Low Testosterone: Symptoms, Testing and Treatment
Testosterone plays an important role in men's health, affecting sexual function, muscle mass, bone health, red blood cell production and other aspects of normal physiology. When testosterone levels are consistently low and a man has symptoms or signs consistent with testosterone deficiency, a medical evaluation can help determine whether low testosterone may be contributing to those symptoms.
At Elevate Medical, we evaluate men for possible testosterone deficiency using a combination of symptoms, medical history, physical evaluation and laboratory testing. If testosterone replacement therapy is appropriate, treatment is individualized and monitored over time.
What is Low Testosterone
Low testosterone, sometimes called testosterone deficiency or hypogonadism, occurs when the body does not produce enough testosterone.
Testosterone naturally changes throughout a man's life, and a single testosterone measurement does not necessarily mean that someone has testosterone deficiency.
A proper diagnosis considers both testosterone levels and symptoms or signs that are consistent with testosterone deficiency. The Endocrine Society recommends diagnosing hypogonadism only when compatible symptoms or signs are present along with consistently and unequivocally low testosterone concentrations.
This distinction is important because symptoms such as fatigue, decreased concentration or changes in body composition can have many possible causes.
Common Symptoms of Low Testosterone
Symptoms can vary considerably from one person to another. Some men with low testosterone may experience several symptoms, while others may have relatively few.
Possible symptoms and signs include:
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Reduced sex drive
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Erectile difficulties
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Decreased energy
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Fatigue
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Reduced muscle mass or strength
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Increased body fat
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Decreased exercise performance
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Changes in mood
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Difficulty concentrating
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Reduced motivation
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Decreased frequency of spontaneous or morning erections
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Changes in body composition
Some of these symptoms are nonspecific and may be caused by other medical conditions, medications, sleep problems, psychological factors or lifestyle factors. For that reason, symptoms alone are not enough to diagnose testosterone deficiency.
When should you consider getting evaluated?
If you're experiencing several symptoms associated with low testosterone, particularly changes in sexual function, energy, strength or body composition, talking with a qualified healthcare provider can help determine whether testosterone testing or another medical evaluation is appropriate.
What Causes Low Testosterone?
There are many possible causes of testosterone deficiency.
Some causes originate in the testicles, where testosterone is produced. Others involve the hypothalamus or pituitary gland, which regulate testosterone production.
Potential contributors can include:
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Disorders affecting the testicles
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Pituitary or hypothalamic disorders
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Certain medications
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Obesity and metabolic conditions
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Significant illness
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Certain medical treatments, including some cancer treatments
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Genetic conditions
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Problems affecting the body's hormone signaling system
Determining the underlying cause is an important part of the evaluation. The Endocrine Society recommends additional diagnostic evaluation when hypogonadism is identified to help determine its cause.
What Testosterone Level Is Considered Low
There isn't a single testosterone number that should be interpreted in isolation.
The American Urological Association uses 300 ng/dL as a reasonable cutoff to support the diagnosis when combined with appropriate symptoms and signs, while also emphasizing that testosterone deficiency should not be diagnosed from the number alone.
The Endocrine Society emphasizes the importance of accurate assays and appropriate laboratory reference ranges rather than relying solely on a universal number.
This is why we don't recommend looking at a testosterone result by itself and assuming that treatment is automatically necessary.
Your symptoms, medical history, examination and laboratory results all matter.
What Blood Tests Are Used to Evaluate Low Testosterone?
Depending on the patient's symptoms and medical history, a provider may order several laboratory tests rather than testosterone alone.
Testing may include:
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Total testosterone
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Free testosterone when appropriate
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SHBG when clinically indicated
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LH
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FSH
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Estradiol when appropriate
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Prolactin when indicated
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CBC/hematocrit
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PSA when appropriate based on age, risk and clinical circumstances
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Thyroid testing when clinically appropriate
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Additional metabolic or other laboratory testing based on the patient's medical history
The purpose of testing is not simply to determine whether testosterone is low. It is also to help determine why it may be low and whether testosterone therapy is appropriate and safe for that individual.
The Endocrine Society recommends measuring LH and FSH in men diagnosed with hypogonadism to help distinguish between primary and secondary causes.
Testosterone Replacement Therapy (TRT)
When a man has appropriately diagnosed testosterone deficiency and testosterone replacement is determined to be appropriate, testosterone therapy can be used to restore testosterone levels toward a physiologic range.
Testosterone therapy is available in several forms, including certain injectable, topical and other prescription formulations.
