You’re not feeling like yourself. Maybe you’ve been feeling more fatigued than you’re used to or are having trouble getting into the mood. There are many different factors that can affect how men feel from day to day. But if you’ve been experiencing ongoing issues with both your energy levels and your motivation for sex, especially if you’re over the age of 40, you may be wondering if it could be low testosterone.
Low testosterone, known medically as testosterone deficiency or male hypogonadism, is a hot topic in the health and wellness industry, and there are endless supplements that promise to boost it. But the truth is that low testosterone has specific markers, and proper, supervised treatment may only be helpful for certain people. Here, we’ll discuss the role of testosterone in men’s bodies, signs and symptoms of low levels, how a doctor can help and more.
Signs of low testosterone (hypogonadism) in men can relate to sex, energy and physical changes
Signs of low testosterone are directly related to the roles that the testosterone hormone fulfills in men’s physical and sexual health. Testosterone supports:
- Body and facial hair growth
- Bone density
- Energy and mood regulation
- Erectile function
- Lean body mass and fat distribution
- Libido (sex drive)
- Muscle mass
- Red blood cell production
- Sperm production and health
With the different aspects of health that testosterone supports, low levels can result in a wide range of symptoms. However, it’s important to note that men can have low testosterone levels without any symptoms, and symptoms of low testosterone can overlap with those of other conditions.
The symptoms that are most likely to indicate male hypogonadism include:
- Decreased armpit and pubic hair
- Decreased libido
- Fewer spontaneous erections
- Fatigue or lethargy
- Hot flashes
- Infertility as a result of low sperm count
Other possible signs of low testosterone include:
- Concentration issues
- Depression
- Erectile dysfunction
- Loss of body and facial hair
- Loss of muscle size and strength
- Increased body fat, including breast development
- Osteoporosis (low bone density)
- Sleep issues
Causes of low testosterone include aging, medications and health conditions
In the same way that women experience a natural decrease in estrogen and progesterone during menopause, men experience a natural decrease in testosterone levels as they age. The rate of this decrease can vary, but it’s generally gradual, with around a 1-2% loss per year starting around age 40.
In addition to aging, other health factors can cause testosterone levels to decrease more quickly or prematurely. These factors can be categorized into two groups: factors that affect testosterone production in the testicles and factors that affect the pituitary gland or hypothalamus, which tell the testicles to produce testosterone.
Examples of health factors that can affect testicular function include:
- Certain infections, like mumps
- Chemotherapy or radiation therapy
- Direct injuries to the testicles
- Genetic conditions like Klinefelter syndrome or hereditary hemochromatosis
Examples of health factors that can affect the pituitary gland or hypothalamus include:
- Certain medicines, such as opioids, corticosteroids and hormones used in prostate cancer treatment
- Human immunodeficiency virus (HIV)
- Inflammatory diseases such as tuberculosis, sarcoidosis and histiocytosis
- Kallmann syndrome
- Obesity
- Stress
- Substances such as marijuana and alcohol
Diagnosing low testosterone mainly involves blood tests
To diagnose low testosterone, doctors begin by assessing your symptoms and testing the testosterone levels in your blood. Two or more blood tests may be necessary, as testosterone levels can vary throughout the day. If the testosterone levels in your blood are low, your doctor may order additional tests to look for other symptoms, such as osteoporosis or a low sperm count. They may also order tests to look for underlying causes like genetic conditions or gland dysfunction.
Testosterone replacement therapy (TRT) and other treatments for low testosterone
The main treatment for low testosterone is testosterone replacement therapy (TRT), in which the body’s testosterone levels are supplemented with testosterone injections, topical gels or pellet-shaped implants. TRT is only recommended for men with proven low testosterone levels who are experiencing symptoms, and it requires ongoing monitoring by your care team. This is because overly high doses may carry a risk of side effects like prostate overgrowth or overproduction of red blood cells.
TRT can also reduce fertility during use, so it isn’t recommended for men who are trying to conceive. For some men, medicines like clomiphene citrate or supplemental human chorionic gonadotropin can increase testosterone production without affecting fertility.
Aside from TRT and medicines, treatments for low testosterone depend on the cause. For example, a doctor may recommend lifestyle changes such as dietary adjustments, exercise or counseling to manage things like obesity or high stress levels. Changes to existing medications, such as stopping chronic opioid use, can also help improve testosterone levels. Lifestyle changes are the main form of treatment for men who have symptoms of low testosterone without low test results, and for men who have low test results but no symptoms.
Think your testosterone is low? Talk with an expert.
If you’re feeling off, it can be hard to tell what’s causing it. Low testosterone is one possibility, but other conditions can cause similar symptoms. For initial testing and recommendations, talk with a primary care doctor who specializes in men’s health. They can evaluate your symptoms, order blood tests and refer you to a specialist if necessary.
