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Low Testosterone: The Complete Guide — Low T Symptoms and Causes

Ask the average man to identify some of the most important hormones in his system, and the first one likely to be mentioned is testosterone.

Yet, while most men know that it’s their principal hormone and has something to do with masculinity, very few realize exactly what it does, and even fewer understand the health risks associated with a decline in this hormone.

This decline is known as low testosterone, Low T, or hypogonadism (the proper medical term for low testosterone levels).

What do those terms actually mean?

What is low testosterone?

What Is Considered Low Testosterone?

In order to answer those and many other related questions as thoroughly as possible, we’ve created this comprehensive guide covering all aspects of low testosterone.

The following table of contents outlines the information you’ll find in this guide to low testosterone.

  1. What Is Testosterone and What Does It Do?
    1. The Role of Testosterone in Development and Adult Health
    2. Testosterone Levels Fluctuate
  2. Normal Free Testosterone Levels — The Most Important Measure of Your Testosterone
    1. Normal Free Testosterone Levels for Men
    2. Sex Hormone Binding Globulin Affects Your Body’s Normal Free Testosterone Levels
    3. Normal Testosterone Levels by Age — The Definition of Low Testosterone
    4. Testosterone Levels by Age Can Be Misleading — Focus on the Symptoms
  3. The Truth About Low Testosterone
    1. Is Low T Real or Just a Popular Myth?
  4. The Common Causes of Low Testosterone (Hypogonadism)
    1. What Causes Low Testosterone in Men?
    2. Hypogonadism: An Abnormal Condition
    3. Primary and Secondary Hypogonadism
      1. Secondary Hypogonadism
      2. Primary Hypogonadism
        1. Low Testosterone and Testicular Removal
        2. Primary Hypogonadism and Radiation or Chemotherapy
        3. Primary Testicular Failure and Treatment With TRT
    4. Can Testicular Cancer Cause Low Testosterone?
      1. I Have Low Testosterone — Should I Be Concerned About Testicular Cancer?
    5. Low Testosterone and Pituitary Tumors
      1. What Is a Pituitary Tumor?
      2. Types of Pituitary Tumors
      3. Low Testosterone and Pituitary Tumors: The Basics
      4. Prolactin
      5. Gonadotropin
      6. The Symptoms of a Pituitary Tumor
    6. Low Testosterone And Diabetes: The Surprising Role Of Fat Tissue
      1. How Fat Tissue Connects Testosterone and Diabetes
      2. Diabetes in Men — Lifestyle Choices
    7. Non-biological Factors That Can Contribute to Low T
      1. Pesticides
      2. Parabens
      3. Stress and Depression
  5. Symptoms of Low Testosterone
    1. Low T and Fatigue
      1. Fatigue Should Be Investigated by a Professional
      2. The Cost of Fatigue: Financial and Personal Repercussions
    2. Low T and Low Sex Drive (Libido)
      1. Testosterone and Libido: What to Expect
    3. Low T and Erectile Dysfunction
      1. ED Is Primarily a Blood Flow Problem
      2. Low T, Low Libido, and ED: The Overlap
      3. Low T and ED: Co-occurring but not Cause-Effect
      4. Finding an ED Treatment Plan
    4. Low T and Infertility
      1. The Effects of TRT on Fertility
      2. Infertility Symptoms in Men
      3. Possible Causes of Infertility
    5. Low T and Weight Gain/Weight Control
      1. The Role of Testosterone in Weight Control
      2. Low T and Weight Gain — Feeling Down Affects Your Lifestyle Choices
      3. Low Testosterone Hinders Lean Muscle Development
      4. TRT May Help With Weight Loss
    6. Low T and Anxiety, Difficulty Concentrating
      1. Low T, Anxiety, and Irritability
      2. Low Testosterone and Anxiety: What Are My Options?
    7. Low T and Memory Loss
      1. Low T is Linked to Memory Loss
      2. Low Testosterone and Alzheimer’s Disease
    8. Low T and Depression
      1. Low Testosterone and Depression — If You Have Milder Symptoms
      2. Depression In Men With Low T
      3. Testing For Low T and Depression Screening
      4. Irritability vs. Depression
      5. Low T, Depression, and Concentration
      6. Low Testosterone and Depression — Talk to Your Medical Care Provider
    9. TRT And “Roid Rage”?
    10. Low T and Osteoporosis
    11. Low T and Heart Issues
    12. Low T and Thinning (Body) Hair
    13. Low T Is Common, but It’s not Normal
    14. The Dangers of Low Testosterone: Damaging Your Quality of Life
    15. Low T’s Impact on Job Performance
    16. Low Testosterone Health Risks May Be Quite Broad
  6. Andropause Does not Equal Low Testosterone
    1. Andropause Is not Like Menopause
    2. Andropause or Manopause Is Unlikely to Cause Low Testosterone
    3. The Normal Effects of Aging
  7. Vasectomy and Low Testosterone — An Unexpected Connection
    1. Vasectomy and Low Testosterone — Symptoms to Watch For
  8. Low T in Young Men (20s-30s)
    1. The Symptoms of Low T in Young Men (20s-30s)
    2. Substance Use and Lifestyle Choices
      1. Opioid Use
      2. Excessive Alcohol Consumption
    3. Serious Illness and Medical Conditions
    4. Testicular Trauma
    5. Low T in Young Males Can Indicate a Serious Problem
  9. Hormone Imbalance Affects Your Entire Body
  10. Myths About Low Testosterone In Men
    1. Low T Is Uncommon — False
    2. Low T Treatment Is Expensive — False
    3. Testosterone Only Affects Sex Drive — False
    4. Low T Can Be Ignored Because It Doesn’t Affect Other Aspects Of Your Health — False
    5. I’m Too Young To Have Low T — False
  11. Overcoming the Symptoms of Low T: What to Do Next

Before we dive into defining low testosterone (also known as Low T) and describing its symptoms, let’s quickly explain what testosterone actually is (and what it does in the body of a man).

1. What Is Testosterone and What Does It Do?

What is low testosterone?

Let’s start with the basics.

Testosterone is a sex hormone that’s primarily produced in the testicles. It’s produced at higher levels in men than women.

Only about 5% of male testosterone is produced in the adrenal glands, which means that these glands can’t really take over testosterone production if your testicles are injured or damaged in some way.

Testosterone is generally associated with certain “male” behavioral characteristics, like aggression and risk taking, but this a drastic oversimplification of the role of testosterone in the body.

1.a. The Role of Testosterone in Development and Adult Health

The main role of testosterone in your (male) body is to help you transition from childhood to adulthood.

Male testosterone production does level off after puberty, but production certainly should not fall back to prepubescent levels, which can be incredibly low compared to an adult male.

As production increases during puberty, and healthy levels are maintained throughout adulthood, testosterone plays a vital role in driving the following bodily systems:

  • Produces lean muscle mass
  • Develops bone tissue and maintains density
  • Governs distribution of body fat
  • Deepens a boy’s voice
  • Involved in the regulation of libido (sex drive)
  • Involved in the production of sperm
  • Stimulates normal erectile function
  • Contributes to cognitive function
  • Increases energy production
  • Involved in the creation of blood cells
  • Involved in the regulation of mood
  • Involved in the production of body hair

Though we’re still not quite sure yet, it seems that testosterone also plays a protective role in heart health, possibly affecting everything from rhythm disorders to heart attack severity.

We also suspect it plays a more significant role in cognition than historically recognized, including perceptions of happiness (or a lack thereof i.e. depression), and other brain-related functions, possibly including anxiety.

Testosterone plays a critical role in the building of muscle mass. If you have low testosterone, you’re going to have a hard time building muscle, no matter how much protein you eat, how hard you lift, or how much recuperation you get.

Testosterone also plays a crucial role in how your body distributes fat. Even if your exercise goal is only to lose weight, if you have low testosterone, you may not be able to get rid of the fat you want to shed.

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1.b. Testosterone Levels Fluctuate

Female doctor talking to her male patient at office about testosterone side effects

Even in men who don’t have any hormone issues, testosterone levels fluctuate daily. This is common to every hormone in your body, including estrogen, insulin, adrenaline, cortisol, and others.

What Is Considered Low Testosterone?

This is one of the reasons we only measure testosterone levels in the morning — in the afternoon and evening, men’s testosterone levels tend to drop, sometimes severely.

Why do testosterone levels fluctuate the way they do? It’s an evolutionary matter and not a question we can really answer.

If your peak levels are just barely in the normal range, insurance may say you don’t need therapy; however, this does not take into account what happens as your levels naturally lower throughout the day.

Interestingly, it is believed that testosterone levels do fluctuate from day to day (that is, throughout the month) in addition to the normal daily fluctuation, though the science behind this is new and not nearly as well established as the research behind women’s monthly and yearly hormone fluctuations.

The trouble is, it’s difficult to say how much your levels will rise and fall since every man’s body is different. For some men, levels can fluctuate severely, dropping low enough to result in the symptoms of low testosterone.

For others, who are perhaps in better health, levels may not fluctuate enough to be noticeable.

Clinical low testosterone and normal hormone fluctuation are very different things. Testosterone levels do fluctuate over time, but, unless you are right on the edge of what is considered low testosterone, it is unlikely that the natural fluctuation of your hormone levels will lead to the manifestation of the symptoms of low testosterone.

If you suffer from low testosterone, your endocrine system, made up of glands and hormones, is coming up short on delivering what your body needs, and you could be experiencing negative symptoms as a result.

2. Normal Free Testosterone Levels — The Most Important Measure of Your Testosterone

Normal free testosterone levels for men are 9–30 ng/dl.

Normal free testosterone levels are an important starting point for anyone considering testosterone replacement therapy.

When getting your testosterone levels tested, we can’t stress enough the importance of testing free testosterone (and not simply total testosterone) using a calculated free testosterone test.

Free testosterone is one of the most important measures of hormonal health. The medical community has come up with some benchmarks to compare your levels with. They’re averages based on tests of many, many different people.

They’re not one size fits all.

If you’re experiencing symptoms, it really doesn’t matter what your levels are. You might not technically have low free testosterone, but you might still have testosterone levels that are too low for your body.

Everyone is different, and what works in your body might not work in someone else’s. That’s why we change dosing based on your body’s response (using numbers as a guideline) and recommend injections (which allow us to precisely measure and change your dose).

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2.a. Normal Free Testosterone Levels for Men

As mentioned above, normal free testosterone levels for men are 9–30 ng/dl.

If you’d like to take a look at specific levels by age, check out the results of studies by the Mayo Clinic.

Of course, these numbers mean nothing if your levels are being checked inappropriately. That’s why it’s so critical to get the right test at the right time.

There are other factors that affect free testosterone levels, and these must also be taken into account.

2.b. Sex Hormone Binding Globulin Affects Your Body’s Normal Free Testosterone Levels

Men are often told that their levels are perfectly normal, but unfortunately, they haven’t been thoroughly evaluated.

Their free testosterone levels have not been measured correctly, and the role of sex hormone binding globulin (SHBG) has not been assessed properly.

SHBG has a perfectly descriptive name. It binds to your sex hormones, and, along with albumin, renders them effectively inert.

Your hormones can no longer act in your tissues the way they need to.

And if you have too much SHBG in your body, even if your total testosterone is normal, you may effectively have low testosterone because your normal free testosterone levels are too low.

This leads to the symptoms of low testosterone.

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2.c. Normal Testosterone Levels by Age — The Definition of Low Testosterone

A confirmed clinical diagnosis of low testosterone is made when your levels fall below a particular threshold for men (300 ng/dl for total testosterone and 9 ng/dl for free testosterone).

The Endocrine Society has release definitive guidelines on how to diagnose and treat low testosterone.

To read more about the guidelines set down by The Endocrine Society, click here.

Both men and women experience a gradual decline in both total and free testosterone levels as they age, but these declines should be gradual.