The appropriate treatment depends on factors such as:
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Testosterone levels
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Symptoms
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Medical history
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Other medications
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Treatment goals
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Fertility plans
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Potential risks and contraindications
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Patient preference
Treatment should be individualized rather than based on a one-size-fits-all protocol.
When a man has appropriately diagnosed testosterone deficiency and testosterone replacement is determined to be appropriate, testosterone therapy can be used to restore testosterone levels toward a physiologic range.
Testosterone therapy is available in several forms, including certain injectable, topical and other prescription formulations.
The appropriate treatment depends on factors such as:
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Testosterone levels
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Symptoms
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Medical history
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Other medications
-
Treatment goals
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Fertility plans
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Potential risks and contraindications
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Patient preference
Treatment should be individualized rather than based on a one-size-fits-all protocol.
What to Expect When Starting Testosterone Therapy
Before starting treatment, your provider will review your symptoms, medical history, medications and laboratory results.
If testosterone therapy is appropriate, your provider will discuss the treatment approach, expected effects, potential adverse effects and follow-up requirements.
Testosterone levels are subsequently monitored along with other appropriate clinical or laboratory parameters.
The goal is not simply to make the testosterone number as high as possible.
The goal is to determine whether appropriately treating testosterone deficiency improves the patient's symptoms while maintaining appropriate monitoring and safety.
Monitoring During Testosterone Therapy
Testosterone therapy requires ongoing medical follow-up.
Depending on the treatment and the patient's circumstances, monitoring may include:
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Testosterone levels
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Blood pressure
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Hematocrit/hemoglobin
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PSA or prostate-related monitoring when appropriate
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Symptoms and treatment response
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Adverse effects
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Other laboratory testing based on individual risk factors
Who May Not Be a Candidate for Testosterone Therapy?
Testosterone therapy isn't appropriate for every man with a low testosterone result.
Before treatment, your provider should consider medical history, fertility plans, prostate health, cardiovascular health, blood counts, blood pressure and other relevant factors.
For example, testosterone therapy can suppress sperm production, so men who are actively trying to conceive should discuss fertility implications with their provider before beginning treatment. The Endocrine Society specifically recommends against starting testosterone therapy in men planning fertility in the near term.
Your provider will determine whether testosterone therapy is appropriate based on your individual circumstances.
Low Testosterone Treatment in Naples and Fort Myers
Elevate Medical provides testosterone evaluation and hormone therapy services at our Naples and Fort Myers, Florida clinics.
Naples
Elevate Medical
2349 Vanderbilt Beach Road, Suite 508
Naples, FL 34109
239-325-8594
Fort Myers
Elevate Medical
1850 Boy Scout Drive, Suite 102
Fort Myers, FL 33907
239-887-3921
We serve patients throughout Southwest Florida, including the surrounding Naples, Fort Myers and Cape Coral areas.
Our approach begins with an evaluation of your symptoms, health history and appropriate laboratory testing before determining whether testosterone therapy is appropriate.
Frequently Asked Questions About Low Testosterone
What are the most common symptoms of low testosterone?
Common symptoms can include decreased libido, erectile difficulties, reduced energy, fatigue, decreased muscle mass or strength, increased body fat and changes in mood or concentration. These symptoms can have many causes, so they do not establish a diagnosis by themselves.
Can I have low testosterone without symptoms?
A low laboratory value by itself does not establish testosterone deficiency. Major clinical guidelines recommend considering symptoms or signs together with consistently low testosterone measurements.
Is 300 ng/dL considered low testosterone?
The AUA uses 300 ng/dL as a reasonable cutoff that can support the diagnosis, but a testosterone level below that number does not automatically mean that treatment is appropriate. Symptoms, signs, repeat testing and clinical evaluation are important. A level above 300 ng/dL also does not mean that you are not a candidate for therapy. This is the importance of checking other lab values and treating symptoms rather than just a number.
How long does testosterone replacement therapy take to work?
The timeline varies depending on the symptom being treated and the individual patient. Some changes may occur relatively early, while others can take longer. Your provider should monitor both symptoms and laboratory results rather than relying on a single measurement.
Does testosterone therapy affect fertility?
Yes. Testosterone therapy can suppress sperm production. Men who may want children in the near future should discuss fertility before starting treatment.
Ready to find out where your levels actually are? Tap below on "Start Registration" to book your visit and lab work, or call our Naples clinic at (239) 325-8594 or our Fort Myers clinic at (239-887-3921) and we will get you booked