Low Testosterone in Men: Understanding, Diagnosing, and Treating Testosterone Deficiency
By Arsenal Men's Health | Medically Reviewed by Courtney LaSumner Bass, NP | Updated December 2024 | 18 min read
KEY STATISTICS: Up to 39% of men over 45 may have low testosterone • Only 5-12% of men meet full diagnostic criteria for testosterone deficiency syndrome • Prevalence increases with age: 20% in 60s, 30% in 70s, 50% over 80
You're exhausted despite getting enough sleep. Your motivation has disappeared. Your sex drive isn't what it used to be. You've gained weight around your midsection despite no changes to your diet. If this sounds familiar, you're not alone—and there may be a medical explanation: low testosterone.
Low testosterone, clinically known as testosterone deficiency or hypogonadism, is one of the most underdiagnosed conditions affecting American men. Research indicates that up to 39% of men over age 45 presenting to primary care may have testosterone levels below the clinical threshold. Yet despite its prevalence, many men suffer in silence—either unaware that their symptoms have a treatable cause or too embarrassed to seek help.
At Arsenal Men's Health, we understand. As a veteran-owned, nurse practitioner-led telehealth clinic serving Utah men, we've helped hundreds of men reclaim their energy, vitality, and quality of life through evidence-based testosterone management. This comprehensive guide will give you everything you need to understand low testosterone—and what to do about it.
What Is Low Testosterone?
Low testosterone (often abbreviated "Low T") occurs when your body doesn't produce enough testosterone—the primary male sex hormone responsible for everything from muscle mass and bone density to libido and mood. The American Urological Association (AUA) defines low testosterone as a total testosterone level below 300 nanograms per deciliter (ng/dL) combined with clinical symptoms of deficiency.
This definition is crucial: low testosterone is not simply a lab value. According to both the AUA and Endocrine Society guidelines, a diagnosis requires both documented low testosterone levels AND symptoms that impact quality of life. A man with testosterone at 280 ng/dL but no symptoms may not require treatment, while a man at 310 ng/dL with significant symptoms deserves clinical evaluation.
The Two Types of Hypogonadism
Understanding where the problem originates helps guide treatment decisions:
Primary Hypogonadism (Testicular Failure)
In primary hypogonadism, the testes themselves fail to produce adequate testosterone despite receiving proper signals from the brain. Laboratory findings typically show low testosterone with elevated luteinizing hormone (LH) and follicle-stimulating hormone (FSH)—the brain is "shouting" for more testosterone, but the testes can't respond.
Causes include: Klinefelter syndrome (a genetic condition affecting approximately 1 in 650 males), testicular injury or trauma, undescended testicles, mumps orchitis (testicular inflammation from mumps infection), chemotherapy or radiation therapy, and testicular tumors.
Secondary Hypogonadism (Central/Hypothalamic-Pituitary Dysfunction)
In secondary hypogonadism, the problem lies in the brain—specifically the hypothalamus or pituitary gland. The testes are capable of producing testosterone but don't receive adequate hormonal signals. Laboratory findings show low testosterone with low or inappropriately normal LH and FSH levels.
Causes include: Pituitary tumors or disorders, obesity (one of the most common causes), type 2 diabetes, chronic opioid use, corticosteroid medications, hemochromatosis (iron overload), HIV/AIDS, chronic kidney disease, and Kallmann syndrome.
Many men have a combination of both primary and secondary factors, particularly as they age. This "mixed" hypogonadism is characterized by declining testicular function alongside age-related changes in the hypothalamic-pituitary axis.
Signs and Symptoms: How Low Testosterone Affects Your Life
The European Male Aging Study (EMAS)—one of the largest studies on male aging and hormones—found that sexual symptoms are the most specific indicators of testosterone deficiency. However, the condition affects virtually every body system. Recognizing these symptoms is the first step toward diagnosis and treatment.
