Testosterone — Low Levels, Testing and Treatment

Low testosterone can happen for several different reasons, including:

• problems affecting the testicles, where most testosterone is made
• problems affecting the pituitary gland or hypothalamus in the brain, which send the signals that control testosterone production
• some long-term health conditions, including diabetes and chronic illness
• obesity
• certain medicines, including long-term opioid painkillers and long-term steroid treatment
• some cancer treatments, including chemotherapy and radiotherapy
• injury to the testicles, or surgery affecting them
• genetic conditions present from birth, such as Klinefelter syndrome

Late-onset hypogonadism is a specific medical condition in which testosterone is genuinely low and causing symptoms. It is not simply an inevitable part of getting older, and it needs proper assessment. The everyday expression “male menopause” is sometimes used in the media, but it is not a formal medical diagnosis and it can be misleading, because men do not go through a sudden hormone change in the way women do at menopause.

Contact your GP if symptoms:

• carry on for weeks or months rather than settling
• affect your daily life, work or relationships
• affect your sexual health
• affect your mood, motivation or concentration
• affect your fertility, or you are trying for a baby

Talking about sexual symptoms can feel embarrassing, but GPs deal with these concerns regularly and routinely. You can ask for a longer appointment, ask to see a particular clinician, or write your main points down beforehand if that feels easier.

Diagnosis normally considers both your symptoms and your blood-test results. Neither on its own is enough.

• Testosterone levels change during the day, and can also be affected by illness, sleep, shift work and some medicines.
• Blood samples are generally taken in the morning, when levels are usually at their highest and most comparable.
• A low result will normally need to be confirmed with a second test on another day.
• Further blood tests may be needed to look for the cause — for example tests of the hormones made by the pituitary gland, or other general health checks.

Sixpence Support UK does not publish a single “normal” testosterone number, because laboratory reference ranges differ, the type of test matters, and results have to be read alongside your symptoms and circumstances. Ask the clinician who ordered your test to explain your own results.

Medically prescribed testosterone replacement therapy may be considered when testosterone deficiency has been properly confirmed, and when a clinician judges it appropriate for that person.

• Treatment may be supplied as a gel applied to the skin, or as an injection, depending on the person’s circumstances and specialist advice.
• Specialist input from an endocrinologist or other specialist service is often involved.
• It is not a general treatment for tiredness, ageing, low mood or reduced fitness where testosterone deficiency has not been confirmed.

Whether treatment is suitable, and which form is used, is a decision for a qualified clinician who knows your full medical history. This page does not include doses.

For someone with properly confirmed testosterone deficiency, possible benefits of prescribed treatment may include improvements in sexual function, energy, mood, muscle strength and bone health. Benefits vary from person to person and may take time to appear.

Possible side effects or risks can include:

• acne or oily skin
• increased red blood-cell levels
• changes in mood
• breast tenderness or enlargement
• reduced sperm production and fertility
• testicular shrinkage
• worsening of untreated sleep apnoea
• prostate or urinary symptoms
• skin reactions where a gel is applied
• accidental transfer of testosterone gel to another person through skin contact

Risks and suitability must be assessed individually by a qualified clinician. Tell your clinician about all your other conditions and medicines, and report any new or troubling symptoms while on treatment.

People receiving prescribed testosterone need regular reviews and blood tests. The exact schedule is set by the clinical team. Monitoring may include:

• testosterone levels, to check treatment is neither too low nor too high
• a full blood count or haematocrit, because red blood-cell levels can rise
• liver function tests where appropriate
• prostate checks where appropriate, based on age and individual risk
• a review of symptoms, side effects, mood and general wellbeing

Do not change your dose or stop prescribed treatment without discussing it with your clinician. Stopping suddenly, or using extra testosterone from another source, can be harmful.

Women also produce testosterone, in smaller amounts. It contributes to sex drive, muscle and bone strength and general wellbeing.

In limited circumstances, a menopause specialist may consider testosterone for persistent low sexual desire when standard hormone replacement therapy has not helped sufficiently. It is not routinely prescribed for general tiredness, weight loss or improving mood.

Treatment for women requires specialist assessment and monitoring, and is prescribed and reviewed by a clinician with the right experience. Do not obtain testosterone products without a prescription.

Testosterone bought online, shared at a gym or obtained in any way without a prescription may be counterfeit, contaminated or incorrectly dosed. You cannot know what is in it, and there is no medical monitoring behind it.

Misuse of testosterone and anabolic steroids can cause serious physical and mental-health problems, including effects on the heart, liver, fertility and mood.

Anyone worried about their own steroid use, or someone else’s, can speak confidentially with a GP, a pharmacist or a local drug and alcohol support service. You will not be judged for asking.