What is Low Testosterone?
Low testosterone (hypogonadism) occurs when the body doesn't produce enough testosterone. Normal levels: 300-1000 ng/dL. Symptoms include low energy, reduced sex drive, erectile dysfunction, depression, and muscle loss. Diagnosis requires blood tests and treatment can significantly improve quality of life.
Common Symptoms of Low Testosterone
Sexual Symptoms
- • Low libido: Reduced interest in sex
- • Erectile dysfunction: Difficulty getting or maintaining erections
- • Reduced spontaneous erections: Fewer morning erections
- • Decreased sexual satisfaction: Less intense orgasms
- • Infertility: Low sperm count or quality
Physical Symptoms
- • Fatigue: Persistent tiredness, low energy
- • Muscle loss: Decreased muscle mass and strength
- • Increased body fat: Especially abdominal fat, gynecomastia (breast tissue)
- • Reduced bone density: Higher fracture risk (osteoporosis)
- • Hot flashes: Similar to menopause symptoms
- • Hair loss: Body and facial hair thinning
- • Small testicles: Testicular atrophy
Cognitive & Emotional Symptoms
- • Depression: Low mood, sadness, loss of motivation
- • Irritability: Mood swings, increased anger
- • Brain fog: Difficulty concentrating, memory problems
- • Reduced confidence: Low self-esteem
- • Sleep problems: Insomnia or excessive sleep
Causes of Low Testosterone
Primary Hypogonadism (Testicular Problem)
- • Klinefelter syndrome: Genetic condition (extra X chromosome)
- • Undescended testicles: Cryptorchidism
- • Testicular injury: Trauma, torsion
- • Chemotherapy/radiation: Cancer treatment damage
- • Mumps orchitis: Viral infection affecting testicles
Secondary Hypogonadism (Pituitary/Hypothalamus Problem)
- • Pituitary disorders: Tumors, damage, medications
- • Kallmann syndrome: Genetic condition affecting GnRH
- • Chronic illness: HIV/AIDS, kidney disease, liver cirrhosis
- • Medications: Opioids, steroids, some antidepressants
- • Obesity: Excess body fat converts testosterone to estrogen
- • Sleep apnea: Disrupts hormone production
Age-Related Decline
- • Normal aging: Testosterone decreases 1-2% per year after age 30
- • Late-onset hypogonadism: Significant drop in older men
- • Not inevitable: Many older men maintain normal levels
Diagnosis
Blood Tests Required
- • Total testosterone: Two morning blood tests (levels highest 7-10 AM)
- • Normal range: 300-1000 ng/dL
- • Low if: <300 ng/dL on two separate tests
- • Free testosterone: Bioavailable portion (not bound to proteins)
- • LH and FSH: Determine if primary vs. secondary
- • Prolactin: Rule out pituitary tumor
- • Estradiol: Check estrogen levels
- • CBC, liver, kidney function: General health screening
Treatment Options
Testosterone Replacement Therapy (TRT)
- • Injections: Most common - weekly or bi-weekly shots
- • Gels/creams: Daily application to skin (shoulders, arms)
- • Patches: Daily transdermal patches
- • Pellets: Implanted under skin, lasts 3-6 months
- • Oral tablets: Less common, potential liver effects
- • Nasal gel: Applied inside nose 3x daily
Benefits of TRT
- • Improved libido: Within 3-6 weeks
- • Better erections: 3-6 months
- • Increased energy: 3-6 weeks
- • Mood improvement: 3-6 weeks
- • Muscle mass: 12-16 weeks
- • Bone density: 6+ months
- • Fat loss: 12-16 weeks
Risks & Side Effects
- • Acne and oily skin: Common but usually mild
- • Fluid retention: Ankle swelling
- • Prostate enlargement: BPH symptoms may worsen
- • Sleep apnea: Can worsen existing condition
- • Blood thickening: Increased red blood cells (polycythemia)
- • Reduced fertility: Sperm production decreases
- • Testicular shrinkage: Body stops natural production
Monitoring on TRT
- • Testosterone levels: Check 3-6 months, then annually
- • Hematocrit: Monitor for polycythemia every 3-6 months
- • PSA test: Prostate cancer screening (age-appropriate)
- • Liver function: If using oral testosterone
- • Lipid panel: Cholesterol monitoring
- • Bone density: DEXA scan if osteoporosis risk
Who Should NOT Take TRT?
Contraindications:
- • Prostate cancer: Absolute contraindication
- • Breast cancer: In men
- • Trying to conceive: TRT reduces fertility
- • Severe heart failure: Uncontrolled
- • Severe sleep apnea: Untreated
- • Hematocrit >50%: High red blood cell count
Lifestyle Approaches to Boost Testosterone
- • Lose weight: If overweight - significant impact on levels
- • Strength training: Heavy compound lifts (squats, deadlifts)
- • Quality sleep: 7-9 hours nightly, treat sleep apnea
- • Stress reduction: Chronic stress elevates cortisol, lowers testosterone
- • Limit alcohol: Excessive drinking suppresses testosterone
- • Adequate zinc: Oysters, beef, pumpkin seeds
- • Vitamin D: Sunlight or supplement if deficient
- • Avoid endocrine disruptors: BPA, phthalates in plastics
Medical Review
Reviewed by: Ricardo Hamilton, MD
Last Updated: November 26, 2025
Sources: American Urological Association, Endocrine Society, Mayo Clinic