Sexual and Reproductive Symptoms
Sexual symptoms are often the earliest and most specific signs of low testosterone. They include:
Reduced libido (sex drive): The most consistent symptom, often described as a lack of interest in sex that doesn't match your previous patterns
Erectile dysfunction: Difficulty achieving or maintaining erections sufficient for satisfying sex
Fewer spontaneous erections: Particularly noticeable with morning erections, which are normally triggered by hormonal peaks
Reduced ejaculate volume: Noticeably less semen with ejaculation
Infertility: Low sperm count or quality affecting ability to conceive
Physical Symptoms
Fatigue and low energy: Persistent tiredness that doesn't improve with adequate sleep—often described as "afternoon crashes" or feeling "depleted"
Loss of muscle mass and strength: Difficulty building or maintaining muscle despite regular exercise
Increased body fat: Particularly around the abdomen (visceral fat), even without dietary changes
Gynecomastia: Breast tissue development or tenderness due to testosterone-estrogen imbalance
Decreased bone density: Increased risk of osteoporosis and fractures
Body hair loss: Reduced facial and body hair growth
Hot flashes: Sudden feelings of warmth, similar to menopausal hot flashes in women
Cognitive and Emotional Symptoms
Depression or low mood: Meta-analyses show men with low testosterone are 1.8 times more likely to experience depression
Difficulty concentrating: "Brain fog" that affects work performance and daily tasks
Memory problems: Difficulty with recall and mental sharpness
Irritability: Unexplained mood changes and reduced patience
Decreased motivation: Loss of drive and ambition that was previously present
Sleep disturbances: Insomnia or poor sleep quality, sometimes linked to sleep apnea
"The men I treat often describe the same experience: they feel like they're functioning at 50% capacity. They know something is wrong, but because the changes happened gradually, they convinced themselves it was just 'getting older.' When we identify and treat their low testosterone, many tell me they feel like themselves again for the first time in years." — Courtney LaSumner Bass, NP, Arsenal Men's Health
Risk Factors: Who Is Most Likely to Develop Low Testosterone?
While any man can develop testosterone deficiency, certain factors significantly increase risk:
Age
Testosterone naturally declines with age, typically beginning in the 30s and progressing at approximately 1-2% per year. Research estimates that low testosterone affects approximately 20% of men in their 60s, 30% in their 70s, and up to 50% of men over age 80. However, age-related decline alone doesn't guarantee symptoms—many factors influence individual outcomes.
Obesity
Obesity is one of the strongest modifiable risk factors for low testosterone. Research from the Medical Therapy of Prostatic Symptoms (MTOPS) study found that the prevalence of low testosterone increased dramatically with BMI: 14.7% in normal weight men, 24.2% in overweight men, and 39.3% in obese men. This occurs because fat tissue contains aromatase enzymes that convert testosterone to estrogen, and excess body fat suppresses the hypothalamic-pituitary-testicular axis.
Type 2 Diabetes and Metabolic Syndrome
Studies consistently show a bidirectional relationship between low testosterone and type 2 diabetes—each condition increases risk of the other. Men with diabetes have a significantly higher prevalence of testosterone deficiency, and low testosterone is associated with increased insulin resistance. Metabolic syndrome (the combination of high blood pressure, elevated blood sugar, excess abdominal fat, and abnormal cholesterol) is also strongly linked to low testosterone.
Chronic Opioid Use
Opioid-induced androgen deficiency is a well-documented phenomenon. A meta-analysis of seven studies found that men on opioid treatment for 30 days or longer had testosterone levels approximately 117 ng/dL lower than opioid-free patients. This is particularly concerning given the prevalence of chronic opioid use for pain management.
Other Medical Conditions
HIV/AIDS: Approximately 30% of men with HIV and 50% of men with AIDS have low testosterone
Chronic kidney disease and liver cirrhosis: Both significantly impact testosterone production
Sleep apnea: Disrupts nocturnal testosterone production and creates a cycle of hormonal dysfunction
COPD: Moderate-to-severe chronic obstructive pulmonary disease is associated with testosterone deficiency
Previous cancer treatment: Chemotherapy and radiation, particularly to the pelvic region, can permanently impact testosterone production
Getting Diagnosed: The Proper Evaluation
Proper diagnosis of testosterone deficiency follows established guidelines from the American Urological Association and Endocrine Society. The evaluation includes clinical assessment and laboratory testing.
Laboratory Testing Requirements
The Gold Standard: Two separate morning blood tests showing total testosterone below 300 ng/dL, combined with symptoms of deficiency.
