Low testosterone happens when men cannot make normal amount of testosterone. While low testosterone happens gradually with age, certain conditions can cause it to happen earlier.
Men with low testosterone may benefit from testosterone replacement therapy (TRT) available through injections, gels, creams, and pills (which are not always covered by insurance).
Michael Via, MD
“For men who truly have low testosterone, TRT is generally a safe and effective treatment when prescribed and monitored appropriately,” says Michael Via, MD, a Mount Sinai endocrinologist.
In this Q&A, Dr. Via discusses who should be screened for low testosterone and the potential risks and benefits of TRT.
When should men be screened for low testosterone?
Testosterone levels naturally decrease as men get older, but the rate of decline varies from person to person. Because of this, routine screening for low testosterone is not recommended. It does not need to be part of your regular annual blood work.
However, if you are experiencing symptoms that could be related to low testosterone, talk with your doctor about whether testing is appropriate.
What are the symptoms of low testosterone?
The symptoms of low testosterone can be similar to many other common health concerns, so they are not always caused by low testosterone alone.
Common symptoms include:
- Feeling more tired than usual
- Muscle weakness or loss of strength
- Low energy
- Lower sex drive
- Erectile dysfunction
- Less facial or body hair growth
Some people also notice:
- Trouble concentrating
- Increased anxiety
These symptoms can have many different causes. If you are experiencing several of them, your doctor may recommend checking your testosterone level to see whether it could be contributing.
What can cause low testosterone besides aging?
Besides aging, several health conditions can lead to low testosterone.
- Genetic conditions that affect testosterone production
- Serious head injuries that damage the pituitary gland, a small gland in the brain that helps control hormone production. In many cases, testosterone levels return to normal within about a year without treatment
- Metabolic syndrome: Conditions including excess weight around the waist; high blood pressure; high blood sugar; high triglycerides (a type of blood fat); and low HDL (“good”) cholesterol
- Pituitary disorders, including pituitary tumors that produce excess prolactin, or large pituitary tumors that may need surgery can cause testosterone levels to be low. Both of these are uncommon, and your doctor can help guide evaluation
For many men, improving overall health may help restore the body’s natural testosterone production without testosterone replacement therapy. This would include:
- losing weight
- exercising regularly
- eating a healthier diet
- taking medications such as GLP-1 medicines when appropriate
- having bariatric surgery
What are the benefits and risks of testosterone replacement therapy?
For men who have confirmed low testosterone and bothersome symptoms, testosterone replacement therapy may be appropriate.
In the right patients, TRT can improve symptoms, including better muscle strength, bone health, sexual function, and quality of life, but symptom improvement varies from person to person. Some men feel much better, while others notice little improvement.
The potential risks of testosterone replacement therapy include:
- A reduction in your body’s own testosterone production
- An enlarged prostate (benign prostate enlargement), which can worsen urinary symptoms in some men
- An increase in red blood cells, which can make the blood thicker and may increase the risk of blood clots if blood counts become too high
Researchers have also studied whether testosterone therapy increases the risk of heart disease or prostate cancer. Current evidence has not shown an increased risk of major heart problems from testosterone therapy. The relationship between testosterone therapy and prostate cancer remains less certain, though current evidence suggests the risk may not be increased.
How long does testosterone replacement therapy treatment last?
Treatment is often a long-term commitment. In some cases, your doctor may recommend trying treatment for a few months and then stopping it to see whether it made a meaningful difference. Men already on TRT should continue regular follow-up with their doctor so they can monitor prostate health and blood counts.
Can testosterone replacement therapy improve my libido, energy, and mood?
Many men believe testosterone therapy will completely restore their energy, improve their mood, and solve every symptom they are experiencing. In reality, testosterone is not a cure-all. While it can be very helpful for men with confirmed low testosterone, it does not improve every symptom for every person.