What is Low Testosterone (Hypogonadism)?

What is Testosterone

Testosterone is the sex hormone that helps boys become men. This hormone is key during puberty and the development of male physical features. Testosterone helps to maintain men's muscle strength and mass, facial and body hair, and a deeper voice. Testosterone levels can affect men's sex drive, erections, mood, muscle mass and bone density. Testosterone is also needed for men to produce sperm.

What is Low Testosterone?

Some men have low levels of testosterone. This is called hypogonadism, or low-T.

A man's testosterone level normally decreases with age. About 4 out of 10 men over the age of 45 have low testosterone. It is seen in about 2 out of 10 men over 60, 3 out of 10 men over 70, and 3 out of 10 men over 80 years old.

What are the Signs of Low Testosterone in Men?

There are sexual and non-sexual signs of low testosterone. Sexual signs include:

  • Low sex drive
  • Poor erections (weaker and fewer)
  • Wanting sex less often

Non sexual signs include:

  • Increase in body fat
  • Lower energy
  • Reduced muscle mass
  • Feeling depressed
  • Anemia (low iron)
  • Loss of calcium from bone

What are Risk Factors for Hypogonadism?

Men with certain health problems also tend to have low testosterone. Some of these are:

  • High blood pressure (about 40 out of 100 also have low testosterone)
  • High cholesterol (about 40 out of 100 also have low testosterone)
  • Diabetes (about 50 out of 100 also have low testosterone)
  • Overweight (about 50 out of 100 also have low testosterone)
  • HIV (about 30 out of 100 also have low testosterone)
  • AIDS (about 50 out of 100 also have low testosterone)
  • Long-term opioid use (almost 75 out of 100 also have low testosterone)

How is Hypogonadism Diagnosed?

Low testosterone is found with a blood test. In general, a diagnosis of low testosterone is made if your hormone level is below 300 ng/dL.

Your health care provider will also do a PSA (prostate specific antigen) blood test to check for signs of prostate cancer. Your provider may also do a test to measure the red blood cells in your body (hematocrit). A hematocrit is checked to keep record of your red blood cell count, because it can go up if you take testosterone.

Testosterone Replacement Therapy (TRT)

If you have signs and symptoms of low testosterone that bother you, there are many choices for raising the levels. Not everyone chooses treatment. Testosterone replacement therapy (TRT) can be given using:

  • Skin gel
  • Shots
  • Long-acting pellets
  • Patches
  • Pills

The most common type is skin gel, which is used by about 70 out of 100 patients. The gel is rubbed onto your shoulders or upper arms after a shower. About 17 out of 100 patients use shots and 10 out of 100 use patches. About 3 out 100 patients use testosterone in other forms, such as patches or pellets placed in the body. At this time, pills are not approved for use in the U.S.
You should not take testosterone for non-medical reasons, such as body building, preventing aging changes or performance enhancement. Men should not take TRT if they have normal testosterone levels or if their testosterone levels have not been tested. If you have normal testosterone levels, using TRT will not help your health problems. Also, if you are trying to father a child, you should not be on TRT. TRT can decrease your sperm count and fertility.

Before you take TRT, a doctor who is skilled in diagnosing low-T should examine you carefully. Your doctor should not prescribe TRT without taking an in-depth health history and giving you a physical exam and blood tests. Many of the symptoms for low-T can be the result of other health problems. Other causes of symptoms need to be ruled out before testosterone is prescribed.

Before you start TRT, your doctor should talk to you about possible side effects. Side effects can include:

  • Acne (pimples)
  • Breast swelling or soreness
  • A high red blood cell count
  • Swelling of the feet or ankles
  • Smaller testicles
  • Infertility

If your doctor prescribes TRT, you should have regular check-ups. Your doctor should follow up with blood tests for testosterone level, PSA and hematocrit. (PSA is a test for prostate issues including prostate cancer. Hematocrit tests your red blood cell count.) Based on your health history, your doctor may want to follow up with other tests.

Discuss the benefits and risks of taking testosterone replacement therapy with your doctor. You should not be taking TRT if you do not have low levels of testosterone. You should understand the possible benefits, side effects and risks before you start taking TRT. You should also know that today's science does not offer final answers about whether taking TRT will increase your risk of prostate cancer or heart disease.

What Can I Expect after Treatment?

Testosterone replacement has been shown to:

  • Improve energy
  • Improve sex drive
  • Increase muscle mass
  • Lower body fat
  • Help sleep
  • Improve erections
  • Raise energy level
  • Improve mood

Testosterone treatment may also increase bone mineral density and lower the risk for broken bones. Testosterone treatment is a life-long therapy, just like in other chronic conditions. Stopping treatment will result in low levels.

More Information

Frequently Asked Questions

What are safety issues with using testosterone?

  • Men with known breast cancer or known or suspected prostate cancer should not take testosterone.
  • Men taking testosterone have a higher risk of getting urinary symptoms (such as urinating more often, blood in the urine, and enlarged prostate). In men who already have these problems, they could get worse.
  • Men with kidney, liver, or heart problems may have a higher risk of water retention (edema).
  • Testosterone replacement may make sleep apnea worse.
  • If you are trying to father a child, you should not be on TRT. TRT can decrease your sperm count and fertility. Taking testosterone for a long time may harm fertility.

What are common side effects from testosterone treatments?

  • Skin gels can cause rashes or skin reactions.
  • Some men experience tenderness in the breast, or enlarged breasts.
  • Some men experience dizziness, lightheadedness, or feeling faint.
  • Some men become more emotionally sensitive, with mood swings.
  • Testosterone creams can impact women and children in close contact, especially pregnant women. Women and children should not touch unwashed clothes after treatment.

It's important to talk with your doctor if you notice any of these problems.

Does taking testosterone cause prostate cancer?

So far, studies have found no increase in prostate cancer risk among men who take testosterone compared to men who don’t. This issue needs further research.

Does taking testosterone affect cardiovascular health?

There are major concerns that taking testosterone can raise the risk of heart problems. These can include blood clots, heart attack and stroke. Two recent studies have suggested that TRT raises the risk of heart attack in men. The U.S. Federal Drug Administration is studying the risk of heart attack, stroke and death in men taking TRT.

There are also conflicting studies that suggest TRT may lower heart risk. More studies need to be done to be certain whether and how TRT changes men’s risk of heart attack. It’s important to ask your doctor about your heart health before you begin therapy.

What if I don’t treat low testosterone?

Symptoms of low testosterone will remain. You may find other ways to increase your energy level or you may choose to live with changes in your sexual desire and body.

Will testosterone treatment help with erectile dysfunction?

Erectile dysfunction (ED) is not the same as hypogonadism. It has other causes and requires other treatments. It’s important to talk about ED with your doctor as a separate issue. If you have normal testosterone levels, using TRT will not help your erection problems.