For instance, the generally accepted normal range for a man’s total testosterone is 300-1000 ng/dl, and it’s considered normal to lose 1% of production per year after age 30.

Since T levels should peak in your 20’s, let’s assume someone has a level of 750 ng/dl when they turn 30.

If you subtract 1% of production every year from a starting level of 750, you would have to live until you are 122 before your total testosterone levels would dip below 300 ng/dl.

Yes, testosterone does decline over time, but the average amount of testosterone in a man’s body between the ages of 85 and 100 is around 350. The natural decline of testosterone over time in a man’s body cannot by definition lead to low testosterone.

Clinical diagnosis requires your levels to be tested before 10 AM on two separate days.

Though diagnosis of low testosterone based solely on your total testosterone level is still the norm, we’ve found that directing therapy by managing your calculated free testosterone levels is much more precise.

Though you can look at testosterone levels by age and try to see where you fall, it doesn’t really matter, because age-related testosterone decline is not the same as low testosterone. Further, even if you have a total or free testosterone level that is within the norm, you might still experience symptoms if the levels are too low for your unique biology.

People with “normal” total testosterone levels may still exhibit symptoms of low testosterone, and people with “low” levels may not have any symptoms.

Testosterone levels are nothing more than a marker — they tell us where to start.

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2.d. Testosterone Levels by Age Can Be Misleading — Focus on the Symptoms

Testosterone replacement therapy (TRT) is designed to bring your testosterone levels back to what is normal for your body.

It’s normal to slow down a bit as you age — it’s normal to be less active at 60 than you were at 20. Testosterone replacement therapy isn’t going to give you your youth back.

However, it’s not normal to experience extreme fatigue, sexual dysfunction, depression, weight problems, or any of the other symptoms of low testosterone.

Aging naturally is one thing — falling apart along the way is quite another.

Abnormally low testosterone has a variety of causes in both men and women, many of which are rooted in illness or disease. Aging is not one of these causes.

Also, restoring testosterone levels to “normal” will not reverse aging, but it can definitely help you feel the age you are, instead of 20 years older.

All that matters is this: If you’re suffering, if you’re experiencing the symptoms of low testosterone, then you need to find out where you stand.

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3. The Truth About Low Testosterone

Manopause is a very real condition with very real consequences, but it doesn't always cause low testosterone for this reason

The progressively worsening symptoms of testosterone deficiency are often misattributed to normal aging.

However, it has become commonplace for men in their 50’s, 40’s, and even many in their 30’s, to be plagued by low testosterone and the many symptoms associated with it.

Despite that fact, it is also commonplace to hear medical professionals unfamiliar with testosterone replacement therapy (TRT) say things like:

  • “Low T is made up. You’re supposed to feel this way.”
  • “Only bodybuilders need testosterone shots or TRT.”
  • “You just aren’t working out as hard as you used to. That’s why you’re unhappy with your results.”
  • “You can’t gain muscle because you’re getting older. It’s normal.”
  • “Work stress is the reason you’re irritable all the time.”
  • “Forgetfulness is a normal part of aging. You can’t expect to be as mentally sharp as you were 20 years ago.”
  • “You need better coping skills or a therapist. That’s why you’re feeling depressed.”
  • “You’re not 20 anymore! It’s normal to lose interest in sex.”
  • “You’re old now. Playing sports is for younger men.”
  • “You should be happy you were so fit when you were younger.”
  • “Sleeping poorly is just a normal part of aging. You don’t have anything to worry about.”

Due to pieces of advice like this, many men with true biological reasons for their symptoms never get tested.

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3.a. Is Low T Real or Just a Popular Myth?

Many articles on the subject of low testosterone chronicle the debate over whether this is an “invented” disease or something of substance.

In short, testosterone replacement is both popular and prevalent. Simply because something is common does not make it normal. Cancer is common, thyroid disease is common, diabetes is common, but none of these are normal physiologic states.

Just as with thyroid disorders, once you dip below a certain threshold, it is practically impossible for you to naturally and spontaneously start making more of what your thyroid gland produces.

It creates a disease state that necessitates treatment. In all fairness, you can live with low testosterone, but the prevalence of Low T does not make it normal. Since there are treatment options available, you aren’t required to deal with these symptoms for life.

For patients who are both suffering from symptoms of Low T and have levels that are quantifiably low, testosterone replacement can be literally life changing.

On the other hand, when no physical exam is performed, when no medical interview is conducted, and when no lab studies are ordered to first confirm the condition, testosterone replacement therapy should not be initiated.

Furthermore, if the benefits and risks associated with therapy have not been explained to the patient’s understanding and satisfaction, responsible treatment is on a shaky foundation.

The heart of the matter is whether treatment is done for the right reasons.

For more information, we recommend that you read our definitive guide on Testosterone Replacement Therapy.

4. The Common Causes of Low Testosterone (Hypogonadism)

The dangers of low testosterone — Male patient tells the doctor about his health complaints

Hypogonadism is the medical term for low testosterone.

Coming from the Greek hypo- (meaning “under” or “below”) and gon- (meaning “seed” or “offspring”), hypogonadism is a below-average functioning of the testes in men that can have some serious impacts on your health.

To start with, the testes play an important role in both your reproductive system and your endocrine system (how your body regulates hormone levels, which are primary influences on how your body behaves and reacts).

The two main jobs your testes perform are producing sperm and producing testosterone, along with other androgens (a fancy word for all the hormones that cause the development of male characteristics, like facial hair or increased muscle mass).

Androgens also influence the structure and cognitive performance of the brain.

If you consider that testosterone plays a vital role in your hormonal system and in brain function, you’ll begin to understand why it’s important for medical providers to know the science of Low T — the causes, results, treatments, and outcomes all matter.

One of the most common indicators that this process has begun occurs when men first notice a slight drop in their sex drive. While this is completely normal, T levels that begin to drop faster, and drop too low, can actually lead to the onset of other health issues.

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4.a. What Causes Low Testosterone in Men?

Diseases of the bodily structures that make and manage testosterone, such as the hypothalamus or pituitary glands, are one category of possible causes.

Damage to the testes from an accident, radiation, surgery or chemotherapy for testicular cancer, is another potential cause.

Certain medical conditions could result in low testosterone, including:

  • Klinefelter syndrome
  • Down syndrome
  • Obesity
  • Opiate pain medication use or abuse
  • Hypothalamic disease, including hypopituitarism or hyperprolactinemia
  • Pituitary disease
  • Type II diabetes
  • Alcoholism and drug abuse
  • Hemochromatosis
  • Sickle cell disease

These are only some of the possible causes, not a comprehensive list.

Unfortunately, due to the complex nature of hormones generally (and their wide range of actions in your body), they can be disrupted in many different ways.

Many experts point to our environment (exposure to chemicals or other suspected or actual endocrine disruptors) as a probable reason.

It’s not always clear what the culprit is. In fact, this study shows that the generational decline we are seeing is not related to behavior or health.

The simple truth is that abnormally low testosterone levels can affect almost everything in a man’s system, often negatively contributing to much more serious conditions.

Maintaining proper levels of this critically important androgen is finally beginning to be appreciated as central to preserving male health.

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4.b. Hypogonadism: An Abnormal Condition

When we talk about hypogonadism in men, we’re talking about an abnormal medical condition — something that shouldn’t be happening or that’s happening unnaturally.

In men, the majority (over 95%) of testosterone is produced in the testicles. This means that diseases, disorders, or even physical damage to your testicles can result in low testosterone — not the natural decline of hormones.

You are likely to experience symptoms of low testosterone as a result, such as:

  • Fatigue
  • Sexual dysfunction
  • Weight problems
  • Trouble concentrating
  • Loss of endurance
  • Depressed mood
  • Muscle weakness and loss

The natural decline in hormone production is supposed to be very slight. Studies show that this should only be a loss of about 1% per year. What we are seeing in our practice proves that this is not what is happening.

It’s not normal for your hormones to naturally drop below normal parameters without some disease or disorder causing this decline — it’s just not going to happen.

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4.c. Primary and Secondary Hypogonadism

Doctor talking to senior man in an office appointment about chronic low testosterone

This rather common and treatable condition is broken down into two types — primary hypogonadism and secondary hypogonadism.

4.c.i. Secondary Hypogonadism

Secondary hypogonadism is basically a breakdown in the hormonal communication network between your brain (the hypothalamus and pituitary gland) and your testes, where testosterone and sperm are produced.

Secondary hypogonadism could be thought of as crossed wires or a problem with your body’s operating system. Your biochemical communication network of hormones is malfunctioning. Secondary hypogonadism is often a problem intrinsic to the pituitary gland.

Even though the body’s machinery responsible for testosterone production is in good working order, it’s simply not getting the messages that tell it when and how to do its job, to produce the needed quantities of testosterone and other hormones.

For one reason or another, a member of this communication system is not sending the proper messages or interpreting your body’s signals appropriately, and the testes aren’t being notified that the body needs to produce testosterone.

Low testosterone and its associated symptoms can result.

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4.c.ii. Primary Hypogonadism

Primary hypogonadism generally refers to a condition that is more severe, and, often, more permanent. Basically, you have a hardware malfunction. The machinery in your body that produces hormones is damaged in some way.

Primary hypogonadism is often referred to as primary testicular failure. Your testicles are not able to produce the necessary testosterone for balanced hormone levels, often due to injury or trauma.

Some causes of testicular failure and primary hypogonadism are:

  • Klinefelter’s syndrome
  • Adolescent mumps (or other infections) causing extreme swelling of the testicles
  • Trauma or injury to the testicles
  • Tumors and cancer
  • Radiation treatment for testicular cancer
  • Surgical removal of one or both testicles

All of these causes, including both tumors and their rather harsh treatment options, fall under a general heading of testicular trauma, preventing the testicles from functioning properly.

We often find primary hypogonadism to be the issue when treating a younger male for low testosterone.

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4.c.ii.A. Low Testosterone and Testicular Removal

This is the most obvious type of “testicular trauma” — removal of one or both testicles can be necessary in the event of accidental injury or as a part of cancer treatment.

When only one testicle is removed, there is usually a severe, initial drop in testosterone production. However, in many cases, the remaining testicle will pick up the slack by increasing production, resulting in a return to more-or-less normal testosterone levels (though this is not always the case).

Removal of both testicles leads a total loss of testosterone production, necessitating hormonal replacement therapy.

4.c.ii.B. Primary Hypogonadism and Radiation or Chemotherapy

Harsh treatments for cancer can result in the testicles ceasing to function, or functioning at lower-than-optimum levels.

This is usually temporary, and the testicles could return to normal function some time after the radiation or chemotherapy has been completed.

Unfortunately, this is not always the case. The physical trauma caused by these harsh (but often life-saving) treatments can sometimes cause a permanent reduction in testosterone production.

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4.c.ii.C. Primary Testicular Failure and Treatment With TRT

If you suffer from primary hypogonadism, a treatment regimen of supplementary testosterone is recommended.

This article from The National Center for Biotechnology Information sums up the benefits of testosterone replacement therapy (TRT) for men suffering from all forms of low testosterone, including primary hypogonadism:

“For men who have a diagnosis of primary or secondary hypogonadism, with symptoms referable to consistently low serum testosterone levels, testosterone replacement should be offered because most studies show that benefits outweigh potential risks. In most studies concerning hypogonadal men receiving testosterone replacement, improvement in sexual function and lean mass, decrease in fat mass and increase in bone mineral density are more consistent in younger than older men.”

Those are much needed benefits for someone suffering from primary hypogonadism, especially when you consider that the effects of testicular trauma may be permanent.

Men who have lost function in one or both testicles may never return to normal testosterone production. They will have to rely on exogenous testosterone (testosterone administered from outside the body) to return to normal testosterone levels.

Fortunately, this is exactly what testosterone replacement therapy does. Through injections or other methods, the testosterone your body used to produce is replaced, and, as far as your body is concerned, nothing has changed.