Timing matters: Blood should be drawn between 8 AM and 10 AM, when testosterone levels peak. Afternoon levels can be 20-40% lower, potentially leading to falsely low results
Fasting recommended: Fasting improves consistency and reduces variability in results
Two separate measurements: Because testosterone fluctuates daily, guidelines require confirmation on a second occasion
Acute illness delays testing: Illness can temporarily suppress testosterone; wait until recovered for accurate assessment
Additional Testing
Beyond total testosterone, your provider may order:
Luteinizing Hormone (LH): Distinguishes between primary and secondary hypogonadism—essential for determining the cause and guiding treatment
Follicle-Stimulating Hormone (FSH): Provides information about testicular function and fertility potential
Prolactin: Elevated prolactin can suppress testosterone and may indicate pituitary tumors
Free Testosterone or Sex Hormone-Binding Globulin (SHBG): Helpful when total testosterone is borderline; elevated SHBG can leave less bioavailable testosterone
Complete Blood Count (CBC): Establishes baseline hematocrit before treatment, as testosterone therapy can increase red blood cell production
Prostate-Specific Antigen (PSA): Baseline assessment for men over 40, monitored during treatment
Metabolic Panel: Assesses kidney function, liver function, and metabolic health
The Arsenal Men's Health Approach
We've designed our diagnostic process for convenience and accuracy. Our at-home lab kits are processed by CLIA-certified laboratories—the same certification required for hospital labs. You collect your samples in the morning comfort of your home, ship them with our prepaid label, and receive results reviewed by our licensed providers. No waiting rooms, no awkward conversations, no time off work.
Treatment Options: Restoring Your Testosterone
Once testosterone deficiency is confirmed, treatment focuses on restoring testosterone to physiological levels and alleviating symptoms. The FDA has approved testosterone therapy for men with documented hypogonadism due to specific medical conditions. Treatment decisions are individualized based on symptoms, overall health, fertility goals, and patient preferences.
Testosterone Replacement Therapy (TRT)
TRT directly supplements your body with testosterone to restore normal levels. Multiple delivery methods are available:
Injectable Testosterone
Testosterone cypionate and enanthate are the most commonly prescribed forms. Administered intramuscularly or subcutaneously, typically every 1-2 weeks. Provides reliable testosterone delivery with predictable pharmacokinetics. Self-injection at home is straightforward once trained.
Topical Gels and Creams
Applied daily to shoulders, upper arms, or thighs. Provides steady-state testosterone levels without peaks and troughs. Requires precautions to prevent transfer to partners or children through skin contact.
Transdermal Patches
Applied nightly, mimicking natural circadian testosterone release. May cause skin irritation in some men.
Subcutaneous Pellets
Implanted under the skin during an office procedure. Provides consistent testosterone release over 3-6 months. Eliminates daily or weekly dosing considerations.
Fertility-Preserving Alternatives
Critical consideration: Traditional TRT suppresses sperm production. Exogenous testosterone signals the pituitary to stop producing LH and FSH, which are required for spermatogenesis. For men who want to preserve or restore fertility, alternative approaches are available:
Enclomiphene Citrate
A selective estrogen receptor modulator (SERM) that blocks estrogen feedback at the pituitary, increasing LH and FSH production. This stimulates the testes to produce more testosterone naturally while maintaining or improving sperm production. Research has shown enclomiphene can increase testosterone levels in men with secondary hypogonadism in as little as two weeks, while preserving fertility.
Human Chorionic Gonadotropin (hCG)
hCG mimics LH and directly stimulates testicular testosterone production. Often used in combination with TRT to maintain testicular size and fertility, or as monotherapy for fertility preservation.
Clomiphene Citrate
Similar mechanism to enclomiphene. Used off-label for testosterone optimization while preserving fertility.
