What is low testosterone?

As you get older, you will likely experience typical ageing-related physical and mental changes. You may gain weight and belly fat, lose muscle, and start noticing a gradual loss of vigour and sex drive, and get the feeling that you have passed your peak. But what if this isn’t just because of ageing?

Ageing is accompanied by gradual deterioration in general measures of health and well-being, which may be related to low testosterone levels.1 Low testosterone, also called testosterone deficiency or hypogonadism, is a medical condition in which the testes (testicles, the male reproductive glands) do not produce enough testosterone (the male sex hormone).2-5 While it is common for testosterone levels to progressively decline in men as they get older,6 low testosterone can occur even in young men, especially if they have developed a belly or have an excess amount of total body fat.7 Other possible causes for low testosterone in younger men is life/work stress8,9 and use of medications, such as opioids,10 selective serotonin reuptake inhibitors (SSRIs)11 and statins.12 Therefore, low testosterone is not just an “old man’s problem”. Less common causes of low testosterone in young men include testicular trauma, concussion and congenital (present at birth) disease caused by chromosomal abnormalities or gene mutations.13

So why is testosterone important? Testosterone not only gives you sexual desire (libido) and enables you to have an erection,14 it also provides a wide range of health benefits, such as improvement in wellbeing/quality of life, blood sugar control, cholesterol profile, body composition (reduced body fat and increased muscle mass) and bone density, that might be expected to reduce long-term sickness and prevent premature death.15,16 In fact, it is well documented that men with low testosterone have increased risk of the metabolic syndrome, diabetes, heart disease and death.15-17

Talking to your doctor


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What are the signs & symptoms of low testosterone?

Signs & symptoms

Men who have symptoms and sign of low testosterone – summarised in the illustration and listing below - commonly ignore them, thinking “I’m just getting older” and believing that nothing can be done to get rid of these bothersome symptoms.

Common symptoms and signs of hypogonadism (low testosterone) in men.2,4,5,18,19

Metabolic symptoms / signs


  • Obesity (BMI 30 or higher)
  • Abdominal (belly) obesity (waist circumference 102cm or higher)
  • Metabolic syndrome
  • Insulin resistance, prediabetes or type 2 diabetes

Sexual symptoms


  • Decreased sexual desire and activity
  • Decreased frequency of sexual thoughts
  • Erectile dysfunction
  • Delayed ejaculation
  • Decreased volume of ejaculate
  • Decreased frequency or absent morning or night-time erections
  • Small testes
  • Infertility
Marek on his own

Psychological symptoms


  • Depressed mood
  • Loss of energy
  • Reduced motivation
  • Poor concentration
  • Decreased well-being and/or poor self-rated health
  • Irritability
  • Sadness
  • Impaired memory
  • Decreased cognitive function (including impaired concentration, verbal memory, and spatial performance)

Physical symptoms


  • Decreased muscle mass and strength
  • Reduced physical performance
  • Hot flushes or sweats
  • Sleep disturbances
  • Fatigue
  • Reduced bone mineral density, osteoporosis,
    low trauma fractures
  • Decreased body hair
  • Gynaecomastia (enlarged breasts)

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See if you should have your testosterone level checked

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What causes low testosterone?

Although many people think that the main cause of low testosterone is ageing, observational studies consistently show a strong association of obesity with low circulating testosterone levels in men.6,23,24

This means that by living a healthy lifestyle with regular exercise and healthy food habits, you improve your chances of maintaining your testosterone in the healthy range even as you get older. In other words, low testosterone – while common - is not inevitable in men as they get older, as menopause is in women.

Other possible factors for low testosterone the metabolic syndrome25-27 and type 2 diabetes.28-31 Chronic diseases, such as high blood pressure, heart disease, liver disease, kidney disease, arthritis, stroke, emphysema, rheumatoid arthritis and depression may also be risk factors for low testosterone.1,29,32

Which men are most at risk of TD?

Men with...
Obesity


Up to 80% of men with a BMI ≥ 50 have low testosterone.33,34 Medical guidelines state that all men with BMI > 30 kg/m2, or waist circumference > 102 cm should be checked for low testosterone by having testosterone levels measured.35

Men with...
Erectile dysfunction


Among men with erectile dysfunction, over one third (36%) have low testosterone levels.9 Low testosterone can cause erectile dysfunction and/or non-responsiveness to treatment with PDE5i (phosphodiesterase 5 inhibitors) such as Viagra. Therefore, according to medical guidelines is it mandatory that men with erectile dysfunction have testosterone levels measured.39,40 This is particularly important if your erectile dysfunction treatment doesn’t appear to be working well.

Men who...
Take medications


Certain medications, especially opioids,10 selective serotonin reuptake inhibitors (SSRIs)11 and statins,12 may reduce your testosterone level.

Men with...
Type 2 diabetes


Nearly half of men with type 2 diabetes have low testosterone.36 Obesity is common among men with type 2 diabetes,37 but even non-obese men with type 2 diabetes commonly have low testosterone.36 The frequent occurrence of low testosterone in men with type 2 diabetes prompted medical guidelines to recommend that testosterone levels are measured in men with type 2 diabetes who have symptoms.4

Men with...
Heart disease


Studies have found an association between heart disease and low testosterone, with nearly one in four men studied with heart disease also presenting with low testosterone. Another study found an association between risk of death and low testosterone among men with heart disease. The cause of these associations is not yet known and requires further investigation.

Men with...
High life/work stress


Among men with sexual dysfunction, half who report a high degree of life/work stress have been found to have low testosterone.

Low testosterone?

Think you’ve got low testosterone?

Here's how to find out.

Regardless of age, if you’re rarely in the mood for sex and perhaps have difficulties getting an erection, often feel tired/lethargic and have a depressed mood, you may be experiencing symptoms of low testosterone.

If you are concerned that you may have low testosterone, COMPLETE OUR SYMPTOM CHECKER AND TALK TO YOUR DOCTOR. With a simple blood test, it is possible to find out your testosterone level and establish whether or not you have the diagnosis of testosterone deficiency (hypogonadism).

Check your symptoms

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References

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