4.d. Can Testicular Cancer Cause Low Testosterone?

can low testosterone cause depression? Depressed man in the dark.

Yes, it can, but it’s actually more likely that the treatment for testicular cancer is resulting in testicular trauma and primary hypogonadism.

In fact, as many as 38% of those receiving treatment for testicular cancer or rebounding from the treatment process were found to have below-normal testosterone levels or were receiving testosterone replacement therapy.

As a result, many men with low testosterone during or after testicular cancer treatment had developed health problems identified as symptoms of low testosterone, including:

  • High blood pressure
  • Diabetes
  • Erectile dysfunction
  • Anxiety
  • Depression

The effects of chemotherapy and radiation often subside after a period of time, and the testicles may return to normal function. However, the effects are sometimes permanent.

Unfortunately, testicular cancer can necessitate the surgical removal of one or both of the testicles in order to save the patient’s life, an operation called an orchiectomy.

The body has no backup system for testosterone and sperm production, which means that, if removal of both testicles is necessary, natural testosterone production will cease.

However, should it only be necessary to remove one testicle, low testosterone levels may normalize as the remaining testicle increases production to compensate. It is possible that removal of a single testicle may not be permanently detrimental to testosterone levels.

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4.d.i. I Have Low Testosterone — Should I Be Concerned About Testicular Cancer?

If you suffer from low testosterone, there is no need to panic. There are many more common indicators of testicular cancer that you should be on the lookout for. Common indicators include:

  • Pain
  • Changes in size or shape of the testicles, including detectable lumps
  • Blood clots causing swelling of 1 or both legs or shortness of breath
  • Breast tenderness or growth — called gynecomastia
  • Sudden buildup of fluid in the scrotum

If you’re experiencing low testosterone in conjunction with these other symptoms, it would be advisable to get checked out by a medical professional, such as your primary care physician or a urologist.

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4.e. Low Testosterone and Pituitary Tumors

Testosterone levels do vary by age, but normal reduction of testosterone over time, but it can never result in clinically low testosterone.

One of the less common causes of low testosterone is a specific type of pituitary tumor.

The pituitary gland is a tiny organ about the size of a pea, located in your brain. Pituitary tumors are a type of brain tumor that can often mimic the function of this gland, producing extra hormones that your body doesn’t need and throwing your overall hormone balance into disarray.

Hormones are fickle things. The complex interplay of hormones in your body is quite delicate, and it doesn’t take much to throw it off balance and affect your body profoundly.

To fight the tumor, you must first know the tumor is present.

4.e.i. What Is a Pituitary Tumor?

First, let’s briefly discuss the difference between having a tumor and having cancer.

Although many people use the terms interchangeably, they don’t mean the same thing. A tumor is just an abnormal clump of cells that either grew in a way it shouldn’t have or that should have died and didn’t (or both).

Cancer, on the other hand, is when your tissue is dividing abnormally (usually in an out-of-control way) and is threatening or invading other tissues.

Many cancers begin as tumors, but not all tumors are cancerous. Tumors generally come in two forms — benign (meaning harmless) and malignant (meaning harmful).

Cancer can spread to other areas of the body.

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4.e.ii. Types of Pituitary Tumors

As you might expect, there are different types of pituitary tumors. Some are benign, and some are malignant, but all are made out of cells that originated in your pituitary gland or the surrounding tissues.

The symptoms of a pituitary tumor depend a great deal on the type of pituitary tumor that you have. These tumors come in various forms:

  • Benign
  • Invasive
  • Malignant

For pituitary tumors, benign means that the tumors grow slowly and do not spread. Invasive means that the tumor spreads only into the tissues that surround the tumor (into other areas of your skull, basically). Malignant means that the tumor is cancerous and can spread to other areas of your body beyond your skull.

Fortunately, malignant pituitary tumors are rather uncommon.

Because a tumor is simply an abnormal growth of cells, it exhibits many of the same properties of whatever cells it grew out of in the first place. A tumor that grows out of a bone is often a bony growth, while a tumor that grows out of your skin is, in many cases, just a big lump of skin.

But a tumor that grows out of your pituitary gland is still made of the same cells as your pituitary gland, meaning that the symptoms of a pituitary tumor are directly related to the type of hormone-producing pituitary gland cells where the tumor originated.

That means the tumor may have the capacity to create hormones and spread them into your bloodstream.

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4.e.iii. Low Testosterone and Pituitary Tumors: The Basics

There are two main types of pituitary tumors, designated by what they do in your body: functional and nonfunctional adenomas.

Functional means the tumor is behaving like another pituitary gland, adding too much of a particular hormone into your body.

Depending on the tumor, it might produce one or more of the following hormones:

  • Growth hormone
  • ACTH (which stimulates your body to produce steroid hormones)
  • Thyroid-stimulating hormone
  • Prolactin
  • Luteinizing hormone

It’s the last two hormones that interest us most. These hormones can be produced by two specific types of pituitary tumors:

  • Prolactinomas (secrete excess prolactin)
  • Gonadotropin-secreting adenomas (secrete excess luteinizing hormone or other hormones)

The problem with these hormones is that both can cause secondary hypogonadism and associated sexual dysfunction.

4.e.iv. Prolactin

Prolactin is a hormone normally associated with milk production in women, but it naturally occurs in small amounts in men. Excess prolactin has been associated with low testosterone levels, and according to one study:

Hyperprolactinemia [excess prolactin] induces hypogonadism [low testosterone in men] by interfering with the secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus.

4.e.v. Gonadotropin

Another class of hormones, gonadotropins, are also associated with secondary hypogonadism.

According to The Merck Manual:

“High gonadotropin levels, even with low-normal testosterone levels, indicate primary hypogonadism, whereas gonadotropin levels that are low or lower than expected for the level of testosterone indicate secondary hypogonadism.”

While adding any of these hormones to your system is severely problematic, there’s not much that can be done to help with excess growth hormone.

However, if your body is making excess luteinizing hormone or prolactin, the effects this would have on your testosterone levels can be countered once the source of the problem is addressed.

For many functional pituitary tumors, even the treatment itself (brain surgery or radiation) can disrupt normal hormone production, leading to primary or secondary hypogonadism.

In these cases, long-term testosterone replacement therapy (TRT) may be necessary because your body no longer produces testosterone normally.

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4.e.vi. The Symptoms of a Pituitary Tumor

If you have a pituitary tumor, no matter if it’s benign, invasive, or malignant, that tumor may have the capacity to function, basically, as a second pituitary gland, making just about any hormone that your pituitary gland can make.

If it doesn’t have the ability to function, it can still cause the same types of symptoms that any tumor might cause.

The symptoms of a pituitary tumor are determined largely by the ability of the tumor to function. If your body is producing too much of one type of hormone or another, you’re going to experience symptoms related to the excess hormone that’s being produced.

The way the tumor is growing also affects your symptoms. The tumor can not only cause pain or symptoms because it’s pressing on certain areas of your head or skull, but it can also cause your pituitary gland to act abnormally.

Here’s a few different symptoms that you may experience:

  • A headache
  • Erectile dysfunction (for men)
  • Libido problems or lack of a sex drive
  • Lactation (for women, and in extreme cases, men)
  • Vision problems or loss (at the periphery and usually both sides)
  • Mood problems (anxiety, irritability, or depression)
  • Snoring, apnea, insomnia, or other sleep problems
  • Seizures, dizziness, confusion, nausea, or even vomiting
  • Runny nose
  • Hair loss or hair growth
  • Abnormal weight gain, or weight gain in the face, neck, and upper body (while extremities stay small or thin)

Unfortunately, the range of symptoms for pituitary tumors is quite wide, mostly because the different types of pituitary tumors can vary so widely.

Many of these symptoms also apply to a wide variety of diseases.

If you really want to dive into pituitary tumors and how they work, you can read this comprehensive article on pituitary tumors.

Also, check out this list of many possible symptoms for different types of pituitary tumors. If your symptoms align with these, you’ll want to consult your primary healthcare provider about next steps.

Once your treatment is complete, testosterone replacement therapy may be appropriate, especially if you’re exhibiting signs of low testosterone (hypogonadism).

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4.f. Low Testosterone And Diabetes: The Surprising Role Of Fat Tissue

More and more clinicians are beginning to see a connection between low testosterone and diabetes centered around one particular body tissue:

Fat.

When we think of diabetes in men, one of the first things that comes to mind is being overweight.

Scientists have long known that a large amount of adipose tissue (fat) is often correlated with diabetes. Similarly, several studies have shown that low testosterone can often be found in conjunction with high levels of adipose tissue.

Naturally, researchers began to look at the possibility that low testosterone and diabetes could also be related.

4.f.i. How Fat Tissue Connects Testosterone and Diabetes

We are still not entirely sure of the role that fat plays in the regulation of hormones, though we’ve learned quite a bit in the last few decades.

For instance, we now know that adipose tissue can produce estrogen. This is one of the many reasons we recommend our patients lose weight as part of their fight against low testosterone.

Research has shown that visceral body fat (that is, fat stored around the abdominal cavity) actually acts a lot like an endocrine organ, taking on the same functions of the pituitary gland.

Clinically, we also often see the direct, positive effect of testosterone on visceral body fat. Men and women who undergo testosterone replacement therapy tend to lose weight.

Diabetes is strongly correlated with high amounts of visceral body fat, indicating a possible connection between low T and diabetes. Since the 2000s, an increasing amount of research on testosterone and diabetes has shown a strong link between the two conditions.

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4.f.ii. Diabetes in Men — Lifestyle Choices

Insulin is a hormone. Choices leading to poor physical condition can negatively affect hormone levels, increasing the likelihood of diabetes.

In men, the following factors can increase the chances of type 2 diabetes, as well as other hormone imbalances:

  • Poor diet
  • Lack of exercise
  • Obesity

If you maintain a healthy diet and exercise regularly, it may be possible to reverse your diabetes and better regulate your hormones (though it is unlikely to reverse clinically low hormone levels).

Some symptoms of Low T can contribute to the negative lifestyle choices mentioned above. Exercise can be hard enough to fit into your hectic daily schedule, but making it to the gym, to the bike trail, or to the running meetup is so much harder when you already don’t feel well.

Anxiety and depression, other common symptom of low testosterone, can also lead to poor eating choices at irregular times.

These daily hindrances, which can be caused or worsened by clinical hypogonadism (low testosterone), may contribute to a lower quality of health and possibly to obesity.

As testosterone levels begin to drop, your exercise will likely become less impactful. Losing weight will become more difficult, making diabetes that much more likely.

Diabetes will also cause your testosterone levels to fall more rapidly than if your body handled glucose normally.

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4.g. Non-biological Factors That Can Contribute to Low T

Many experts in the field point to environmental exposures or endocrine system disruptors as a reason we are seeing an increasing number of low testosterone diagnoses in recent years.

4.g.i. Pesticides

Studies have shown that Glyphosate-based pesticides, one of the most common being Roundup, work as endocrine disruptors.

Exposure to these pesticides and herbicides via ingestion or physical exposure can affect male testosterone levels as well as sperm counts.

4.g.ii. Parabens

Take a look at your body washes, shampoos, and skin products, and you may see some derivative of the word “paraben.”

Parabens are also endocrine disruptors. They elevate estrogen levels while simultaneously decreasing testosterone levels.

We recommend looking for products that are paraben-free before taking them off the shelf.

4.g.iii. Stress and depression

In an era where people are always on the go, stress has become a state of being.

Unfortunately, studies are showing that continued stress takes its toll on testosterone levels. The same is true for depression. If you are chronically stressed or prone to depression, you are more likely to suffer from Low T.

Fortunately, testosterone replacement therapy, can be effective regardless of the cause.

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5. Symptoms of Low Testosterone

One of the greatest difficulties with diagnosing low testosterone is that low testosterone symptoms can vary so widely.

Testosterone Deficiency Symptoms—Low T

Like any medical condition, effects and symptoms strike individuals differently.