What to Expect From Treatment
Testosterone therapy doesn't work overnight. Different symptoms improve at different rates:
Energy and mood: Often improve within 2-4 weeks
Sexual function: Typically improves within 3-6 weeks, with continued improvement over months
Muscle mass and strength: Noticeable changes in 3-6 months with proper exercise
Body composition: Fat loss and muscle gain typically visible by 3-6 months
Bone density: Improvements measurable at 6-12 months
Full benefits: May take 6-12 months to fully realize
Monitoring and Safety
Ongoing monitoring is essential for safe and effective treatment. The AUA recommends evaluation at 3-6 months after starting therapy and annually thereafter. Monitoring includes:
Testosterone levels: Ensuring therapeutic range is achieved (typically 450-700 ng/dL)
Hematocrit: Monitoring for polycythemia (elevated red blood cells), the most common adverse effect
PSA: Prostate monitoring for appropriate candidates
Symptom assessment: Tracking improvement and any side effects
Potential Side Effects
Like any medical treatment, testosterone therapy has potential side effects. Common effects include acne and oily skin, fluid retention, breast tenderness, increased red blood cell count, and potential worsening of sleep apnea. Serious but rare concerns include blood clots and cardiovascular events in high-risk individuals. Most side effects are manageable with proper monitoring and dose adjustment.
Prevention and Lifestyle Optimization
While some causes of low testosterone are beyond your control, lifestyle factors play a significant role—particularly in secondary hypogonadism. These strategies support healthy testosterone production and may enhance treatment outcomes:
Weight Management
Given the strong relationship between obesity and low testosterone, achieving and maintaining a healthy weight is perhaps the most impactful lifestyle modification. Weight loss in obese men often leads to significant improvements in testosterone levels—sometimes enough to avoid or reduce medication needs.
Exercise
Both resistance training and cardiovascular exercise support testosterone. Research suggests that aerobic exercise may help increase testosterone by reducing fat and improving cardiorespiratory fitness. Resistance training stimulates acute testosterone release and improves body composition. Balance is key—excessive endurance training without recovery can actually suppress testosterone.
Sleep
Testosterone is primarily produced during sleep, particularly during deep sleep phases. Sleep deprivation significantly impairs testosterone production. Address sleep apnea if present—it creates a cycle of hormonal disruption. Aim for 7-9 hours of quality sleep nightly.
Stress Management
Chronic stress elevates cortisol, which directly suppresses the hypothalamic-pituitary-testicular axis. Prolonged stress has been found to hinder testosterone production. Effective stress management—whether through exercise, meditation, hobbies, or professional support—supports hormonal health.
Nutrition
A 2023 study found that the Mediterranean diet improved testosterone levels in men with low fertility. Key nutrients for testosterone production include zinc (found in shellfish, meat, legumes, and seeds), vitamin D (sunlight, fatty fish, fortified foods), and healthy fats (olive oil, avocados, nuts). Avoid ultra-processed foods and excessive alcohol, both of which are associated with lower testosterone levels.
Limit Alcohol
Research shows alcohol use is associated with low testosterone and other negative effects on sexual function and reproductive health. Following moderate drinking guidelines (up to two drinks per day for men, and not daily) supports testosterone levels.
Frequently Asked Questions
Is low testosterone just a normal part of aging?
While testosterone naturally declines with age, symptomatic testosterone deficiency is not inevitable. Many older men maintain adequate testosterone levels. The AUA emphasizes that age-related decline alone doesn't mandate treatment—clinical symptoms must be present. If low testosterone is significantly impacting your quality of life, regardless of your age, evaluation and treatment may be appropriate.
Does testosterone therapy cause prostate cancer?
Current evidence does not support a causal link between testosterone therapy and prostate cancer development in men without existing prostate disease. Large meta-analyses have not shown increased prostate cancer risk with treatment. However, testosterone therapy is contraindicated in men with active prostate cancer.
What about cardiovascular risk?
The relationship between testosterone and cardiovascular health has been extensively studied with mixed results. Importantly, low testosterone itself is a risk factor for cardiovascular disease. The TRAVERSE trial (2023)—the largest randomized study to date—found no increased risk of major cardiovascular events with testosterone therapy compared to placebo. The key is appropriate patient selection, proper dosing, and ongoing monitoring.
Will I need testosterone therapy forever?
It depends on the cause. If you have primary hypogonadism (testicular failure), long-term therapy is typically needed. If secondary hypogonadism is related to reversible factors like obesity, weight loss may restore natural production. The AUA recommends discussing discontinuation with patients who normalize testosterone levels but don't experience symptom improvement after 3-6 months.
