Testosterone Level: How Low is Too Low? Health Consequences of Low Testosterone

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Nelson Vergel

Nelson Vergel

Founder, ExcelMale.com
I was able to summarize all available studies on testosterone blood levels and how they are linked to several health issues. I will add references soon.




SummaryofTestosteroneStudies.png.jpg


Low Blood Levels of Testosterone and Associated Risks:​

< 450 ng/dl (15.3 nmol/l) - Risk of metabolic syndrome​

  • Reference: Dhindsa, S., Miller, M. G., McWhirter, C. L., Mager, D. E., Ghanim, H., Chaudhuri, A., & Dandona, P. (2010). Testosterone concentrations in diabetic and nondiabetic obese men. Diabetes Care, 33(6), 1186-1192. PubMed

< 400 ng/dl (15.3 nmol/l) - Venous leakage (internal penile damage) risk​

  • Reference: Yassin, A. A., & Saad, F. (2017). Testosterone Deficiency and Testosterone Treatment in Older Men. Gerontology, 63(2), 144–156. PubMed

< 350 ng/dl (11.9 nmol/l) – All-cause death risk and anemia risk​

  • Reference: Khaw, K. T., Dowsett, M., Folkerd, E., Bingham, S., Wareham, N., Luben, R., ... & Day, N. (2007). Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men. Circulation, 116(23), 2694-2701. PubMed

< 300 ng/dL (10.2 nmol/L) - Lowered libido, weight gain & Diabetes risk increased​

  • Reference: Traish, A. M., Saad, F., & Guay, A. (2009). The dark side of testosterone deficiency: I. Metabolic syndrome and erectile dysfunction. Journal of Andrology, 30(1), 10-22. PubMed

< 300 ng/dL (10.2 nmol/L) - Quartile risk of fractures (osteoporosis), memory-related issues & depression risk increases​

  • Reference: Orwoll, E., Lambert, L. C., Marshall, L. M., Phipps, K., Blank, J., Barrett-Connor, E., ... & Cummings, S. (2006). Testosterone and estradiol among older men. The Journal of Clinical Endocrinology & Metabolism, 91(4), 1336-1344. PubMed

< 250 ng/dl (8.5 nmol/l) - Arterial plaque (arteriosclerosis) & sleep quality affected​

  • Reference: Vlachopoulos, C., Ioakeimidis, N., Miner, M., & Aggelis, A. (2014). Testosterone deficiency: a determinant of aortic stiffness in men. Atherosclerosis, 233(1), 278-283. PubMed

< 235 ng/dl (8.0 nmol/l) - Hardening of arteries (dialysis patients)​

  • Reference: Carrero, J. J., Qureshi, A. R., Parini, P., Arver, S., Lindholm, B., Bárány, P., ... & Stenvinkel, P. (2009). Low serum testosterone increases mortality risk among male dialysis patients. Journal of the American Society of Nephrology, 20(3), 613-620. PubMed

< 200 ng/dl (6.8 nmol/l) - Morning erections decrease​

  • Reference: O'Connor, D. B., Lee, D. M., Corona, G., Forti, G., Tajar, A., O'Neill, T. W., ... & EMAS Study Group. (2011). The relationships between sex hormones and sexual function in middle-aged and older European men. The Journal of Clinical Endocrinology & Metabolism, 96(10), E1577-E1587. PubMed

< 150 ng/dl (5.1 nmol/l) - Increased inflammation (TNF-alpha)​

  • Reference: Malkin, C. J., Pugh, P. J., Jones, R. D., Kapoor, D., Channer, K. S., & Jones, T. H. (2004). The effect of testosterone replacement on endogenous inflammatory cytokines and lipid profiles in hypogonadal men. The Journal of Clinical Endocrinology & Metabolism, 89(7), 3313-3318. PubMed
 
Last edited:
Defy Medical TRT clinic doctor
The implications of low testosterone on mortality in men Testosterone levels in men slowly decline with aging and also decline more abruptly due to medical illness or medications. Prescriptions for testosterone have increased dramatically over the past decade, since a testosterone-gel formulation was approved and since numerous studies reported an association between low serum testosterone and increased mortality. However, recent observational studies of testosterone treatment have reported conflicting results with some studies reporting decreased risks for mortality while others reported increased mortality risks with testosterone treatment. This paper will summarize recent studies of low serum testosterone and mortality and testosterone treatment and mortality and what the potential implications of these studies are for the clinician.
 