However, there are a few common symptoms that apply broadly and can really hamper a man’s lifestyle, including:

  • Fatigue
  • Low libido (sex drive)
  • Erectile difficulty
  • Weight control problems
  • Anxiety and trouble concentrating
  • Memory loss
  • Depressed mood
  • Weakened bone structure (osteoporosis)
  • Possible pulmonary issues
  • Loss of body hair

The symptoms of Low T can be debilitating, but it is paramount that you realize your symptoms are not normal. It’s not just aging, and you don’t have to live with it.

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5.a. Low T and Fatigue

The symptoms of a pituitary tumor — man in PJs holding head with one hand on edge of the bed.

Fatigue is one of the more common symptoms of low testosterone, but what does that term really mean?

This isn’t the same as simply feeling tired or exhausted, which should go away after a good night’s sleep. Within the context of Low T, fatigue is a potential sign of disease that presents as prolonged exhaustion — feeling so tired and unmotivated that you can’t do anything, day after day, week after week, month after month.

The type of fatigue we’re talking about often has two components — a mental side and a physical side. This means that you could very well be experiencing fatigue without necessarily feeling physically exhausted (or vice versa).

Here’s what fatigue looks like, according to a report from the Journal of the Royal Society of Medicine:

  • Lack of motivation
  • Lack of alertness
  • Lack of energy
  • Lack of strength
  • Significantly affects your functioning
  • Isn’t proportionate to your exertion
  • Represents a clear change from a previous state

However, all of this is subjective. Fatigue means many different things to many different people. You may hear it used interchangeably with the following terms:

  • Lethargy
  • Low energy
  • Tiredness
  • Listlessness
  • Weariness
  • Exhaustion
  • Burnout

Undoubtedly, it is one of the most widely reported symptoms across hundreds of disease states, including low testosterone and low estradiol — there’s no way to know what’s causing it without further testing.

To sum all this up, chronic fatigue is a marker of disease. It signals that something is wrong with your body, and it can be triggered by stress, medication, overwork, or mental and physical illness or disease.

Thinking of fatigue in this way allows one to acknowledge that this symptom may be multifactorial. That is, it may have several different causes at one time. Also, it is entirely possible for someone to be suffering from Low T and not experience significant fatigue at all.

The presence or severity of fatigue will manifest differently, and be experienced differently from person to person.

As imprecise as fatigue may be, evaluation of how a lack of energy may be keeping you from engaging your family and loved ones or how exhaustion may be contributing to a deteriorating work performance remains relevant.

In the absence of outside stressors, if you’re experiencing chronic fatigue, it may indicate a deeper issue.

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5.c.i. Fatigue Should Be Investigated by a Professional

There is little diagnostic value in using fatigue as a stand-alone marker of testosterone levels, so you need to see a medical care provider and find out what’s going on in your body. It’s not normal to be tired all the time.

A blood test will often reveal what the actual cause is, including the possibility that your fatigue is related to low testosterone.

For the purposes of screening for Low T, fatigue must be evaluated as a single component of a conglomerate of symptoms. It should take its place among the myriad of possible negative effects that hypogonadism (low testosterone production) can induce. Rarely would a person with only an isolated symptom of “tiredness,” absent of other symptoms, be appropriate for treatment.

Testosterone Replacement Therapy (TRT) should be reserved for those individuals who are truly symptomatic and verifiably testosterone deficient.  As with any medical intervention, there are side effects to be contemplated and monitored, and forging ahead with unnecessary treatments is both reckless and unethical.

5.c.ii. The Cost of Fatigue: Financial and Personal Repercussions

A study (by Shahraki S, Bakar N.) published in the International Journal Of Academic Research in 2011 showed that the “costs” of fatigue “were roughly equal to 2.3 days absent per worker every month.” This is not counting actual absenteeism, but rather time at work when so little is accomplished by a given employee, that it is as if they aren’t even there.

While this virtual absenteeism may not affect your wages as a sick day might, it is likely that it could affect your performance evaluations, attainment of success, and salary raises (or lack thereof).

One can only imagine the economic impact on larger scales.

If your testosterone levels are too low, you may find it more difficult to think clearly, function at work, and work out at the gym, or simply move through your day with the same amount of energy as your friends and co-workers.

This fatigue can also carry over into poor performance at home and in the bedroom. You may have less energy when it comes to socializing as well as running around with your kids.

Consider whether you’ve shown any of the other symptoms of low T (that we’re going to discuss in the following sections) in combination with fatigue. If so, you may benefit from Testosterone Replacement Therapy.

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5.b. Low T and Low Sex Drive (Libido)

What is libido? Your libido is your desire to have sex, as opposed to your ability: click to learn more.

Libido refers to the biological urge toward physical intimacy. Libido is not your ability to have sex, but your desire to have sex.

We see low/non-existent libido from time to time as a hallmark symptom of low testosterone, both in men and women.

To briefly clarify the difference, erectile dysfunction is a lack of the ability to have sex, even if the desire is still present. Low libido, on the other hand, is the lack of desire to have sex, even if you have the ability.

When discussing your libido, the question you need to answer is, “Do you feel that your desire/appetite for sex is normal and healthy?”

It’s no secret that low levels of testosterone and sex drive are closely linked and that millions of men suffer from this degrading and discouraging condition, suffering in silence while their partners suffer silently next to them.

A significant or appropriate sex drive is a vital component of a healthy adult relationship between you and your partner. A healthy libido should not be overpowering and distracting, but neither should it be nonexistent.

Testosterone is the key hormone supporting a man’s libido.

5.d.ii Testosterone and Libido: What to Expect

If testosterone is deficient, Testosterone Replacement Therapy will certainly support your libido and possibly improve physical performance. Libido changes are often specifically linked to testosterone changes.

Returning testosterone levels to normal alone isn’t going to turn you into Superman in bed, but the increase in your confidence brought on by success in other parts of your life could definitely help you connect more deeply and significantly with your partner.

Being more confident and having an improved sense of well being may work wonders. If you feel confident and ready then you are confident and ready.

Only a blood test will tell you if your sex drive issues are a result of low testosterone. For example, it’s possible your libido is low because you’re taking antidepressants or other medication. A simple blood test and thorough evaluation can help you define what the real problem is — testosterone or otherwise.

Most men find their libidos return after only a few weeks of TRT.

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5.c. Low T and Erectile Dysfunction

Low T can cause ED in some cases.

Low T and Erectile Dysfunction (ED)

However, it’s more likely that something else is causing your erectile dysfunction if it is severe, and that low testosterone is simply making a bad situation worse.

The role of testosterone in gaining and maintaining erections is important, but not as huge as you might think. Advertising media might want you to believe that low testosterone is the one and only cause of erectile dysfunction, but it simply is not. Few cases of erectile dysfunction are solely related to low testosterone, which separates it from low libido.

Erectile dysfunction is most often associated with vascular dysfunction. For some men, erectile dysfunction is expected as they age, but younger men who suffer from the inability to achieve an erection might have Low T contributing to their troubles.

TRT may not cure most cases of erectile dysfunction.

5.c.i. ED Is Primarily a Blood Flow Problem

ED has less to do with your hormones than your blood flow.

To simplify a complicated process, an erection is achieved when your penis fills with blood. Your blood’s ability to flow through your body the way it should has a much more direct effect on your ability to have an erection and to maintain it, and it also has a much more direct effect on the strength of your erection.

So, it makes sense that diseases or disorders that affect blood pressure and blood flow are going cause erectile dysfunction. Here are a few diseases and disorders that can affect circulation and may have a more powerful effect than low testosterone:

  • Obesity
  • Diabetes
  • Heart disease
  • Atherosclerosis
  • High blood pressure
  • High cholesterol

That said, if you combine these problems with clinically low testosterone, you’re probably going to have worse ED than you would otherwise.

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5.c.ii. Low T, Low Libido, and ED: The Overlap

Testosterone and libido

Testosterone plays a key part in a man’s libido, or natural drive toward sexual intimacy. Testosterone is also what helps you achieve an orgasm. If you are having difficulty achieving orgasms, Low T might be a reason.

Testosterone, because of its libido connection, helps men achieve an erection. In men with low testosterone levels, achieving an erection may take much longer than it once did.

There are strong psychosocial, or “brain/emotion,” influences that are involved in erectile function. Testosterone plays a role in most of these triggers. However, to say that “fixing” your Low T will fix your problems with ED would be a huge overstatement.

Since the majority of what happens when a man gains an erection is related to blood flow and blood vessels, men with severe erectile dysfunction will need to have these vascular issues properly addressed, regardless of their testosterone levels.

5.c.iii. Low T and ED: Co-occurring But Not Cause-effect

ED and low testosterone often occur together, along with a host of other disorders and diseases.

When this is the case, treatment of erectile dysfunction with drugs like viagra will be more effective when combined with treatment for low testosterone. One study found that a form of testosterone helped restore sexual function in diabetic patients who weren’t responding to viagra.

Another study found that viagra, when given to men with diagnosed low testosterone and erectile dysfunction, was more effective when combined with testosterone than when given alone, especially in men who were found to be unresponsive to viagra alone.

For several of the diseases I listed above, low testosterone can be a severely complicating factor, which means that low testosterone may be indirectly contributing to erectile dysfunction by worsening obesity, diabetes, and other circulatory diseases.

Feedback loops are established: For instance, low testosterone can exacerbate obesity (and make weight loss harder), and the additional body fat can drive testosterone levels down even further, which can then turn around and drive the obesity. The negative cycle is fairly clear.

The obesity may then lead to high blood pressure or heart disease, which would then make the ED even worse — problems begin to compound.

Then, add in the fact that low libido due to low testosterone can also further complicate your ability to achieve an erection.

As you can see, the truth is a lot more nuanced than it appears at first, so we often say:

Low testosterone can cause ED… But it’s complicated.

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5.c.iv. Finding an ED Treatment Plan

In order to come up with a treatment plan for erectile dysfunction, it is important to understand what is causing the problem.

Testing testosterone is an easy, straightforward blood test. If testosterone is found to be low, a treatment plan can be put in place that will raise those numbers, and potentially help you improve your sex life.

If low testosterone isn’t the culprit, your problems will need to be addressed differently.

The use of medications such as Viagra, Levitra, and Cialis can help many men with erectile dysfunction, and studies show that treating your Low T while taking these drugs appropriately helps them to work more effectively.

It may be that Testosterone Replacement Therapy, combined with other treatments for ED (and even diet and exercise) may all combine to address a combination of problems.

Evaluation by a medical professional is critical to make sure that all contributing factors are addressed.

It is possible your symptoms are related to Low T, and it is also possible they are not. The best way to figure it out is to speak with an experienced provider as soon as possible.

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5.d. Low T and Infertility

 

testosterone and fertility

It’s true that testosterone and fertility go hand in hand, as do low testosterone and infertility.

Testosterone plays a key role in the production of sperm and a low sperm count, so, if your testosterone is low, your sperm count likely will be too. While a man with low testosterone can perhaps still father a child, optimum fertility seems directly linked to healthy levels of hormones in the body.

Testosterone also factors heavily into your sex drive, interest in sex, and your ability to have and maintain an erection, all of which are necessary to conceive a child.

It would stand to reason that higher levels of testosterone would mean higher levels of fertility, easily achieved by increasing testosterone levels, but it’s not that simple.

While it’s true that low levels of testosterone could be the culprit for low sperm production or a lack of sexual performance, simply treating your low testosterone is not necessarily an effective solution to your infertility.

If you have secondary hypogonadism (low testosterone caused by a failure in your pituitary gland or hypothalamus), certain hormonal therapy may help restore fertility.

The bad news is, if you have primary testicular failure (direct damage to the testes) or primary hypogonadism, testosterone replacement therapy will likely make your infertility worse.

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5.d.i. The Effects of TRT on Fertility

The goal of Testosterone Replacement Therapy is to place you within optimal hormone levels, but it does this by adding outside testosterone to the body.