Can I have children while on testosterone therapy?
Traditional TRT suppresses sperm production and should not be used if you're actively trying to conceive. However, fertility-preserving options like enclomiphene or hCG can boost testosterone while maintaining fertility. If TRT is preferred and fertility is a future concern, sperm banking before starting treatment is an option.
Take Action: Your Path to Feeling Like Yourself Again
If you're experiencing symptoms of low testosterone, you don't have to accept them as "just getting older." Testosterone deficiency is a medical condition with safe, effective treatments—and you deserve answers.
At Arsenal Men's Health, we make it simple for Utah men to get evaluated and treated:
Schedule Your Free Consultation: Speak confidentially with our licensed medical providers via telehealth
Convenient At-Home Testing: CLIA-certified lab kits delivered to your door—no clinic visits required
Personalized Treatment: If eligible, receive a customized protocol designed for your specific needs and goals
Ongoing Optimization: Regular monitoring and adjustments to ensure you achieve optimal results
Ready to get started? Contact Arsenal Men's Health today at (385) 666-6292 or visit arsenalmenshealth.com to schedule your free consultation.
We accept cash-pay, HSA, and FSA. Discreet packaging. Veteran-owned and operated.
Medical Disclaimer: This article is for educational purposes only and does not constitute medical advice. All treatment decisions are made by a licensed medical provider based on individual clinical appropriateness and patient history. Individual results may vary.
References
Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. J Urol. 2018;200(2):423-432.
Bhasin S, Brito JP, Cunningham GR, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744.
Anaissie J, DeLay KJ, Hatzichristodoulou G, et al. Testosterone deficiency in adults and corresponding treatment patterns across the globe. Transl Androl Urol. 2017;6(2):183-191.
Wu FC, Tajar A, Beynon JM, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med. 2010;363(2):123-135.
Mulligan T, Frick MF, Zuraw QC, et al. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract. 2006;60(7):762-769.
Camacho EM, Huhtaniemi IT, O'Neill TW, et al. Age-associated changes in hypothalamic-pituitary-testicular function in middle-aged and older men. Eur J Endocrinol. 2013;168(3):445-455.
Parsons JK, Carter HB, Platz EA, et al. Serum testosterone and the risk of prostate cancer: potential implications for testosterone therapy. Cancer Epidemiol Biomarkers Prev. 2005;14(9):2257-2260.
Lincoff AM, Bhasin S, Flevaris P, et al. Cardiovascular Safety of Testosterone-Replacement Therapy. N Engl J Med. 2023;389(2):107-117.
Corona G, Giagulli VA, Maseroli E, et al. Testosterone supplementation and body composition: results from a meta-analysis of observational studies. J Endocrinol Invest. 2016;39(9):967-981.
Wiehle RD, Fontenot GK, Wike J, et al. Enclomiphene citrate stimulates testosterone production while preventing oligospermia. Fertil Steril. 2014;102(3):720-727.
Grossmann M. Diagnosis and management of testosterone deficiency in men. Med J Aust. 2015;203(4):173-176.
Araujo AB, O'Donnell AB, Kupelian V, et al. Prevalence and incidence of androgen deficiency in middle-aged and older men: estimates from the Massachusetts Male Aging Study. J Clin Endocrinol Metab. 2004;89(12):5920-5926.
Snyder PJ, Bhasin S, Cunningham GR, et al. Effects of Testosterone Treatment in Older Men. N Engl J Med. 2016;374(7):611-624.
Shores MM, Smith NL, Forsberg CW, et al. Testosterone treatment and mortality in men with low testosterone levels. J Clin Endocrinol Metab. 2012;97(6):2050-2058.
Tags: low testosterone, testosterone deficiency, hypogonadism, low T, TRT, testosterone replacement therapy, men's health, hormone therapy, Utah men's health, telehealth, Arsenal Men's Health
SEO Meta Description: Complete guide to low testosterone for Utah men. Learn the causes, symptoms, diagnosis, and treatment options for testosterone deficiency. Evidence-based information with 14 peer-reviewed references from Arsenal Men's Health.
Featured Image Alt Text: Utah man experiencing renewed energy and vitality after low testosterone treatment
