Low Testosterone
Also known as: Male hypogonadism, Testosterone deficiency, Low T, Andropause
Low testosterone, medically called male hypogonadism, is a condition in which the testicles do not produce enough testosterone, the hormone responsible for male sexual development, sex drive, muscle and bone strength, red blood cell production, and aspects of mood and energy. It can result from problems in the testicles themselves or from the pituitary gland and hypothalamus, which signal the testicles to work. Testosterone also declines gradually with age, and in some older men this drop is enough to cause symptoms. Diagnosis requires both consistent symptoms and repeatedly low morning blood levels, because many of the symptoms, such as tiredness and low mood, have other common causes. Testosterone replacement can help men with a confirmed deficiency, but it is not appropriate for vague symptoms with normal levels.
At a Glance
- Common symptoms
- Reduced sex drive and fewer spontaneous erections, Erectile dysfunction, Persistent fatigue and lack of motivation
- Main treatments
- Testosterone replacement therapy by gel, injection, patch, or implant for men with confirmed deficiency and symptoms, Regular monitoring of testosterone levels, blood count, PSA, and symptoms during treatment, Alternative medications such as clomiphene or hCG for men who wish to preserve fertility, since testosterone itself suppresses sperm production
- Category
- Endocrine · Common in older men and men with obesity or diabetes; often undiagnosed
- See a doctor if
- Persistently low sex drive, erectile difficulties, or fatigue lasting more than a few months
Symptoms
Causes
- Testicular conditions such as Klinefelter syndrome, undescended testicles, mumps orchitis, injury, or chemotherapy and radiation (primary hypogonadism)
- Pituitary or hypothalamic problems including tumors, head injury, or inflammatory diseases (secondary hypogonadism)
- Obesity, type 2 diabetes, and metabolic syndrome, which suppress testosterone production
- Chronic illness, sleep apnea, and severe stress
- Medications such as opioids, anabolic steroids, and glucocorticoids
- Normal aging, with a gradual decline from the 30s onward
Risk Factors
- Obesity and type 2 diabetes
- Older age
- Long-term opioid use or past anabolic steroid use
- Untreated sleep apnea
- Previous testicular injury, surgery, or cancer treatment
- HIV, chronic kidney or liver disease
Diagnosis
- Assessment of symptoms and physical examination, including testicle size and signs of low testosterone
- Morning total testosterone blood test on at least two separate days, since levels vary through the day
- Additional tests such as free testosterone, LH, FSH, prolactin, and sex hormone binding globulin to find the cause
- Blood count, PSA, and bone density assessment where appropriate
- Pituitary MRI if secondary hypogonadism or very low levels are found
Treatment
- Testosterone replacement therapy by gel, injection, patch, or implant for men with confirmed deficiency and symptoms
- Regular monitoring of testosterone levels, blood count, PSA, and symptoms during treatment
- Alternative medications such as clomiphene or hCG for men who wish to preserve fertility, since testosterone itself suppresses sperm production
- Treating the underlying cause, for example a pituitary tumor or sleep apnea, or reviewing medications with your doctor
- Supportive: weight loss through diet and exercise, which can raise testosterone meaningfully in men with obesity
- Supportive: resistance training, adequate sleep, and limiting alcohol, which all support natural production
- Supportive: vitamin D and zinc only if you are deficient; over-the-counter 'testosterone boosters' lack good evidence
Prevention
- Maintain a healthy weight and stay physically active
- Treat sleep apnea and get adequate sleep
- Avoid anabolic steroids and limit opioid use where possible
- Keep diabetes well controlled
- Limit alcohol
- Protect the testicles from injury during sport
When to See a Doctor
- Persistently low sex drive, erectile difficulties, or fatigue lasting more than a few months
- Loss of muscle, breast enlargement, or reduced body hair
- Delayed puberty in a teenage boy
- Difficulty conceiving
- Headaches, vision changes, or very low levels on testing, which may point to a pituitary problem
Frequently Asked Questions
Related Conditions
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