When this happens, the brain registers the hormone levels in the body and shuts down its normal production of testosterone, which simultaneously stops the production of sperm.

However, if your testes are producing a normal amount of testosterone and your glands are actually the problem, introducing other stimulatory hormones like hCG or medications like Clomid may restore fertility.

So while TRT can be a tremendous boon in combating other unwanted symptoms of low testosterone and can help some types of low testosterone, it’s not useful for correcting infertility.

If you’re looking into Testosterone Replacement Therapy for reasons other than infertility, it’s important to ask yourself if having children now (or in the future) is something you are still considering.

Both low testosterone and fertility are issues that can be addressed, separately or in combination — start a conversation with your medical care provider and get the process moving.

You don’t have to live with either.

Click to read more about the connection between TRT and fertility.

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5.d.ii Infertility Symptoms in Men

For men, the main sign of infertility is often simply an inability to impregnate their partner.

Because conception can be difficult to achieve anyway, it can often take a very, very long time for a man to begin to suspect that he’s infertile.

The only way to be sure is get a semen analysis performed by your medical provider, but there are a few infertility symptoms that are more visible, or at least, more noticeable, than simply not having a baby, such as:

  • Reduced or increased hair growth
  • Sexual dysfunction or a lack of libido
  • Physical changes in testicles
  • Pain or swelling in the testicles

If you find that any or all of the above symptoms are taking place, it’s important to speak to your medical provider because you need to ensure that you don’t have a deeper, more problematic issue underlying your infertility.

5.d.iii. Possible Causes of Infertility

Possible causes of infertility include:

  • Low testosterone (or other hormonal imbalance)
  • Sexually transmitted diseases
  • Alcohol or drug use, abuse, or dependence
  • Genetic abnormalities like Klinefelter syndrome
  • Injury to the genitals

Just to make sure we’re on the same page, infertility can also be caused by a vasectomy. Yes, this is the goal of the procedure, but the potential side effects of a vasectomy include permanent infertility, even if you’ve had the vasectomy reversed.

Your body can begin producing sperm antibodies. These antibodies will attack, and render ineffective, any sperm that you produce.

This means that, even if your vasectomy is successfully reversed, you may still be infertile.

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5.e. Low T and Weight Gain/Weight Control

Low testosterone effects (weekly pill container with pills in front, digital blood pressure machine and cuff, pills sealed in aluminum packaging)

If you’re a man who is somewhat overweight and suffers from Low T, controlling your weight or achieving significant weight loss is going to be more difficult, even for men who may have had no trouble staying lean and strong in their younger years.

Some fluctuation of weight is expected in later life, but, if you are finding it difficult to control your weight, and mild changes in diet or exercise are not proving effective, low testosterone could be a contributing factor.

Low T and weight gain are linked in a cycle where each condition makes the other worse. Low T contributes to more fat tissue, and a greater amount of fat tissue creates estrogen, which further pushes down testosterone levels.

Whether the initial weight gain was brought on by low testosterone, or whether the low testosterone was caused by the weight gain, they both feed into one another, making it difficult to break free of the downward spiral.

As men age, they can easily become trapped in this cycle. No matter how hard they exercise, how well they eat, or how careful they are, many men gain weight as they age, especially around the midsection.

In this way, Low Testosterone could explain why it’s so much harder as we age for us to maintain the lean, healthy body we kept with much less effort when we were younger.

This cycle must be interrupted somehow in order for weight loss solutions to be effective.

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5.e.i. The Role of Testosterone in Weight Control

Hormones play a central role in controlling our body’s development and maintaining its overall health.

The following are some of the critical bodily processes that testosterone affects in men:

  • Sex drive regulation (libido)
  • Fat distribution control
  • Muscle mass creation
  • Strength development
  • Red blood cell production
  • Bone mass maintenance
  • Sperm production

You can easily see how some of these contribute to a healthy physique and a more vibrant appearance — when testosterone levels are healthy, your body looks and feels better.

On the other hand, when testosterone levels drop abnormally, one of the unwanted symptoms that can develop is weight gain. That weight gain can occur for a couple of different reasons.

5.e.ii. Low T and Weight Gain — Feeling Down Affects Your Lifestyle Choices

Low T in young males, like the young man pictured here, is abnormal — but there's something you can do about it.

The first way that Low T and weight gain are connected is a little more indirect.

Is low mood dampening your desire to hit the gym?

Are frequent episodes of fatigue persuading you to skip your usual runs or limiting the effectiveness of your workouts?

When we consider that fatigue, low energy levels, and mild depression are common symptoms of low testosterone, it is entirely likely that Low T may be, in turn, affecting your health choices related to diet and exercise.

Weightlifting and HIIT (high intensity interval training) have proven to be great forms of exercise that can both burn fat and provide a slight increase in testosterone.

Better forms of exercise might be enough to get you out of that low-energy cycle and back on track if you’re suffering from mild or occasional low testosterone.

Additionally, the common symptoms of irritability and anxiety can lead to poor decisions about when and what to eat, leading to calorie overages that contribute to weight gain.

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5.e.iii. Low Testosterone Hinders Lean Muscle Development

Testosterone is responsible for building and maintaining muscles, the primary reason men typically have more muscle and put on muscle more easily than women.

When testosterone is especially low, muscle mass will begin to decline, and strength will suffer as well. This works against you when trying to maintain your fitness level. Less muscle burns fewer calories. When your testosterone levels are low, muscle recovery and growth is stunted.

The best diet and exercise in the world may not be enough if you’re struggling with clinically diagnosed chronic hypogonadism (the medical term for low testosterone).

Men’s bodies contain both testosterone and estradiol (a form of the female sex hormone estrogen), and they work together like cast members in a theatrical production.

When testosterone levels are in the normal, healthy range, testosterone plays the leading role, and estradiol is more of a supporting cast member (though very important). The result of this healthy partnership is more lean muscle mass being developed instead of fat tissue.

But, if testosterone decreases, estradiol may become more dominant than it should, and those higher estrogen levels will result in increased fat production, directly connecting weight loss problems and loss of muscle mass.

Too much estrogen results in a compounding problem. Increased fat tissue acts as an estrogen-producing organ, which means even more estrogen is released into a man’s system, leading to even greater fat production, and so on in a worsening pattern.

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5.e.iv. TRT May Help With Weight Loss

TRT may help with weight loss, but only in conjunction with diet and exercise. More importantly, healthy testosterone levels can help you improve your body composition.

Low T treatment, weight loss, and more efficient muscle development are intricately connected in men suffering from clinical low testosterone.

Studies have shown that testosterone can help combat obesity, demonstrating statistically significant changes in both body weight and body fat.

But these same studies suggest that testosterone alone is insufficient — hard work is necessary, both in the gym and in the kitchen.

5.f. Low T and Anxiety, Difficulty Concentrating

Does a vasectomy hurt? Pensive man researching vasectomies with a worried expression

Low testosterone can seriously hamper your daily performance at work, in your hobbies, and in your relationships by contributing to anxiety or difficulty concentrating.

In fact, there have been more than a few studies on how testosterone and anxiety interact.

Brain fog, or a decline in cognitive acuity, is also a symptom of Low T, especially if your inability to concentrate is coupled with fatigue, depressed mood, or other symptoms related to hormone imbalance.

Unfortunately, Low T symptoms don’t tend to subside as the day goes on, but instead worsen. By the time the afternoon rolls around, you’re probably feeling like you’re really dragging. Your energy level is almost completely gone, and it’s very difficult to concentrate on your work.

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5.f.i. Low T, Anxiety, and Irritability

It’s one of the worst feelings any parent can experience: Your kids are innocently playing (and making a racket) when you irritably snap at them, yelling “Knock it off!”

You realize that your behavior is an over-reaction, and you feel terrible as a result, but that undercurrent of grumpiness just won’t go away.

What’s going on?

The fact is that mood swings of this type among men, seemingly coming out of nowhere, may be an indication of hormonal imbalances (like low testosterone) that are difficult to recognize as such when they first begin to appear.

Testosterone is without a doubt the central element in the spectrum of hormones that work together to control the host of physical and psychological characteristics that define being male, and that includes your mood.

Those anxiety-driven emotional outbursts you’ve experienced may be the result of clinically low testosterone.

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5.f.ii. Low Testosterone And Anxiety: What Are My Options?

The goal of TRT is to put you in your optimum hormone range, where you’re firing on all cylinders and feeling your best, which can result in a reduction in anxiety levels.

One of the most difficult parts of identifying symptoms of low T is that many of them are often mistaken for being isolated issues unrelated to hormonal problems at all. This usually results in the single symptom being treated while the true underlying cause goes unaddressed.

If your self-confidence has waned and you’ve experienced anxiety or brain fog because of low testosterone, TRT might make a significant difference.

For many patients, this can be an incredible gift since many anti-anxiety drugs simply mask the problem, and a large portion of them are potentially addictive. Finding a way to treat anxiety without using drugs could be life changing.

If you are experiencing difficulties with mood stability and wondering if prescription medication might be the avenue for you, talk to your medical provider about the possibility that your testosterone is low.

TRT might be a more agreeable avenue to feeling like yourself again, especially when compared to taking antidepressants or other psychiatric medications.

Not only could these physical symptoms be helped, but the anxiety and lack of confidence you may be feeling may also be noticeably improved with TRT.

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5.g. Low T and Memory Loss

Low Testosterone and Memory Loss

It’s pretty common for people to jump to conclusions or push the panic button when they notice symptoms like forgetfulness or disorientation.

Very quickly, let’s revisit some common symptoms of Low T, which include:

  • Difficulty concentrating
  • Irritability
  • Depressed mood
  • Anxiety
  • Sleep problems

These cognitive symptoms are not entirely unique to hypogonadism—these same symptoms are common in dementia. It’s actually not uncommon for Low T to be mistaken for dementia.

You may be experiencing irritability or difficulty concentrating. You may even have some memory loss connected to low testosterone, so don’t be so quick to chalk up mild memory lapses to dementia.

Think hormone imbalance first.

5.g.i. Low Testosterone Is Linked to Memory Loss

Researchers have found that men undergoing testosterone reduction therapy for the treatment of prostate cancer experienced more serious and more rapid memory loss, strongly resembling the memory difficulties associated with Alzheimer’s and dementia.

They experienced difficulty processing and retaining information that they were initially able to comprehend.

Stressful memory lapses or confusion may result from low testosterone levels.

You might experience some symptoms, like reduced energy and poor sleep with irritability and difficulty concentrating, and those may magnify the stress of your daily life.

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5.g.ii. Low Testosterone and Alzheimer’s Disease

A handful of recent scientific studies are examining a possible link between sex hormones, especially testosterone, and Alzheimer’s Disease, suggesting that Testosterone Replacement Therapy (TRT) might potentially benefit Alzheimer’s patients.

Researchers, rather than looking for a cause-and-effect relationship between low testosterone and Alzheimer’s Disease, are trying to discover if treating a patient’s low testosterone might help with overlapping Alzheimer’s symptoms.

At first glance, we might assume that restoring testosterone levels to a more normal range, or even to slightly elevated levels, could reduce the severity or postpone the onset of symptoms of Alzheimer’s Disease, providing some relief, as well as hope, to patients and their families, but that is not necessarily the case.

In this study from Alzheimer’s Research and Therapy, Alzheimer’s patients experienced increased irritability and aggressive behaviors more frequently after raising their testosterone levels.

However, Alzheimer’s patients with low testosterone who did not receive supplemental testosterone were found to act out less, possibly because the low mood and fatigue effects of low testosterone robbed them of the energy to display aggression.

In other words, low testosterone may have actually helped suppress these negative and sometimes harmful behaviors.

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5.h. Low T and Depression

What does fatigue mean

Many people are interested in the connection between low testosterone and depression, and for good reason — they manifest in extremely similar ways. Often, symptoms present by robbing you of the joy you typically would feel while doing things you love.

