11种可能导致睾酮水平低下的原因

通常，你的睾丸激素水平在每分升300到1000纳克（ng/dL）之间。如果低于300纳克/分升，说明睾酮水平较低，或“T低”。从30岁左右开始，男性的睾酮水平开始缓慢下降。正因为如此，人们一度认为衰老在低T细胞中起着关键作用。这可能是错误的。健康男性在整个生命中可能保持睾酮水平，或[睾酮]下降将不足以达到正常水平，“佛罗里达州迈阿密大学卫生系统M.D.的泌尿科医师Ranjith Ramasamy说。

尽管如此，随着男性年龄的增长，他们更有可能患上一系列慢性病，比如diabetes,爱游戏ayx网 ,high cholesterol,andheart disease，而且他们也倾向于减少体力活动。拉马萨米博士说：“确实患有这些疾病的男性，随着年龄的增长，睾丸激素水平可能会降低。”。为什么这些健康问题会产生这种影响？“这是一个百万美元的问题，”哥伦布俄亥俄州立大学韦克斯纳医学中心的内分泌学家Luma Ghalib医学博士说。“生活方式和共病如何影响睾酮水平，有多个层面。”

当你负重过多时，体内多余的脂肪会导致一种名为芳香化酶的激素将睾酮转化为雌二醇，这是一种雌性激素。结果是：你的睾丸激素水平下降，而另一种雌性激素雌激素水平上升。“这就是为什么肥胖男性性欲下降，性功能下降，”加利布博士说。这反过来会导致你的能量水平下降。你变得疲劳，运动能力下降，因此体重增加，T水平下降更多。“这是一个恶性循环，”她补充道。

它变得更加复杂,Ramasamy博士说。“Obesity typically goes hand in hand with a sedentary lifestyle, and this leads to a lack of brain stimulation of the hormones necessary for testosterone production.” What’s the brain got to do with it? Your pituitary gland, which is attached to a part of your brain called the hypothalamus, tells your testicles to produce testosterone. If it doesn’t send out the message (in the form of other hormones), testosterone production dwindles. (Things can also go wrong with your pituitary gland, but this is rare. We’ll share those details momentarily, after covering more common causes.)

Poorly managed2型糖尿病also can contribute to low T. As Dr. Ramasamy points out, people with this disorder tend to be obese and less physically active. There’s also a link between high blood sugar levels caused by diabetes and lower levels of testosterone. In fact, recent research suggests that treating low T also improves the way the body handles insulin. “If diabetic men are not treated for low testosterone, their diabetes treatment will not be as effective as it could be,” says Dr. Ramasamy. The American Diabetes Association estimates that diabetes double’s a man’s risk of low T.

Sleep problems also increase the risk of low T.阻塞性睡眠呼吸暂停（OSA）is one example. “Sleep apnea can lead to more obesity and worsening hypogonadism,” says Dr. Ghalib. And, she adds, treatment for low T will be less effective if you don’t treat sleep apnea first. According to a 2018 scientific review, the poor sleep caused by OSA leads to a drop in testosterone levels because it disrupts the hormone-producing partnership between the pituitary gland and the testicles. Another complicating factor: Many people with OSA also are obese. The vicious circle continues.

Dr. Ramasamy points to anabolic steroids, synthetic versions of testosterone that he says are the biggest cause of testosterone deficiency. Despite being illegal, these performance-enhancing drugs often are used by young, healthy men who want to build muscle and lose fat quickly. It’s a big risk. Your body stops making testosterone while you take them. More unsettling? “After you stop taking them, your body may not start making natural testosterone again,” says Dr. Ramasamy. Dr. Ghalib says many men don’t realize their muscle-building protein supplements contain anabolic steroids.

但导致睾丸激素下降的不仅仅是非法药物。拉马萨米博士解释说，SSRIs是一种常见的处方抗抑郁药，包括百忧解（氟西汀）、塞来昔布（西酞普兰）和帕罗西汀（帕罗西汀），它会干扰产生睾酮所需的一些大脑化学物质。2017年，研究人员对六种此类抗抑郁药进行了研究，发现它们都会降低睾酮水平。“如果你在服用SSRI时出现睾丸激素水平低的症状，请咨询医生，”他建议。

This is particularly true of hormone therapy forprostate cancer，它可以抑制睾酮的产生，从而减缓癌症的进展。拉马萨米博士说，即使经过治疗，约40%的男性仍不能完全恢复之前的睾酮水平。结肠癌和其他癌症的化疗和放疗也可能影响睾酮。但也有好消息：“尽管一些化疗和放疗会影响睾丸或大脑，并导致更永久性的性腺机能减退，但在患病期间发生的大多数病例都是暂时的，”加利布博士说。

同样，这种情况非常罕见，但有时确实会发生。“脑下垂体是控制包括睾酮在内的大多数激素的主要腺体，”加利布博士说。“垂体的部分或完全破坏会导致严重的性腺功能减退。”她说，虽然大多数肿瘤不是癌症，但它们会导致你的睾酮水平降至零。切除此类肿瘤的手术也会显著影响你的睾酮水平。据美国癌症协会称，对于小肿瘤来说，这是一种罕见的并发症，但对于大垂体瘤来说，这可能是不可避免的。

Your testicles can be damaged and your testosterone production affected by other causes, says Dr. Ghalib, such as infections and traumatic injury. Rare chromosome disorders also impact testosterone. One example is Klinefelter syndrome. Boys born with this condition will have smaller than normal testicles and produce smaller amounts of testosterone. It is one of the most common sex chromosome disorders and effects about one in 500 to 1,000 newborn boys, according to the National Institutes of Health. No matter the cause of your low T, ask your doctor if lifestyle changes and/or treatments can increase your levels.