Testosterone is often called the “male hormone”, but its role goes further than most men realise. It plays a part in muscle and bone strength, energy levels, mood, sleep, concentration and sex drive.
When levels drop, the changes are usually gradual, which makes them easy to put down to a busy year or simply getting older. This article covers the symptoms men commonly notice, why those symptoms on their own cannot confirm low testosterone, and what a proper check involves.
Low testosterone, known medically as androgen deficiency or hypogonadism, means the body is not making enough testosterone for good health.
It happens for one of two broad reasons. Either the testicles are not producing enough testosterone, or the hormonal signal from the brain that tells them to produce it is not working properly. Which of those it is matters, because it changes what a doctor does next.
Testosterone levels do fall gradually as men get older. In otherwise healthy men that slow decline is generally not considered a medical problem on its own, and Australian health services point out that terms like “male menopause” are misleading, because there is no clear evidence that lower levels with age are a problem for healthy men.
Androgen deficiency as a diagnosed condition is not especially common. Australian estimates put it somewhere between 1 in 20 and 1 in 200 men.
This is the most important point in the article, so it sits near the top rather than at the end.
Most of the symptoms linked to low testosterone are what doctors call non-specific. They can mimic the symptoms of other conditions, and plenty of men who feel exactly this way turn out to have normal testosterone levels.
It works in the other direction too. A single low reading does not automatically mean androgen deficiency, because a short-term or long-term illness, such as an infection or diabetes, can lower testosterone on its own.
So a symptom list is a good starting point for a conversation with a doctor. It is not a diagnosis, and neither is one blood test taken on one morning. If you want the longer explanation of that, we have written about why blood tests matter separately.
Men notice different things, and most men with androgen deficiency have some of the following rather than all of them. Recognising something on this list does not mean you have low testosterone. It means it is worth mentioning at an appointment.
Sleep is worth paying particular attention to, because poor sleep on its own causes a lot of the same tiredness, low mood and poor concentration. Our article on sleep and men’s health covers that side of it in more detail.
Before putting these changes down to testosterone, it helps to know what else commonly sits behind them:
Regular exercise can help with several of these, particularly extra weight and poor sleep. We look at which kinds of exercise affect testosterone in a separate article.
Food plays its part mainly through body weight, and our guide to how diet affects testosterone sorts the popular claims by the strength of the evidence.
There is a simple question worth taking to your appointment: could these symptoms be caused by something other than low testosterone? A good doctor will want to answer that before anything else.
There is no set number of symptoms that means you should book an appointment. If several of these changes have been going on for a while, or one of them is bothering you enough that you have gone looking for answers, that is reason enough.
It is worth raising sooner rather than later if you are having trouble conceiving, if you have noticed changes in your testicles, or if the symptoms started after an illness, an injury or a new medication.
If low mood is the main thing you are dealing with, please do not wait on a hormone result before getting support. Speak to your GP, or contact Lifeline on 13 11 14 at any time.
One thing to be careful about is the large market of testosterone products and testosterone boosting supplements sold online. Australian health services advise against starting anything based on symptoms alone, without a doctor first assessing your overall health and checking for other conditions.
A doctor will usually start with your medical history and a physical examination, then arrange blood tests. The history covers your symptoms, other medical problems, and any medicines or other substances you are taking, because several of those affect the result.
Testosterone follows a daily rhythm and is usually at its highest in the morning, so the blood test is ideally taken early in the day, while you are fasting. A sample taken in the afternoon can give a misleading picture.
Levels also vary from one day to the next. Because of that, a low result is normally repeated on a second morning before any conclusion is drawn. If you have only had one test, the process is not finished.
Results are read against the testing laboratory’s own reference range, alongside your symptoms, your examination and your history. That is why a number on a page is not the whole answer, and why the doctor reviewing it matters as much as the test itself.
Which of these apply depends entirely on your situation, and that is a decision for the doctor reviewing your results. We have written more about what happens once blood tests come back if you would like to know how that review usually works.
If testing does point to androgen deficiency, the next job is working out why, because the cause shapes the treatment. Where the problem is with the testicles themselves, testosterone replacement therapy is the usual management. Where the signal from the brain is the issue, the underlying cause is treated as well, often alongside testosterone therapy.
Testosterone therapy is a medical treatment. It has possible side effects, it needs ongoing monitoring, and it is not suitable for everyone. It is a decision to make with a doctor who has seen your results and your full health history, not one to make from an article. Our pieces on how TRT actually helps and when TRT helps and when it does not give a more complete picture of both sides.
If testing does not point to low testosterone, that is a useful result too. It means the reason you have been feeling this way is somewhere else, and it is still worth finding.
No. The symptoms are non-specific, which means they overlap with a number of other conditions. They are a good reason to get checked, but only a doctor working from an examination and blood tests can tell you what is going on.
Testosterone does decline gradually with age, and in otherwise healthy men that is generally not treated as a medical problem. Androgen deficiency is a different thing, with an identifiable cause. A bigger drop is more likely if you have a long-term health condition or are carrying extra weight, which is one of the things a doctor will look at.
Early in the morning and while fasting, because that is when levels are usually at their highest. An afternoon sample can read lower than your true level.
Usually, yes. Testosterone varies from day to day, so a low result is normally confirmed with a second test on another morning before anyone draws a conclusion from it.
Australian health services advise against self-prescribing from symptoms. Starting a product without an assessment can delay finding the real cause, and some products carry their own risks. Get the assessment first.
Australian estimates put androgen deficiency at between 1 in 20 and 1 in 200 men, so it is far from the explanation for every case of tiredness or low mood.
If some of this sounds familiar, there is no need to make a big decision today. The useful next step is a small one. Write down what you have noticed and roughly how long it has been going on, then take that to a doctor who can look at the whole picture.
Primal Zone is a men’s health service with Australian registered doctors. You can read more about our approach to low testosterone, look through our treatments, or begin with the online assessment if you would rather start there. Assessment and testing come first, and treatment is only discussed if it is appropriate for you.
Whichever way you go about it, having the conversation is worth doing on its own.
This article is general information about men’s health and is not personal medical advice. If you are concerned about symptoms, speak with your doctor.