Consider this list of symptoms:

  • Fatigue
  • Appetite changes and weight problems
  • Trouble concentrating or making decisions
  • Loss of endurance
  • Low mood
  • Irregular sleep patterns
  • Restlessness or irritability

If you were asked to decide whether this was a list of depression symptoms or a list of Low T symptoms, which would you choose?

Likely, you wouldn’t be able to do better than make a 50/50 guess, and you’d be right every time — These symptoms are associated with both depression and low testosterone.

Low testosterone and depression can look similar, but that doesn’t necessarily mean they’re related.

In fact, we can’t definitively say that low testosterone and depression have a cause-and-effect relationship, but if you have Low T, you may be caught in a cycle that very closely mimics clinical depression.

You may be suffering from depression, from low testosterone, or from depression and low testosterone.

If these symptoms are severe, you should get yourself evaluated by a medical professional immediately as only a medical professional can tell you what, precisely, is going on.

If you’ve gone beyond “low mood” to thoughts of harming yourself or others, you need to seek treatment immediately. Call the National Suicide Prevention Lifeline and speak to someone who genuinely cares about you and wants to see you get better — immediately.

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5.h.i. Low Testosterone and Depression — If You Have Milder Symptoms

If your symptoms are less than severe, it’s possible low testosterone is contributing in a significant way to how you’re feeling.

We often call this state depressed mood or low mood. It is sometimes termed dysthymia, something not as severe as major depressive disorder, but perhaps more than just a transient “slump.”

Smaller research studies have provided support for this, as have our clinical experiences (over 200,000 patient encounters and counting).

Not to mention the experience of the patients themselves. Many of our patients have reported a reduction in the above symptoms after getting on a regular schedule of testosterone replacement therapy.

5.h.ii. Depression In Men With Low T

The truth is that symptoms of depression are experienced by seven percent of men in the US.

Depression statistics for men are often hard to report accurately, however, because many guys don’t like to talk about it and are less likely than women to report symptoms to their doctors.

That said: Scientific studies continue to provide statistical evidence supporting the positive benefits of testosterone replacement therapy on depressed mood.

New research examining the relationship between improved depression symptoms and testosterone replacement therapy has shown that testosterone treatment for depression has positive effects on:

  • Psychological well-being
  • Perceptions of quality of life
  • Energy levels

The study, conducted by a researcher from the Department of Urology at Peking University People’s Hospital in Beijing, China, was a well-controlled clinical trial on men over 50 suffering from testosterone deficiency.

From 160 test subjects, some men were given a dose of testosterone between 120-160 mg daily (depending on their baseline testosterone levels), and others were given a placebo.

Both before beginning treatment and after the treatment concluded, the researchers gave questionnaires to determine depressive symptoms, anxiety symptoms, stress levels, and perceptions around quality of life.

The men receiving the placebo saw no improvement in their depressive symptoms, but, in direct contrast, those receiving testosterone for depression had a statistically significant improvement.

They reported improvements in both physical and mental health and in their quality of life, including:

  • Fewer feelings of anxiety
  • Reduced subjective feelings of stress
  • Improved sexual symptoms

If you are staring down middle age, and these symptoms are mild (less that one would experience with clinical major depression) and/or accompanied by other symptoms of Low T, it could be part of a larger hormonal issue.

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5.h.iii. Testing For Low T and Depression Screening

If you are experiencing any of these symptoms related to depression along with the other hallmark symptoms of low testosterone, such as loss of energy and fatigue, then it may be time to talk to a provider who specializes in the treatment of Low T.

Even though you may be uncomfortable discussing some of these issues, it is important to be forthcoming about everything that has been bothering you so that an accurate assessment and plan can be made. Don’t leave anything out for fear of embarrassment. This can cause a misdiagnosis.

Performing a screening for depression helps as well. Here, it is also important to be honest with your symptoms so that, if clinical depression is found, you can be referred to the proper medical professional.

5.h.iv. Irritability vs. Depression

Irritability is a common symptom of Low T and is one common feature of “depressed mood.”

Depending on your levels, it may be a fairly constant feeling, or it may slowly worsen throughout your day. Just being irritable can have a profound effect on your relationships (and therefore your life).

That hair trigger that comes along with being brooding and petulant can lead to arguments with your mate or resentment between you and your loved ones. In this way, your bad mood can poison not just you, but those around you as well.

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5.h.v. Low T, Depression, and Concentration

A depressed mood can make concentrating on everyday tasks difficult, especially if you haven’t had any previous issues focusing and concentrating.

Combine this with fatigue, another hallmark symptom of low testosterone, and you’ve got a recipe for disaster.

Your concentration not only affects your life at work, school, and home, but it also affects your mood. Some signs of concentration issues include:

  • Lack of focus
  • Lack of physical or mental energy
  • Making careless mistakes
  • Difficulty sitting still
  • Difficulty thinking clearly

5.h.vi. Low Testosterone and Depression — Talk to Your Medical Care Provider

If you are considering taking antidepressants to deal with depression, are having mood swings, or are just feeling down, then you may want to talk to your medical care provider about low testosterone. You should also take a look at some depression resources.

If you think your depression is getting out of control, if you feel suicidal, or if you feel hopeless and you just need to talk, you can text trained crisis counselors here. You don’t even have to talk to them about how you’re feeling — they’re just there to talk about whatever.

You can also call the national suicide hotline at 1-800-273-8255. It’s critical to seek help immediately if you’re in crisis. Don’t wait for an appointment.

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5.i. TRT And “Roid Rage”

Steroid abuse is responsible for the phenomenon known as “roid rage.”

The testosterone levels that are reached with the abuse of anabolic substances are achieved with doses that are 5–15 times higher (or more) than doses used for testosterone replacement purposes.

This hyper-aggressive state is not seen in patients undergoing TRT that is ethically and responsibly managed.

Multiple studies indicate that when Low T is treated appropriately, it can stabilize and improve the overall mood and sense of well being of the patient.

While subjective, in our clinical experience, we have seen the moods of many, many men respond favorably and significantly to TRT without exhibiting the symptoms of “roid rage.”

5.j. Low T and Osteoporosis

Low testosterone is connected to osteoporosis. Low bone density is a condition which contributes to increasing risk of injury during everyday life.

Such injuries include fractures or breaks from activities or accidents that normally wouldn’t be considered dangerous.

Osteoporosis and bone-density issues are often associated with aging women, but research shows that 20% of all cases are men.

Since male hypogonadism has been linked to bone density issues, TRT (testosterone replacement therapy) has been studied as a possible treatment. It has been found in scientific studies to possibly improve bone density in men with hypogonadal osteoporosis.

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5.k. Low T and Heart Issues

 

There has long been controversy about the potential effects of testosterone on the heart.

However, mounting evidence points to the fact that low testosterone may be bad for your heart and that Testosterone Replacement Therapy may help reduce the risk of heart disease in men with low testosterone.

One way to gauge the seriousness of Low T’s impact on a man’s underlying health is to observe its frequent effect on a number of major cardiovascular markers.

Men experiencing abnormally low T levels often suffer from higher blood pressure, lower HDL cholesterol, higher blood glucose, and increased triglycerides.

When all of these are present together, a truly dangerous situation can result.

The studies are few and certainly not completely definitive, but recent research points to Low T as a risk factor for cardiovascular problems.

This study from the Journal of Clinical Endocrinology and Metabolism linked low testosterone to a higher risk of death from heart disease and other cardiovascular complications.

5.l. Low T and Thinning (Body) Hair

Irregularly thinning or patchy hair is one possible side-effect of low testosterone that most people would certainly consider negative.

Low testosterone may lead to diffuse body hair loss, and, infrequently, to patchy loss of hair on the head.

Men may find that they need to shave their face less, or may experience a reduction in hair on the chest, legs, or abdomen, possibly indicating low testosterone.

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5.m. Low T Is Common, but It’s Not Normal

For many men, Low T and its symptoms can take over their lives. Some men feel that they are losing their masculinity, others see these symptoms as proof of their own mortality — a biological midlife crisis.

Many critics would assert that the associated symptoms of this disease state aren’t symptoms at all, but rather just part of “normal” aging. This is an archaic mindset that has been debunked by medical study.

Consider this: Everyone likely knows someone who has faced cancer. Whether that someone is a mother, father, sibling, friend, child or even yourself, it is well known that cancer is all too common.

Nothing about this dreaded disease is normal.

Common does not equal normal.

Low T, while common, is most certainly not normal.

It is not normal to experience fatigue, diminished libido, or difficulty concentrating, especially not to this degree.

It is not just “part of getting older”.

5.n. The Dangers of Low Testosterone: Damaging Your Quality of Life

The true negative effects of low testosterone exist in the overall, cumulative damage they cause to your quality of life and perception of self-satisfaction.

Low testosterone can affect your physical appearance, mood, concentration, and general feelings of wellbeing.

Quite often, men are not even aware of all of their symptoms, and as a result may not even mention them to their doctor during routine physical exams. In fact, it may not be until someone close to them mentions a symptom or three that men consider having their T levels checked.

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5.o. Low T’s Impact on Job Performance

If you’re suffering from the symptoms of low testosterone, you probably no longer feel like the guy who is “killing it” at the office.

Instead, you’re finding it hard to drag yourself out of bed in the morning, and once you’re at work, you’re not nearly as productive as you used to be.

The result can be projects falling behind (or being forgotten), providing incorrect instructions to other employees, delivering a lower-quality product, or a general slowdown of your previous level of efficiency.

Low T symptoms can leave you feeling horrible, and when you’re suffering from these symptoms, your job performance suffers too.

Self-confidence and feelings of well-being are directly tied to hormone levels in the body. Low testosterone can put a serious damper on how you stride into your meeting with the boss or how assertive you are as you close that big deal.

5.p. Low Testosterone Health Risks May Be Quite Broad

Over the past twenty years, we’ve identified many symptoms of low testosterone, but proving specific health risks associated with hypogonadism has been difficult.

The problem is a classic problem in the sciences — correlation vs. causation.

Researchers have found a wide variety of diseases and disorders that sometimes occur alongside low testosterone and hypogonadism, but there aren’t many studies that demonstrate definitive clinical outcomes tied directly to low testosterone.

What we do have are quite a few studies demonstrating a correlation between low testosterone and several negative health outcomes, including overall mortality rates generally.

One longitudinal study found that men with low total testosterone (less than 241 ng/dl) were up to 40% more likely to die than their counterparts, even when other factors were considered.

A study of veterans found that low testosterone levels were also associated with a higher level of mortality.

A third study, this one of kidney dialysis patients, found similar results. Mortality due to all causes was higher in men with low testosterone than in men with high testosterone.

What all these studies may indicate is the importance of testosterone to a variety of processes in your body. Low testosterone doesn’t simply affect one organ or organ system.

Is low testosterone causing these health risks? Are these issues simply made worse by low testosterone? Health risks like these are quite serious, and they can’t be dismissed lightly.

Unfortunately, until more studies are done, the only answer is that we don’t really know.

Low testosterone can affect how you look, feel, and perform, and it can possibly affect your bone and heart health. These symptoms may be common, but they are far from normal.

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6. Andropause Does Not Equal Low Testosterone

Andropause symptoms — man holding head and looking down on black background

Andropause and low testosterone are not synonymous — these are two very different terms, they mean two very different things, and while it is possible for them to overlap, this is not often the case.

Andropause is the gradual decline of natural testosterone production and levels over time, something that does not occur in all men, something that is (generally) independent of your starting testosterone level.

Manopause or andropause is “…a progressive reduction in testosterone and bioavailable testosterone levels and an increase in SHBG [(sex hormone-binding globulin)].”

Here’s the problem:

Many people view this “progressive reduction” in absolute terms, falsely concluding that a progressive reduction must necessarily result in “low testosterone.”