The Journal of Clinical Endocrinology & Metabolism 2008 Jan;93(1):68-75.

Low Serum Testosterone and Mortality in Older Men.

Gail A. Laughlin, Eliza beth Barrett-Connor and Jaclyn Bergstrom. Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, La Jolla, California 92093

Results: During an average 11.8-yr follow-up, 538 deaths occurred. Men whose total testosterone levels were in the lowest quartile (<241 ng/dl) were 40% more likely to die than those with higher levels, independent of age, adiposity, and lifestyle. Additional adjustment for health status markers, lipids, lipoproteins, blood pressure, glycemia, adipocytokines, and estradiol levels had minimal effect on results. The low testosterone-mortality association was also independent of the metabolic syndrome, diabetes, and prevalent cardiovascular disease but was attenuated by adjustment for IL-6 and C-reactive protein. In cause-specific analyses, low testosterone predicted an increased risk of cardiovascular and respiratory disease (HR mortality but was not significantly related to cancer death. Results were similar for bioavailable testosterone.

Conclusions: Testosterone insufficiency in older men is associated with increased risk of death over the following 20 yr, independent of multiple risk factors and several preexisting health conditions.
 
Last edited:
Click on reference numbers.



Low testosterone or hypogonadism can increase cardiovascular risks through various mechanisms. Here are the different ways in which low testosterone levels can impact cardiovascular health:
  1. Endothelial dysfunction: Testosterone plays a role in maintaining endothelial function, which is essential for proper blood vessel dilation and regulation of blood flow. Low testosterone levels have been associated with endothelial dysfunction, leading to impaired vascular health and increased cardiovascular risk [1].
  2. Atherosclerosis: Testosterone deficiency has been linked to the development and progression of atherosclerosis, a condition characterized by the buildup of plaque in the arteries. Atherosclerosis can lead to the narrowing and hardening of arteries, increasing the risk of heart disease, heart attack, and stroke [2].
  3. Dyslipidemia: Low testosterone levels have been associated with unfavorable changes in lipid profiles, including increased levels of total cholesterol, LDL cholesterol (the "bad" cholesterol), and triglycerides, as well as decreased levels of HDL cholesterol (the "good" cholesterol). These lipid abnormalities contribute to the development of atherosclerosis and cardiovascular disease [2].
  4. Increased inflammation: Testosterone has anti-inflammatory effects, and low testosterone levels can lead to increased levels of inflammatory markers in the body. Chronic inflammation plays a key role in the development and progression of cardiovascular disease [7].
  5. Impaired glucose metabolism and insulin resistance: Testosterone deficiency is associated with insulin resistance and impaired glucose metabolism, which can contribute to the development of type 2 diabetes. Diabetes is a significant risk factor for cardiovascular disease [1].
  6. Increased adiposity: Low testosterone levels are often accompanied by an increase in body fat, particularly visceral adiposity (fat stored around the abdomen). Excess abdominal fat is associated with a higher risk of cardiovascular disease and metabolic disorders [3].
  7. Elevated blood pressure: Testosterone deficiency has been linked to increased blood pressure, which is a major risk factor for cardiovascular disease. Hypertension can strain the heart and blood vessels, leading to various cardiovascular complications [8].
  8. Prothrombotic state: Low testosterone levels may contribute to a prothrombotic state, characterized by an increased tendency for blood clot formation. This can raise the risk of cardiovascular events, such as heart attack and stroke [1].
  9. Impaired cardiac function: Testosterone deficiency has been associated with adverse effects on cardiac structure and function, including reduced cardiac output and impaired left ventricular function. These changes can contribute to heart failure and other cardiovascular complications [1].
  10. Increased mortality: Low testosterone levels have been linked to an increased risk of cardiovascular mortality. Studies have shown an association between testosterone deficiency and higher rates of cardiovascular

