PT Health Watch: Hormonal Imbalance in Men – Symptoms, causes and when to seek help

Hormonal imbalance is often discussed in relation to women, but men are affected too, and many do not realise it until symptoms begin to interfere with their health, relationships or productivity.

Experts say the condition is more common than many realise and is frequently overlooked or dismissed as stress or ageing.

Studies show that between two and 35 per cent of men globally may experience low testosterone or some form of hormonal imbalance in their lifetime, with the risk increasing as they grow older.

Speaking with PT Health Watch, a Senior Registrar in Internal Medicine at Irrua Specialist Teaching Hospital (ISTH), Chinedu Izegbu explained that hormonal imbalance occurs when there is too much or too little of a particular hormone in the bloodstream.

“Hormones are chemical messengers. Even a small change in their levels can affect several systems in the body,” Mr Izegbu said.

What it means

According to Mr Izegbu, testosterone is the most commonly discussed hormone in men. It plays a key role in muscle mass, bone density, sexual drive and sperm production.

However, it is not the only hormone involved. Oestrogen, though commonly associated with women, is also present in men and is important for libido, erectile function and sperm production.

Cortisol, known as the “stress hormone,” is produced by adrenal glands and can interfere with testosterone when levels remain high for long periods. Prolactin, when elevated, may suppress testosterone. Insulin regulates blood sugar and an imbalance may lead to weight gain and metabolic problems.

Thyroid hormones control energy levels and metabolic rate. He said a disruption in any of these hormones can trigger noticeable changes.

Symptoms men ignore

According to Mr Izegbu, many men dismiss early symptoms as part of aging or the result of working too hard.

One of the most common complaints is unexplained fatigue, where a man feels exhausted despite having a full night’s sleep. Others include weight gain, especially around the abdomen, reduced sexual desire, difficulty maintaining erections, and a general loss of motivation.

Some men also notice muscle loss even when they exercise regularly, while others experience mood swings, irritability or unexplained sadness.

Why it is happening

According to Mr Izegbu, lifestyle plays a major role. He said chronic stress, particularly in a demanding economic environment, keeps cortisol levels high. Over time, this can suppress testosterone production.

Dietary changes are another factor. Increased consumption of processed foods and sugary drinks contributes to insulin resistance and weight gain, both of which are linked to lower testosterone.

Long hours spent sitting in traffic or at desks reduce physical activity. Poor sleep, common among many working adults, also affects hormone production, as most testosterone is produced during deep sleep.

Environmental exposure to plastic chemicals and pollution in urban centres may also interfere with hormonal balance.

When to see a doctor

Men are advised to consult a doctor if symptoms persist or worsen. Warning signs include ongoing erectile dysfunction, significant drop in libido, infertility after a year of regular unprotected intercourse, sudden mood changes, breast tissue enlargement or unexplained physical changes.

“These could point to an underlying hormonal issue that needs proper evaluation,” Mr Izegbu said.

Speaking on its impact on fertility, sex and mental health, Mr Izegbu said hormonal imbalance can affect multiple areas of a man’s life. It may lower sperm count and reduce sperm motility, leading to infertility.

It can also lead to sexual dysfunction, including difficulty maintaining erections or delayed ejaculation. Beyond physical symptoms, mental health may suffer. Hormonal changes have been linked to anxiety, irritability and depression.

“A man who feels he cannot perform sexually or physically may struggle emotionally as well,” Mr Izegbu said.

Danger of self-medication

The doctor further warned against resorting to unregulated sexual enhancers or so-called “man power” herbs, alcohol-based sexual enhancers and unapproved medications.

He explained that taking testosterone without medical supervision can disrupt the body’s natural production. When the brain detects external testosterone, it may reduce or stop producing the hormone naturally, which can lead to shrinking of the testicles and long-term fertility problems.

He said treating symptoms such as erectile dysfunction without proper evaluation may also mask underlying conditions like diabetes or pituitary tumours.

He explained that some enhancers contain extremely high levels of medications such as sildenafil, which can cause severe hypotension, particularly in individuals already taking blood pressure medications. In severe cases, misuse may lead to heart complications or kidney damage.

He said diagnosis usually involves proper clinical assessment and laboratory tests. Specialists such as endocrinologists, urologists and laboratory physicians may be involved in managing the condition.

Treatment option

The good news, according to Mr Izegbu, is that most hormonal imbalances are treatable. He said lifestyle changes often form the first line of management.

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Regular exercise, particularly resistance training, improved sleep, reduced sugar intake and stress management can naturally support hormone balance. In some cases, medical treatment such as hormone replacement therapy, thyroid medication or drugs to correct prolactin levels may be necessary.

“Hormonal imbalance is not a sentence. With proper diagnosis and treatment, most men can regain balance and improve their quality of life,” he said.