Low testosterone is a condition that must be clinically diagnosed, and it generally means a total testosterone level below (about) 300 ng/dL or a free testosterone level below 9 ng/dL, or both. This can happen at any age and be caused by a variety of different diseases or disorders.

Another problem I often see is when people make a false equivalence between andropause (men) and menopause (women).

6.a. Andropause Is Not Like Menopause

Some have argued that andropause will necessarily result in low testosterone, likening andropause to menopause in women.

However, andropause is not like menopause, which happens to all women and has a clear mechanism of action. All women will eventually stop menstruating and begin menopause, which often results in a rapid, profound change in hormone levels.

Andropause is not being “set off” by a change in a man’s body. Rather, it’s a long, gradual decline (about 1% per year after age 30) of testosterone levels, something not linked to sperm levels or production.

It’s likely that andropause is just a result of the natural aging process and that a similar process is going on in women’s bodies independent of egg production or menstruation.

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6.b. Andropause or Manopause Is Unlikely to Cause Low Testosterone

While andropause is certainly a recognized issue, the actual effects have yet to be definitively determined.

For most people, the natural reduction of testosterone over time, known as manopause, is so minor as to be almost unnoticeable. If you have normal testosterone levels, andropause is highly unlikely to cause you to have clinically diagnosable low testosterone.

However, if your testosterone levels were already in the low range of normal, it is possible that you’ll eventually fall into low testosterone territory.

It’s easy for someone to learn a little bit about manopause, align it with their symptoms, and self-diagnose low testosterone.

In fact, lifestyle choices, like poor eating habits, lack of sleep, lack of exercise, or too much stress, are more to blame. Even dehydration can cause some of the same symptoms as low testosterone.

Chronic, clinical hypogonadism (Low T) is often caused by disease or physical injury. It’s uncommon for a person to develop low testosterone over time.

6.c. The Normal Effects of Aging

Many clinics these days tout the restorative powers of hormones.

They talk about how Testosterone Replacement Therapy (or hormone replacement therapy generally) can help you feel like you’re 20 again.

Not only is this unreasonable, but it’s also misleading.

Therapy is intended to help alleviate debilitating symptoms, as long as you truly suffer from low testosterone or other hormone imbalances, and not lifestyle issues.

Consider this: Normal serum total testosterone levels are between 300-1000 ng/dL.

Most studies say that you should lose about 1%-2% of testosterone production annually after age 30. Let’s say you peak at 750 ng/dL.

Then let’s assume a 1% annual reduction. Mathematically speaking, in this scenario, your levels should not sink below 300 ng/dL until you reach age 122.

That information tells us that having chronically low testosterone levels at ages younger than this is NOT normal.

Therapy isn’t about restoring your lost youth. It’s about getting you back to normal and helping you feel like yourself again.

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7. Vasectomy and Low Testosterone — An Unexpected Connection

Am I Fertile? Infertility symptoms for men. Couple seeing doctor about fertility issues.

A vasectomy is a surgical procedure for male sterilization and permanent contraception. While surgical reversal is possible in some cases, it’s not a guaranteed result.

A vasectomy shouldn’t be a life-altering procedure in the day-to-day sense. After recovery, you shouldn’t feel any different or notice any overwhelming changes in your body.

While there are reports of chronic testicular pain by a small percentage of men, the overwhelming majority of men who have a vasectomy notice no difference at all, including during sexual activities.

Testosterone Replacement Therapy may actually help alleviate that chronic testicular pain.

The medical literature has mostly shown that vasectomy and low testosterone are unrelated.

In fact, a small increase in testosterone following a vasectomy is not uncommon. You can read more about of few of the studies into vasectomy and low testosterone here.

Unfortunately, much of this research was done 20 or more years ago, and is somewhat outdated.

Despite the research, our clinical experience has shown that vasectomy and low testosterone may be linked, possibly causing low testosterone. We have seen multiple patients who have noticed some of the symptoms of low testosterone after a vasectomy.

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7.a. Vasectomy and Low Testosterone — Symptoms to Watch For

Although it is quite unlikely that your testosterone levels will drop because of a vasectomy, based on our clinical experience, we would say it is a possibility.

We recommend that you pay close attention to your body after a vasectomy. Here are just some of the symptoms of low testosterone you should keep an eye out for:

  • Fatigue
  • Decreased sex drive
  • Difficulty concentrating
  • Less effective results from diet and exercise

These and other noticeable differences can be symptomatic of low testosterone, or hypogonadism, a treatable condition. While vasectomy and low testosterone symptoms are most likely not linked, if their presence arises after having the surgical procedure done, you have treatment options available through Testosterone Replacement Therapy (TRT).

8. Low T in Young Men (20s-30s)

low testosterone in young men

Low testosterone is a condition usually experienced by middle-aged or older men.

Developing chronic low testosterone levels at a young age is unusual and may indicate some serious concerns, so the root causes need to be examined.

8.a. The Symptoms of Low T in Young Men (20s-30s)

Here are some of the more common symptoms of low testosterone:

  • Sexual Dysfunction
  • Low Libido
  • Weight Problems
  • Fatigue
  • Trouble Concentrating
  • Depressed Mood
  • Loss of Endurance
  • Muscle Weakness & Muscle Loss

It’s true that low testosterone is usually found in men over the age of 50; however, it can still affect men in their 40s and 30s, or even younger.

The likelihood for low testosterone increases with age. In fact, low testosterone in 20-year-old males doesn’t often occur without some outside influence.

Low testosterone in young men usually has a different set of causes, with 3 major categories of causes for hypogonadism (the medical term for Low T) in young males:

  • Lifestyle choices (including substance use or abuse)
  • Physical damage to the testicles
  • Illness

What’s important to recognize is that there is usually a serious irregularity causing Low T in young adults.

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8.b. Substance Use and Lifestyle Choices

Low testosterone at an early age could be the result of lifestyle choices, such as:

  • Opiate pain medication use or abuse
  • Alcoholism
  • COPD (chronic obstructive pulmonary disease) due to smoking

This category of potential causes for low testosterone needs to be investigated and ruled out right away. Use of some medications or excessive alcohol consumption can have damaging and life-threatening consequences more serious than just lowering testosterone levels.

This is something you may be able to correct by making positive changes to what you put into your system.

8.b.i. Opioid Use

This topic deserves some special attention because opioid medications are often utilized following serious injury or surgical procedures, not uncommon in young men who are physically active or play sports.

Long-term use can lead to a condition called Opioid-Induced Androgen Deficiency (OPIAD), which is essentially low testosterone due to the prolonged use of opioid medications.

A study in the academic journal, Pain Physician, reached the following conclusions regarding OPIAD:

“While the literature regarding OPIAD remains limited, it is apparent that OPIAD is becoming increasingly prevalent among chronic opioid consumers but often goes unrecognized. OPIAD can have a significant negative impact on the the quality of life of opioid users, and clinicians should anticipate the potential for its occurrence whenever long-term opioid prescribing is undertaken. Once diagnosed, treatment for OPIAD may be offered utilizing a number of androgen replacement therapy options, including a variety of testosterone preparations…”

Additional information on opioids and low testosterone can be found here.

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8.b.ii. Excessive Alcohol Consumption

For men, it’s well documented that ethanol alcohol in large amounts:

  • Negatively impacts testicular function
  • Reduces testosterone
  • Lowers sperm count
  • Reduces fertility
  • May damage the testes themselves
  • May increase estradiol levels

Again, that’s usually only true for excessive alcohol consumption.

Alcoholic men often suffer infertility and abnormally low testosterone. A low testosterone count in younger men could signal a serious lifestyle problem with many other health consequences.

However, a harmful lifestyle choice isn’t the only potential cause.

8.c. Serious Illness and Medical Conditions

There are also some severe and rather uncommon medical conditions that can result in low testosterone at a young age, such as:

  • Type II diabetes
  • Hypothalamic or pituitary disease
  • Klinefelter syndrome
  • Kallmann syndrome
  • Down syndrome
  • Hemochromatosis
  • Sickle cell disease

This list mostly contains conditions with serious physical signs and medical symptoms, and many would most likely have been diagnosed at birth or during early childhood.

However, diagnosing low testosterone might lead to a discovery of one of these underlying illnesses, which require their own medical treatment. Restoring testosterone levels will not solve these issues.

Even if you have one or more of the medical issues listed above, that doesn’t mean you have low testosterone. However, a combination of symptoms with a history of one or more of the above illnesses may indicate low testosterone.

Getting a diagnosis from a qualified medical practitioner would be necessary to make certain your testosterone levels have fallen into the clinically low range, determined to be 300 ng/dL (nanograms per deciliter), OR a free testosterone level below 9 ng/dL. We apply the same standards to older men.

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8.d. Testicular Trauma

Testicular trauma, which is associated with primary testicular failure, often refers to an injury to the testicles that prevents the production of sufficient testosterone to maintain a normal hormonal balance.

Testicular trauma can also be the result of damage caused by:

  • Injury
  • Tumors
  • Inflammation (sometimes occurring as a result of childhood mumps)
  • Side-effects of cancer treatment that utilizes radiation or chemotherapy

In simple terms, we’re referring to some type of testicular damage, not a condition that simply developed out of thin air.

8.e. Low T in Young Males Can Indicate a Serious Problem

Low T in younger males is usually caused by testicular trauma or damage, serious illness, or the side effects of harmful substances. It can also be the result of several of these factors happening in conjunction. The causes of abnormally low testosterone at a young age can combine and overlap, leaving no clear, single cause.

Being professionally diagnosed for low testosterone at a young age could be the first step in getting needed medical treatment, or it might help you identify some beneficial lifestyle changes you could start working on right away.

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9. Hormone Imbalance Affects Your Entire Body

What is hypogonadism?

Among the most common indicators of abnormally low T levels are:

  • Erectile dysfunction — many aspects of normal erectile function rely on sufficient T levels
  • Persistently low sex drive — T levels are the engine of men’s sex drive
  • Low semen levels — testosterone works to produce sperm; reduced volume should be noted
  • Chronic fatigue — feeling like your tank is always empty
  • Genital insensitivity — the normal sensation of arousal is missing when this area is stimulated
  • Loss of strength — Low T levels are often accompanied by reduced muscle mass & vigor
  • Increased body fat — sudden onset of midline weight gain is often associated with Low T

The symptoms of Low T are often mistaken for other problems. When this happens, the symptoms are treated as though they were the actual problem, leaving the core issue unaddressed.

While these are some of the most noticeable symptoms of Low T, they can be accompanied by such conditions as general irritability, unusual mood swings, sleeping problems, and an overall loss of energy.

Unfortunately, many men respond to such warning signs as conditions in and of themselves and look for spot remedies that leave the real problem unresolved.

This can lead to even bigger problems as men attempt to mask real symptoms with energy drinks, triple espressos, or unmonitored supplements purchased online.

Some men simply ignore the problem altogether.

Even worse, men may be under the impression that simply pumping their testosterone levels up to some predetermined number on a lab test is the solution.

However, introduction of a single hormone, even supplemental testosterone for the treatment of chronic low testosterone, may cause more problems than it helps.

Proper balance of all your hormones is required to return to overall health and recovery from the symptoms of low testosterone or hormone imbalance.

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Now serving patients in all Texas cities.

10. Myths About Low Testosterone In Men

Myths abound in just about every medical and health arena. Low T is no different.

You can hear arguments for and against testosterone replacement therapy (TRT) that run the spectrum. Some are true, some are outright false, but the numbers, and your symptoms, don’t lie.

Let’s take a look at some of the more common and prevalent myths.

10.a. Low T Is Uncommon — False

It isn’t uncommon at all.

Up to 40% of males over age 45 may suffer from low testosterone.

Despite such prevalence, you and many others may not even recognize the signs and symptoms that you have, and as a result not seek out treatment, when it could be exactly what you need.

These symptoms are often underreported, and they are even more commonly misdiagnosed.

10.b. Low T Treatment Is Expensive — False

Not necessarily.