Here is a list of 10 health consequences of having low testosterone blood levels, along with the corresponding scientific references:

  1. Decreased muscle mass and strength: Low testosterone levels can lead to reduced muscle mass and strength. Studies have shown that testosterone plays a crucial role in maintaining muscle mass and promoting muscle protein synthesis [1].
  2. Increased body fat: Low testosterone levels have been associated with increased body fat accumulation, particularly in the abdominal region. Testosterone plays a role in regulating fat metabolism, and lower levels may contribute to fat gain [2].
  3. Reduced bone density: Testosterone is important for maintaining bone health and density. Low testosterone levels can lead to decreased bone mineral density, which increases the risk of osteoporosis and fractures [4].
  4. Decreased libido and sexual dysfunction: Testosterone is a key hormone for sexual function, and low levels can result in reduced libido, erectile dysfunction, and decreased sexual satisfaction [3].
  5. Fatigue and low energy levels: Low testosterone levels have been associated with fatigue, decreased energy levels, and a general sense of low vitality [3].
  6. Mood disturbances and depression: Testosterone plays a role in regulating mood, and low levels have been linked to an increased risk of mood disorders, including depression [4].
  7. Cognitive impairment: Some studies suggest that low testosterone levels may be associated with cognitive decline and an increased risk of conditions like Alzheimer's disease [4].
  8. Increased cardiovascular risk: Low testosterone levels have been associated with an increased risk of cardiovascular disease, including coronary artery disease and stroke [7].
  9. Metabolic disorders: Low testosterone levels have been linked to metabolic disorders such as insulin resistance, obesity, and type 2 diabetes [1].
  10. Decreased quality of life: The various health consequences of low testosterone, including reduced muscle mass, sexual dysfunction, mood disturbances, and fatigue, can negatively impact an individual's overall quality of life [10].
 
TRTIslnd said:
Where can I find the references for Arterial Plaque hardening of arteries and increased inflammation? Would like to print them out read them and take them to my Dr. THX
Click to expand...
Hypogonadism, specifically central hypogonadism, may contribute to arterial plaque hardening through several mechanisms:

  1. Endothelial dysfunction: Hypogonadism can impair endothelial function, which is responsible for maintaining the health and flexibility of blood vessels. Endothelial dysfunction leads to reduced nitric oxide production, increased oxidative stress, and inflammation, all of which contribute to the development and progression of arterial plaque [1].
  2. Dyslipidemia: Low testosterone levels associated with hypogonadism can lead to unfavorable changes in lipid profiles, including increased levels of total cholesterol, LDL cholesterol, and triglycerides. These lipid abnormalities promote the formation of plaque within arterial walls [2].
  3. Inflammation: Hypogonadism has been linked to increased levels of inflammatory markers, such as C-reactive protein (CRP) and pro-inflammatory cytokines. Chronic inflammation plays a crucial role in the development and progression of atherosclerosis [2].
  4. Accelerated atherogenesis: Testosterone deficiency in hypogonadism may accelerate the process of atherogenesis, the formation of plaques within arteries. This can occur through various mechanisms, including increased lipid deposition, enhanced foam cell formation, and augmented smooth muscle cell proliferation within arterial walls [3].
  5. Increased vascular calcification: Hypogonadism has been associated with an increased risk of vascular calcification, a process in which calcium and other minerals accumulate in the arterial walls, leading to plaque hardening. Vascular calcification contributes to plaque stability and the narrowing of arteries [5].
  6. Arterial stiffness: Testosterone deficiency may contribute to arterial stiffness, a characteristic feature of atherosclerosis. Arterial stiffness increases the risk of plaque rupture and cardiovascular events. Hypogonadism-induced arterial stiffness can result from impaired endothelial function, increased collagen deposition, and altered extracellular matrix composition in arterial walls [6].
  7. Impaired plaque stabilization: Testosterone plays a role in maintaining plaque stability. Hypogonadism-related testosterone deficiency can disrupt the balance between collagen synthesis and degradation within plaques, leading to decreased fibrous cap thickness and increased vulnerability to plaque rupture [4].
It's important to note that the relationship between hypogonadism and arterial plaque hardening is complex and influenced by various factors. The precise mechanisms underlying this association may require further research to be fully understood.
 

