Recognizing the signs of low testosterone, also known as hypogonadism or “low T,” can be challenging because many of the symptoms (like tiredness, weight gain, and low sex drive) are nonspecific and easily attributed to other causes. This is especially true for older males who are more likely to have low testosterone and will often discount their symptoms as being a part of aging.
Even so, there are telltale signs that warrant a visit to your healthcare provider. With a proper diagnosis, you can explore ways to raise your testosterone levels, including lifestyle changes and hormone replacement therapy.
This article explains the symptoms of low testosterone and the damaging effects untreated hypogonadism can have on your body and quality of life. It also explains how low T is diagnosed and ways to change it with or without hormones.
A Note on Gender and Sex Terminology
Male hypogonadism affects people born with testes and a penis who are typically assigned male at birth.
Verywell Health acknowledges that sex and gender are related concepts but are not the same. To accurately reflect our sources, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.
Low Testosterone Symptoms in Males
Testosterone is a hormone produced by the testicles (testes) in males and ovaries in females. In males, it contributes to the development of secondary characteristics like facial and body hair and increased bone and muscle mass.
From puberty onward, testosterone plays a central role in the following:
A drop in the normal, expected level of testosterone can interfere with all these functions.
Although low testosterone is common in older males, it can sometimes affect younger males and even boys due to congenital conditions like Klinefelter’s syndrome, infections like the mumps, testicular injury, pituitary tumors, and even certain medications.
How Common Is Low T?
Hypogonadism affects around 4 to 5 million males in the United States. Although it can occur at any age, low testosterone is especially common in older males.
Studies suggest that 1 in 4 men ages 40 to 70 have low testosterone.
By age 65, over 60% of men have testosterone levels well below those seen in men ages 30 to 35.
Common symptoms of low testosterone in older males include:
In younger males, low testosterone can be harder to recognize because symptoms such as low libido or erectile dysfunction commonly seen in older males are sometimes not present.
Instead, younger males with hypogonadism may experience nonspecific symptoms such as:
- Gynecomastia
- Fewer spontaneous erections
- Loss of body hair and reduced shaving
- Low energy levels
- Shrunken testicles (testicular atrophy)
Low T and Infertility
Low testosterone is often only considered when a couple is unable to get pregnant and seeks fertility counseling. In 40% of cases, infertility is attributed at least in part to male hypogonadism.
Do I Have Low T?
If you suspect you have low testosterone, the only way to know for sure is to get tested. Your healthcare provider can do this, but a specialist in the male reproductive tract called a urologist may provide a more thorough evaluation.
The diagnosis will typically start with a review of your symptoms and medical history (including any medications you take or illnesses you’ve had). You may also be asked about how much you drink and smoke, as these can also affect testosterone levels.
These tests are usually accompanied by a physical exam to check for signs of low T, including abnormal breast growth and shrunken testicles.
In addition to symptoms, hypogonadism can be diagnosed with several blood tests that establish if testosterone levels are low and help narrow the possible causes.
Total Testosterone (TT)
The total testosterone (TT) test measures testosterone in nanograms per deciliter of blood (ng/dL). In adult males, readings that fall anywhere between 300 and 1,000 ng/dL are considered normal. TT levels below 300 ng/dL are considered low.
Because testosterone levels can fluctuate from day to day, two to three consecutive low counts are needed to definitively diagnose male hypogonadism. The blood tests should be taken at least a week apart, ideally between 7 a.m. and 10 a.m. when testosterone levels are at their highest.
In-home testosterone tests are available online and in many drugstores. But, they may be unreliable, especially when testosterone levels are low.
Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH)
The pituitary gland produces hormones that regulate how and when the testicles produce testosterone and sperm. The pituitary gland is part of the endocrine system that regulates hormones in the body.
As part of the investigation, your urologist will order the following blood tests to measure levels of these two pituitary hormones:
- Follicle-stimulating hormone (FSH): This is the hormone that tells the testicles when to produce sperm. Higher levels indicate primary testis failure and impaired sperm production.
- Luteinizing hormone (LH): This is the hormone that tells the testicles when to produce testosterone. LH is normal when it is between 1.8 and 8.6 international units per liter (IU/L).
These tests are important because they can help establish if the cause of your condition is your testicles (primary testis failure includes elevated LH and FSH) or due to pituitary issues (LH and FSH are low). Testosterone may be low in both circumstances.
Effects of Low T
Having low T can significantly impact your life, not only physically but also your moods, well-being, relationships, and quality of life.
Physiological Effects
From a physiological standpoint, untreated hypogonadism can cause the profound loss of muscle and bone mass over time, leading to muscle atrophy (wasting), osteoporosis (porous bones), and an increased risk of hip fractures.
In tandem with the decline of muscle mass, your body’s metabolism will also start to slow down. This can lead to increased body fat and weight gain, which, in turn, increases the risk of the following:
Psychological and Social Effects
Left untreated, low testosterone can have a significant impact on a person’s mental health, self-image, quality of life, and relationships.
This is especially true when physical symptoms like gynecomastia and muscle wasting start to undermine a person’s confidence and self-esteem. These changes are also linked to an increased risk of stigma, both real and perceived, particularly when hypogonadism occurs at an early age.