While insurance coverage varies greatly, especially when it comes to deductibles, do not let the possibility of high costs for Low T treatment deter you from getting an accurate diagnosis.

Typically, visits to any of our testosterone centers is covered the same way a visit to your primary care provider would be.

We can help you find a solution that works for your body and for your budget.

10.c. Testosterone Only Affects Sex Drive — False

Definitely not. Other, more subtle, symptoms include:

  • Irritability
  • Increased fat around the waistline
  • Mood swings
  • Reduced muscle density and mass
  • Fatigue and poor energy levels
  • Mild depression

Diminished sex drive and erectile dysfunction are only two possible symptoms of low testosterone.

10.d. Low T Can Be Ignored Because It Doesn’t Affect Other Aspects of Your Health — False

Wrong, again.

Low T is related to several other health problems and concerns.

Studies show that, compared to low testosterone, normal testosterone levels are linked to several improved health outcomes, including:

  • Lower blood pressure
  • Lower chance of blood clots
  • Lower risk of heart attack
  • Lower risk of osteoporosis

Healthy testosterone levels even reduce the chances of catching this season’s flu.

10.e. I’m Too Young to Have Low T — False

Unfortunately, this is also incorrect. Low testosterone problems can occur as early as your 20s.

While the incidence rate is higher in males over age 40, low testosterone can occur and Low T treatment can be given in the 20s and 30s.

If you are displaying several of the symptoms of low testosterone, regardless of age, you should bring it up with your healthcare provider.

Talk to a TRT expert and get back to feeling the way you're supposed to.
Now serving patients in all Texas cities.

11. Overcoming the Symptoms of Low T: What to Do Next

Many studies have described Low T as a problem that is often not reported by many patients and frequently ignored by providers.

Most men with low testosterone trudge through their daily routine low on energy, finding it difficult to concentrate, and feeling more than just a step behind.

The workday is a struggle that leaves you with little reserve for your family or yourself. Low T can profoundly affect your mood, making it difficult for you to overcome that “short fuse” you end up with at the end of each day.

All of it boils down to your quality of life.

We have good news: the condition of hypogonadism, or Low T, is treatable. The science of Testosterone Replacement Therapy aims to help men with hypogonadism live more productive and fruitful lives.

TRT isn’t about becoming superhuman. It isn’t even about trying to be 20 years old again.

It is about being the “you” that you’re supposed to be right now, before illness, stress, injuries, surgeries, medications, and behaviors that reduce testosterone levels crept in and altered your natural production.

Testosterone Replacement Therapy (TRT) has improved the quality of life of a growing multitude of men worldwide. With a little help from our team of professionals, you can enjoy life again, and you can rest assured that we’ll take good care of you, every step of the way.

We strive for significant improvement of symptoms, careful maintenance of safety and overall health, all while making treatment as convenient as possible. Our commitment is to improve your level of health in all arenas.

Click the button to schedule your free initial consultation today.

Talk to a TRT expert and get back to feeling the way you're supposed to.
Now serving patients in all Texas cities.

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LOW T RESOURCES

(Augie) Juan Augustine Galindo Jr. MPAS, PA-C

(Augie) Juan Augustine Galindo Jr. MPAS, PA-C started his career in healthcare as a fireman/paramedic in West Texas where he served on the Midland Fire Department from 1998-2004.   He became interested in testosterone treatment after seeing how hormone replacement doctors helped those suffering from low testosterone.   After graduating from the Texas Tech Health Sciences Center Physician Assistant Program, he moved to DFW where he currently lives with his wife and three children.

18 Comments

  1. Rick on 04/17/2019 at 11:41 am

    I am a 61 year old Klinefelter Syndrome male and had been on TRT for more than 29 years when all of a sudden by doctor stopped it. I had 1 yes 1 abnormal prostate reading which was 6.1.

    It has now been 5 months since my last injection of 200 mg/1cc testosterone. I have been having severe mood swings, lack of sexual desire, very tired all of the time.

    My medical insurance changed, so I changed doctors and have been referred to an Endocrine doctor who is great. Did blood work and my testosterone test came back at 13. My prostate number was 1.6 way down from the 6.4. Now I know why everything is off.

    My doctor has just in the past 3 weeks restarted me on my testosterone therapy and hopefully will start feeling better soon. I will be having a time study blood drawn in about 9 days to see where my numbers are.

    She advised that my injections may change from every 3 weeks to every 2 weeks once we can get levels back to where they should be.

    So if there is anyone out there that is having TRT treatments, make sure to get with a doctor or Endocrinologist that knows about the proper treatments for TRT or Klinefelters that many males are not even aware of.

    They are the experts and I am glad I did 30 years ago, otherwise my wife might have left me just over the mood swings as we did not know why I had them.

    • Rick,

      I am very glad you were able to find a good provider and resume therapy. That rollercoaster effect must have been beyond unpleasant. Best of luck to you!

      Best regards,
      Augie Galindo, MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  2. John on 04/17/2019 at 11:45 am

    After my heart attack, I went completely off HRT and I had no libido and low energy. After about 4 months my doctor had me start applying a small amount of Fortesta. I started to feel great but then it went down again. My doctor then suggested BioTE. I have been on BioTE pellets since March 2018. My free testosterone has been up to 1400 and I actually felt worse. My doctor told me I would have more energy and better libido. I didn’t notice either of these. I’m going start injections once my pellets go down far enough. My doctor couldn’t answer why I didn’t feel better. Any input from you why I didn’t feel better? Is it because it’s a different type of testosterone?

    • John,

      Without knowing the units of measure, that sounds like an extremely high number for you free T. I am not a fan of pellets, and the skyrocketing levels you can get with them is one of the reasons. The problem is that it’s not just testosterone that is soaring, but also your estrogen levels. This may be why you still felt poorly. This is however, just an educated guess, since there is no medical interview, physical exam, or full lab assessment to refer to.

      Best regards,
      Augie Galindo, MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  3. Karen on 04/17/2019 at 11:49 am

    I received BIOTE pellets twice since March 2018. My testosterone levels spiked very high, now over 120 from 259! I started at -3.
    I have had severe acne since the insertion and it just won’t subside. I feel terrible and wish there was something I can do to lower testosterone. I take 200 mg progesterone by capsule. Estradiol was in pellets also but now dropping.
    Worried about my skin and what these pellets have done to me. I had cataract surgery and lenses inserted opacified right away. Could high hormone levels play a factor in this.
    Very distraught.

    • Karen,

      These are exactly the pitfills that lead me to ban pellets from my practice from day 1. After a quick check, I don’t seen any direct correlation with Posterior Capsule Opacification and HRT/TRT. It appears to be fairly common, occurring in up to 20% of patients. That being said, hormonal imbalances have caused stranger things. I do hope your issues resolve promptly and without further complications.

      Best regards,
      Augie Galindo, MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  4. Paula Lambrechts on 04/17/2019 at 12:01 pm

    I am a 51 years old. My testosterone level are 0.3 nmol/L. I suffer from low sex drive, NO energy, and bad mood swings. I need help. Are my level too low, and what would a suitable level be for me?

    Can you please advise?

    • Paula,

      At 0.3 nmol/L, your levels are at the very bottom end of normal on some reference ranges, and below normal on most. Given your symptoms, it certainly sounds like further investigation and/or treatment is warranted.

      Best regards,
      Augie Galindo, MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  5. Michelle W. on 04/17/2019 at 12:04 pm

    Hi There. I’m 36 year old female healthy and in shape and considering having another baby and I asked my doctor to check my hormone levels. I have no bad symptoms. Everything on the lab paperwork came back in the normal range except for my Testosterone, Free % (calc) and my Testosterone, Bioavailable % (calc). I don’t understand how these testosterone levels are high when the other testosterone levels are in normal range. Can you please review these results and give me your opinion. I don’t want to be scared.

    Testosterone, Total 23
    Testosterone, Free (Direct) 1.81
    Testosterone, Free % (Calc.) 0.79- HIGH
    *normal range for lab was 0.05-0.19%
    Testosterone, Bioavailable (Calc.) 4.24
    Testosterone, Bioavailable % (Calc.) 18.44- HIGH
    *normal range for lab was 0.60-12.90%

    • Michelle,

      The only reliable test there is your Testosterone, Total of 23 ng/dL. The “Testosterone, Free (Direct)” analog assay is a clinically useless test, and in my opinion, shouldn’t even be ordered. To evaluate further, you would need a total T, your sex hormone binding globulin level, and your albumin level. These three metrics are used to obtain your calculated free T, and this is much more reliable the the remainder of the data you were given.

      Best regards,
      Augie Galindo, MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  6. Robert on 04/17/2019 at 1:52 pm

    Sir, I have been diagnosed with hypogonadism several years ago and have tried the patches and creams with neglible results. So my Dr. had me do shots with testosterone cypionate (200mg/ml) which I have done for several years now. I self inject 0.3 mls weekly and my last test showed a total testosterone of 852 which my Dr. says is normal. They did not do a free testosterone test. My current symptoms are lack of energy, lack of motivation, and general malaise. I was utilizing a local gym until there was a screw up with my test which resulted in 1+ month of no shots and after another test my test level was 82. I know I should resume some form of workout but just don’t have the desire or inclination. I am waiting to find out what my hematocrit level is as it will frequently run in the 50s which is way to thick.
    In your professional opinion should I request another test for free testosterone?

    p.s. i was a level 4 paramedic for many years and I congratulate you on your advancing your education.

    • Robert,

      Great to hear from a fellow medic! I would ABSOLUTELY press to get a calculated free T as it could tell a much different story than your total. However, you may be limited by your hematocrit. Look at other things that may be contributing to increase red blood cell production/thickness. If you smoke tobacco regularly or have under or untreated obstructive sleep apnea, now is the time to address those issues.

      Best regards,
      Augie Galindo, MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  7. Jackie on 04/17/2019 at 1:54 pm

    My son, 19 has a has been ℅ fatigue and weight loss and states that he has little to no sex drive. He’s 6’2 and weighs 159# down from 172# 6 months ago. Just had total testosterone level of 295 all other labs were normal except his PTH which was slightly low at 14 with a normal calcium. He has an appointment to see an endocrinologist but now for a few months. I’m very concerned.

    • Jackie,

      It’s a scary journey, I am sure, but it sounds like you two are on the right track. Keep in mind that many clinicians are uneasy about treating younger patients with testosterone due to the fertility suppression. I hope you get some quick and definitive answers!

      Best regards,
      Augie Galindo, MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  8. Kelly Smith on 04/17/2019 at 1:56 pm

    Hi my son is 14 very small 4’7 75 pounds we have to multiple Doctors trying to get a referral to a pediatric endocrinologist with luck they just say he is going to be short.

    he has no body hair has not hit puberty they keep saying wait.
    Decided to do a blood test outside of insurance and his Testosterone results are as follows.

    Estradiol 11.80

    Testosterone total 11.00

    Sex hormone bind 80

    Testosterone free 0.1

    we did not have a LH or FSH TEST DONE.

    Does he need GH or Test or Both

    • Kelly,

      Unfortunately, he does still need further workup before a plan is decided upon. He very well could have more extensive pituitary issues, so that all needs to identified and prioritized before treating just one aspect of a potentially larger problem.

      Best regards,
      Augie Galindo, MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  9. Matt on 04/17/2019 at 3:35 pm

    Hello – could you recommend a course of action for the following scenario? Low T of 240 ng/dL, Normal Free T of 180 pg/mL, and a low/normal SHBG of 14 nmol/L? Both Albumin and Bioavailable normal. Thank you

    • Matt,

      With a calculated free testosterone level being normal between 9-30 ng/dL, these numbers would put your cFT at 6.92 ng/dL. This is definitively low. Now, if you are symptomatic, have no contraindications, and such a result has been confirmed by two morning tests done in a fasting state, then the course of action would be to start contemplating starting TRT.

      Best regards,
      Augie Galindo, MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

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