X chromosome (XXY) affects development.
  • Noonan Syndrome – A rare genetic condition that can delay puberty, cause undescended testicles, or lead to infertility.
  • Myotonic Dystrophy – A type of muscular dystrophy that may affect testosterone production.

Acquired conditions (develop later in life):

  • Testicle injury or removal.
  • Orchitis – Inflammation of one or both testicles due to bacterial or viral infections (e.g., mumps).
  • Chemo- or radiation therapy.
  • Some types of tumours.
  • Anabolic steroid use.

Causes of Secondary Male Hypogonadism

Congenital causes (present at birth):

  • Isolated Hypogonadotropic Hypogonadism – Low levels of gonadotropin-releasing hormone from birth.
  • Kallmann Syndrome – A rare genetic disorder affecting the hypothalamus, often associated with a diminished sense of smell.
  • Prader-Willi Syndrome – A genetic condition that can cause dysfunction in the hypothalamus.

Acquired causes (develop later in life):

  • Hypopituitarism – Pituitary dysfunction due to tumours, infections, injury, or radiation therapy.
  • Hyperprolactinemia – Excess production of prolactin, affecting testosterone levels.
  • Iron overload (Hemochromatosis) – Can harm the pituitary gland.
  • Brain or head injury – May disrupt hormonal regulation.
  • Cushing’s Syndrome – Excess cortisol affecting hormone balance.
  • Liver Disease (Cirrhosis) and Kidney failure – Can affect testosterone production.
  • HIV/AIDS – Affects endocrine function.
  • Obesity and poorly managed diabetes – Can interfere with hormonal signals.
  • Obstructive Sleep Apnoea – Associated with lower testosterone levels.
  • Alcohol use disorder – Can impair hormone production.
  • Specific medications – Including oestrogens, psychoactive drugs, opioids, and androgen biosynthesis inhibitors used for prostate cancer.

(Cleveland Clinic, 2022).

What should I do if I suspect low testosterone?

  • Get a blood test – A venous blood test is the most trustworthy way to check your testosterone levels.
  • Look into possible causes – Testing luteinising hormone (LH) and follicle-stimulating hormone (FSH) can help establish whether the issue originates from the testicles (primary hypogonadism) or the pituitary gland or hypothalamus (secondary hypogonadism).
  • Prioritise quality sleep – Aim for 7 to 9 hours per night, as both too little and too much sleep can negatively affect testosterone levels.
  • Consult a healthcare professional – If you’re experiencing symptoms, seek medical advice for proper evaluation and management.

(Thwaini, 2025).

3 Best treatments for low testosterone

Listed below are three valuable treatment options for managing low testosterone:

  • Exercise – Regular physical activity, particularly weightlifting and resistance training, can help increase muscle mass, boost energy levels, and improve overall health.
  • Weight loss – Obesity is a major risk factor for low testosterone. Losing weight can help restore energy levels and improve testosterone production.
  • Testosterone Replacement Therapy – If testosterone production is decreased, replacement therapy can help restore normal levels. It may improve symptoms and overall well-being. Options include:
    • Injections – Testosterone is injected directly into the muscle.
    • Pellets – Implanted into fatty tissue, releasing testosterone slowly.
    • Patches – Applied to the skin to release testosterone.
    • Gels – Applied directly to the skin for absorption.

(Atlantic Urology Specialists, 2025).

Experts weigh in on TRT and injury management

What experts say about TRT and Muscle Recovery

Experts suggest that testosterone plays a key role in muscle repair and recovery and TRT may help speed up the healing process. When testosterone levels are low, muscle recovery can take longer, potentially affecting strength and performance.

Research, including a study from the Journal of Clinical Endocrinology & Metabolism, has shown that men undergoing TRT experience notable improvements in muscle mass and strength. This effect is especially significant in older individuals, who often struggle with muscle loss due to aging.

What experts say about TRT and Bone Health

Experts highlight that TRT can improve bone density, which may help prevent bone fractures and other injuries, and aid in faster recovery.

The American Urological Association supports this, noting that TRT has been effective in increasing bone strength, particularly in older adults at risk of osteoporosis. By enhancing bone health, TRT may provide long-term benefits in reducing fractures and supporting overall mobility. (Ferrier, 2024).

Disclaimer: While testosterone replacement therapy can be highly effective, it’s important to be aware of potential risks. Some men may experience side effects such as acne, sleep apnoea, breast tenderness, or ankle swelling. Additionally, doctors monitor for high red blood cell counts, which can increase the risk of blood clots. Always consult with your healthcare provider to assess the best treatment approach and monitor for any adverse effects. (Harvard Medical School, 2024).

Conclusion

In conclusion, maintaining optimal testosterone levels is essential for men’s overall health, particularly as they age. Low testosterone can impact not only energy levels and mood but also vital aspects such as bone health (crucial for preventing debilitating injuries), muscle mass, and reproductive function. Early detection through blood tests and addressing contributing factors such as obesity or sleep apnoea is key to managing this condition. Effective treatments, including exercise, weight loss, and testosterone replacement therapy, can improve symptoms and overall quality of life. Always consult with a healthcare professional to find the right approach tailored to your individual needs and risks.

This blog post is for informational purposes only and should not be considered medical/financial advice. Please consult with a healthcare/financial professional for personalised guidance. 

References

Atlantic Urology Specialists:
https://atlanticurologyclinics.com/blog/the-3-best-treatments-for-low-testosterone/

Cleveland Clinic. (2022, February 09). Low Testosterone (Male Hypogonadism). Retrieved from Cleveland Clinic:
https://my.clevelandclinic.org/health/diseases/15603-low-testosterone-male-hypogonadism

Ferrier, C. (2024, September 27). The Connection Between TRT and Injury Management: What You Need to Know. Retrieved from HRT Doctors:
https://hrtdoctorsgroup.com/the-connection-between-trt-and-injury-management-what-you-need-to-know/

Harvard Medical School. (2024, April 03). Is testosterone therapy safe? Take a breath before you take the plunge. Retrieved from Harvard Medical School:
https://www.health.harvard.edu/mens-health/is-testosterone-therapy-safe-take-a-breath-before-you-take-the-plunge

Mediclinic. (2024, June 05). Testosterone deficiency in men: its effects and treatment. Retrieved from Mediclinic:
https://www.mediclinic.co.za/en/infohub-corporate/expertise/endocrinology/testosterone-deficiency-in-men.html

Thwaini, H. (2025). TESTOSTERONE: QUESTIONS AND ANSWERS. Retrieved from Numan:
https://www.numan.com/low-testosterone/testosterone-questions-answers

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