The depression directly caused by low T can be amplified when low libido and erectile dysfunction start to affect a person’s sex life. There is a cause-and-effect relationship, wherein 35% to 50% of men with hypogonadism experience clinical depression, while 63% of men with clinical depression experience sexual dysfunction.
Some studies have also shown a link between low T and relationship conflicts—not only with spouses or partners but with other family members. Males with severe ED coupled with high levels of anxiety or depression tend to be most affected.
How to Raise Low Testosterone Levels
Testosterone replacement therapy (TRT) is the primary form of treatment for male hypogonadism. However, not everyone with low testosterone needs TRT, and some people need to avoid it outright.
TRT is generally recommended when hypogonadism causes symptoms. In the absence of symptoms, treatment is rarely pursued.
When there is infertility, specific fertility-sparing, testosterone-raising regimens are used, generally off-label, including clomiphene citrate or human chorionic gonadotropin HCG). Off-label use is when drugs are prescribed for a purpose other than what it was approved for by the Food and Drug Administration (FDA).
Ultimately, the decision to treat or not treat is shared between you and your healthcare provider, weighing the benefits with the potential risks.
Without Hormones
If your symptoms are not significant or you do not want (or cannot have) TRT, there are things you can do to boost your testosterone. These generally involve changing lifestyle factors that contribute to testosterone deficiency.
These include:
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- Exercising regularly: Routine aerobic exercise and resistance training can stimulate testosterone production. Avoid overexercising, however, as this can decrease testosterone.
- Improving your sleep: Testosterone increases during rapid eye movement (REM) sleep. Aim for seven to eight hours of uninterrupted sleep per night, improving your sleep hygiene as needed.
- Limiting alcohol intake: Drinking heavily can cause hypogonadism due to the increased conversion of testosterone to estrogen. Seek alcohol treatment if you need help stopping.
- Losing weight: Abdominal fat increases levels of an enzyme called aromatase that converts testosterone into estrogen. Reducing abdominal fat leaves more testosterone unconverted.
- Managing stress: Stress triggers the release of a hormone called cortisol, which causes testosterone levels to drop. Stress reduction techniques like meditation can minimize this effect.
- Quitting cigarettes: Cigarette smoking is linked to decreased testosterone in older adults. If you can’t quit, ask your healthcare provider about the use of smoking-cessation aids.
- Trying natural remedies: Some studies suggest that extracts of fenugreek and ashwagandha can help increase testosterone levels. Speak with your healthcare provider before using these remedies to ensure they are safe and don’t interact with any medications you take.
With Hormones
Testosterone replacement therapy comes in many different forms, some of which deliver higher doses (to treat severe hypogonadism or children with growth delays) and others that offer lower doses (typically for long-term maintenance).
TRT, available by prescription only, comes in the following forms:
- Oral tablets (taken by mouth)
- Intramuscular injections (given by injection into a large muscle)
- Transdermal patches (a controlled-release formulation worn on the skin)
- Topical gels or creams (typically applied to the wrist, inner elbow, or groin)
- Intranasal gels (applied inside the nostril)
- Sublingual tablets or films (dissolved under the tongue)
Benefit of TRT
A 2019 review of 27 studies reported TRT given at doses greater than 0.5 grams per week was more than twice as effective at reducing depression symptoms in men compared to a placebo (sham drug).
Among men who experienced sexual dysfunction, TRT increased sexual activity by 49% within six months, improving moods and sex drive but not necessarily erectile dysfunction.
Managing Testosterone Therapy Side Effects
As with all medications, testosterone can cause side effects, The risk of side effects varies by the type of testosterone used (including testosterone enanthate, testosterone cypionate, and testosterone undecanoate), the dosage, and the duration of use.
Possible side effects of TRT include:
To better manage TRT over the long term, see your healthcare provider every 3 to 6 months to repeat blood testing and check for side effects. This may involve having regular prostate-specific antigen (PSA) tests to check for signs of prostate enlargement or cancer.
Who Should Not Receive TRT?
TRT is avoided in males with untreated prostate or breast cancer as testosterone may stimulate the growth of the tumor. TRR is also avoided in people with a recent heart attack or stroke as well as those with advanced heart failure due to the risk of clotting.
If low testosterone is caused by your pituitary gland rather than your testicles, TRT would be of little help as it wouldn’t alter levels of LH or FSH in your blood. If infertility is a concern, injections of LH and FSH may be prescribed to help stimulate sperm production.
Summary
Symptoms of low testosterone (“low T”) are easily missed, especially in older males who experience non-specific symptoms like fatigue, weight gain, low libido, and erectile dysfunction (ED). Spotting low T can even be more challenging in younger males, who often complain of tiredness in the absence of low libido and ED.
Low T is diagnosed with a review of your medical history, a physical exam, and a total testosterone (TT) blood test.
The treatment may involve lifestyle changes or testosterone replacement therapy (TRT) delivered by pill, injection, topical cream, transdermal patch, intranasal gel, or an under-the-tongue tablet or film. Those with fertility interests require specific regimens for raising testosterone since many FDA-approved medications can cause declines in sperm quality and fertility.
