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What are the signs of low testosterone in men?
The hormone testosterone plays an important part in sexual development and function in men. And as men age, they naturally produce less of it. But if your testosterone levels become low, this can cause problems with your sexual health and wellbeing. Here, I discuss the signs of low testosterone and how it can be treated.
What is low testosterone?
Levels of testosterone increase during puberty, when it helps boys develop muscle strength and body hair. It’s also needed to make sperm.
But after the age of 30, men’s testosterone levels naturally start to decrease. The amount they decrease varies between men. Some men have higher testosterone levels than others of a similar age, and some have lower levels. In general, older men have lower testosterone levels.
Low testosterone is sometimes called hypogonadism or testosterone deficiency. This means that you don’t produce enough testosterone.
Studies have estimated that two to five per cent of men worldwide may have testosterone deficiency. It’s hard to say precisely how many men it affects because definitions of ‘low’ testosterone differ. And not everyone with low testosterone will have obvious signs of testosterone deficiency.
What causes low testosterone?
There are a few reasons why someone might have low testosterone. It can happen as part of normal ageing, but some men have low testosterone throughout their lives.
Emotional stress, illness, and surgery can all reduce your testosterone levels. But they should go back to normal once you’ve recovered. If you drink a lot of alcohol or smoke a lot, this can also reduce your testosterone levels.
Other causes of low testosterone include:
- cancer treatment – chemotherapy and radiotherapy can affect testosterone production
- injury to your testicles
- certain medicines, such as some painkillers and antidepressants
- genetic conditions, such as Klinefelter syndrome – these are conditions you’re born with
What are the signs of low testosterone?
It’s common for men to experience problems with their sexual health as they age. These include a low libido and erectile dysfunction. Low testosterone can also cause these issues.
As well as these changes in sexual health, signs of testosterone deficiency include:
- excessive tiredness (fatigue)
- a decrease in muscle mass
- decreased beard and body hair growth
- weight gain and obesity
- symptoms of depression
- poor memory and focus, and difficulty concentrating
- an increase in breast tissue (gynaecomastia)
If you’re worried you have signs of testosterone deficiency, speak to a GP.
What are the treatments for low testosterone?
Your GP might first suggest lifestyle changes to ease your symptoms. These may include:
- increasing your physical activity
- eating a healthy diet
- relieving stress
- getting lots of sleep
- reducing the amount you drink or smoke
If these changes don’t help and blood tests show that your testosterone levels are low, your GP may refer you to a hormone specialist (endocrinologist). They will be able to assess if testosterone replacement therapy is an option for you. They will test your blood to confirm your testosterone levels are low, and to try to determine what could be causing low testosterone.
Testosterone replacement therapy increases the levels of testosterone in your blood. It’s usually given as a gel that you apply to your skin. It may also be given as a long-acting injection. You should notice an improvement in your symptoms after three to six months of treatment.
What are the side-effects of testosterone replacement therapy?
Your specialist will regularly test your blood to monitor your testosterone levels. This is because testosterone replacement therapy can have side-effects. For example, it can thicken your blood and it may enlarge your prostate gland. While taking testosterone, you may also:
- gain weight
- develop acne
- have headaches
You might find that your symptoms continue once your testosterone has reached normal levels. If this happens, your specialist may stop treatment to see what else could be causing your symptoms.
It’s important that you speak with your specialist to figure out if testosterone replacement therapy is right for you. The risks of taking testosterone will probably outweigh any benefits if you:
- are at high risk of prostate cancer
- have a high red blood cell count
- have obstructive sleep apnoea that isn’t being treated
- have heart failure
- would like to have children in the next 6 to 12 months
We don’t yet know the long-term effects of testosterone replacement therapy. But your specialist can suggest the safest way to treat your symptoms.
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Sources Sources
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- Low testosterone. Patient. patient.info, last updated June 2023
- Effects of aging on the male reproductive system. MSD Manual. msdmanuals.com, revised February 2023
- Anaissie J, DeLay KJ, Wang W, et al. Testosterone deficiency in adults and corresponding treatment patterns across the globe. Transl Androl Urol 2017;6:183-191
- Nassar GN and Leslie SW. Physiology, testosterone. StatPearls Publishing. ncbi.nlm.nih.gov, updated January 2023
- Walther A, Breidenstein J, Miller R. Association of Testosterone Treatment With Alleviation of Depressive Symptoms in Men: a Systematic Review and Meta-analysis. JAMA Psychiatry 2019;76:31-40. DOI: 10.1001/jamapsychiatry.2018.2734
- Male menopause (androgen deficiency in the ageing male). British Association of Urological Surgeons. baus.org.uk, accessed July 2024
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