Low Blood Levels of Testosterone and Associated Risks:​

< 450 ng/dl (15.3 nmol/l) - Risk of metabolic syndrome​

  • Reference: Dhindsa, S., Miller, M. G., McWhirter, C. L., Mager, D. E., Ghanim, H., Chaudhuri, A., & Dandona, P. (2010). Testosterone concentrations in diabetic and nondiabetic obese men. Diabetes Care, 33(6), 1186-1192. PubMed

< 400 ng/dl (15.3 nmol/l) - Venous leakage (internal penile damage) risk​

  • Reference: Yassin, A. A., & Saad, F. (2017). Testosterone Deficiency and Testosterone Treatment in Older Men. Gerontology, 63(2), 144–156. PubMed

< 350 ng/dl (11.9 nmol/l) – All-cause death risk and anemia risk​

  • Reference: Khaw, K. T., Dowsett, M., Folkerd, E., Bingham, S., Wareham, N., Luben, R., ... & Day, N. (2007). Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men. Circulation, 116(23), 2694-2701. PubMed

< 300 ng/dL (10.2 nmol/L) - Lowered libido, weight gain & Diabetes risk increased​

  • Reference: Traish, A. M., Saad, F., & Guay, A. (2009). The dark side of testosterone deficiency: I. Metabolic syndrome and erectile dysfunction. Journal of Andrology, 30(1), 10-22. PubMed

< 300 ng/dL (10.2 nmol/L) - Quartile risk of fractures (osteoporosis), memory-related issues & depression risk increases​

  • Reference: Orwoll, E., Lambert, L. C., Marshall, L. M., Phipps, K., Blank, J., Barrett-Connor, E., ... & Cummings, S. (2006). Testosterone and estradiol among older men. The Journal of Clinical Endocrinology & Metabolism, 91(4), 1336-1344. PubMed

< 250 ng/dl (8.5 nmol/l) - Arterial plaque (arteriosclerosis) & sleep quality affected​

  • Reference: Vlachopoulos, C., Ioakeimidis, N., Miner, M., & Aggelis, A. (2014). Testosterone deficiency: a determinant of aortic stiffness in men. Atherosclerosis, 233(1), 278-283. PubMed

< 235 ng/dl (8.0 nmol/l) - Hardening of arteries (dialysis patients)​

  • Reference: Carrero, J. J., Qureshi, A. R., Parini, P., Arver, S., Lindholm, B., Bárány, P., ... & Stenvinkel, P. (2009). Low serum testosterone increases mortality risk among male dialysis patients. Journal of the American Society of Nephrology, 20(3), 613-620. PubMed

< 200 ng/dl (6.8 nmol/l) - Morning erections decrease​

  • Reference: O'Connor, D. B., Lee, D. M., Corona, G., Forti, G., Tajar, A., O'Neill, T. W., ... & EMAS Study Group. (2011). The relationships between sex hormones and sexual function in middle-aged and older European men. The Journal of Clinical Endocrinology & Metabolism, 96(10), E1577-E1587. PubMed

< 150 ng/dl (5.1 nmol/l) - Increased inflammation (TNF-alpha)​

  • Reference: Malkin, C. J., Pugh, P. J., Jones, R. D., Kapoor, D., Channer, K. S., & Jones, T. H. (2004). The effect of testosterone replacement on endogenous inflammatory cytokines and lipid profiles in hypogonadal men. The Journal of Clinical Endocrinology & Metabolism, 89(7), 3313-3318. PubMed
 
Nelson Vergel said:
I was able to summarize all available studies on testosterone blood levels and how they are linked to several health issues. I will add references soon.




View attachment 656

Low Blood Levels of Testosterone and Associated Risks:​

< 450 ng/dl (15.3 nmol/l) - Risk of metabolic syndrome​

  • Reference: Dhindsa, S., Miller, M. G., McWhirter, C. L., Mager, D. E., Ghanim, H., Chaudhuri, A., & Dandona, P. (2010). Testosterone concentrations in diabetic and nondiabetic obese men. Diabetes Care, 33(6), 1186-1192. PubMed

< 400 ng/dl (15.3 nmol/l) - Venous leakage (internal penile damage) risk​

  • Reference: Yassin, A. A., & Saad, F. (2017). Testosterone Deficiency and Testosterone Treatment in Older Men. Gerontology, 63(2), 144–156. PubMed

< 350 ng/dl (11.9 nmol/l) – All-cause death risk and anemia risk​

  • Reference: Khaw, K. T., Dowsett, M., Folkerd, E., Bingham, S., Wareham, N., Luben, R., ... & Day, N. (2007). Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men. Circulation, 116(23), 2694-2701. PubMed

< 300 ng/dL (10.2 nmol/L) - Lowered libido, weight gain & Diabetes risk increased​

  • Reference: Traish, A. M., Saad, F., & Guay, A. (2009). The dark side of testosterone deficiency: I. Metabolic syndrome and erectile dysfunction. Journal of Andrology, 30(1), 10-22. PubMed

< 300 ng/dL (10.2 nmol/L) - Quartile risk of fractures (osteoporosis), memory-related issues & depression risk increases​

  • Reference: Orwoll, E., Lambert, L. C., Marshall, L. M., Phipps, K., Blank, J., Barrett-Connor, E., ... & Cummings, S. (2006). Testosterone and estradiol among older men. The Journal of Clinical Endocrinology & Metabolism, 91(4), 1336-1344. PubMed

< 250 ng/dl (8.5 nmol/l) - Arterial plaque (arteriosclerosis) & sleep quality affected​

  • Reference: Vlachopoulos, C., Ioakeimidis, N., Miner, M., & Aggelis, A. (2014). Testosterone deficiency: a determinant of aortic stiffness in men. Atherosclerosis, 233(1), 278-283. PubMed

< 235 ng/dl (8.0 nmol/l) - Hardening of arteries (dialysis patients)​

  • Reference: Carrero, J. J., Qureshi, A. R., Parini, P., Arver, S., Lindholm, B., Bárány, P., ... & Stenvinkel, P. (2009). Low serum testosterone increases mortality risk among male dialysis patients. Journal of the American Society of Nephrology, 20(3), 613-620. PubMed

< 200 ng/dl (6.8 nmol/l) - Morning erections decrease​

  • Reference: O'Connor, D. B., Lee, D. M., Corona, G., Forti, G., Tajar, A., O'Neill, T. W., ... & EMAS Study Group. (2011). The relationships between sex hormones and sexual function in middle-aged and older European men. The Journal of Clinical Endocrinology & Metabolism, 96(10), E1577-E1587. PubMed

< 150 ng/dl (5.1 nmol/l) - Increased inflammation (TNF-alpha)​

  • Reference: Malkin, C. J., Pugh, P. J., Jones, R. D., Kapoor, D., Channer, K. S., & Jones, T. H. (2004). The effect of testosterone replacement on endogenous inflammatory cytokines and lipid profiles in hypogonadal men. The Journal of Clinical Endocrinology & Metabolism, 89(7), 3313-3318. PubMed
Click to expand...
How long would you need to be low on test before any risk start to present them selves? Before I started TRT just over 2 weeks ago I was at 1.35 nmol/l, and I had the symptoms of low test for around 2 years, so I'm worried after reading this.
 
Simo said:
How long would you need to be low on test before any risk start to present them selves? Before I started TRT just over 2 weeks ago I was at 1.35 nmol/l, and I had the symptoms of low test for around 2 years, so I'm worried after reading this.
Click to expand...
That’s highly variable because everyone has their own normal range where they operate best. So it’s impossible to come up with one number for everyone.

Gene CAG repeats, or androgen receptor sensitivity as well as the abilities for tissues to respond is another variable.

As far as worrying about having low testosterone for 2 years, you can choose not to worry about what’s out of your control.
 
Last edited:
Beyond Testosterone Book by Nelson Vergel
All i can do is do my best to keep on top on things I can controle, and TRT is the start. And thanks for the quick reply
 
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