What you need to know about low T

Testosterone is a sex hormone, primarily associated with men—though women’s bodies also make it in small amounts. It’s primarily produced by the testicles, and it plays an important role in the body by helping to regulate sex drive, sperm production, bone health, muscle function, and hair growth. When your body doesn’t produce enough, you might hear it referred to as low T, testosterone deficiency, or male hypogonadism. Whatever your doctor calls it, low testosterone levels can make you feel tired, cranky, or uninterested in sex—along with other possible symptoms.

But you don’t have to just sigh and accept it. 

“I would urge men to discuss bothersome symptoms and complaints with their [healthcare providers],” says urologist Jay Newmark, MD, chief medical officer of Clarus Therapeutics. “Whether or not they are related to testosterone levels, there may be a remedy available that will improve his overall quality of life.”

What happens when a man’s testosterone is low?

You may be wondering how you would know if your testosterone levels are lower than they should be. According to the American Urological Association (AUA), some of the most common symptoms of low testosterone include:

• Fatigue
• Low sexual desire
• Decreased energy levels
• Erectile dysfunction
• Reduced muscle mass
• Irritability
• Loss of body hair

“If you’re having any symptoms, see a doctor about getting your levels checked,” says Tracy Gapin, MD, a board-certified urologist and founder of Smart Men’s Health.

That’s a good idea because low T can be confused for other medical conditions, according to Leo Nissola, MD, a member of the clinical development team at The Parker Institute for Cancer Immunotherapy. “Patients that suffer from low testosterone production may be wrongly diagnosed with depression since some of the symptoms overlap, such as the lack of interest in sexual activity and lack of energy,” Dr. Nissola says.

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What’s a normal range of testosterone?

If you’re experiencing symptoms of low T and can’t figure out another reason for them, your doctor might suggest a serum testosterone test, which is a blood test that will measure the amount of testosterone in your blood. 

“Normal” levels of testosterone for a healthy adult male without any issues affecting his testosterone production range from 350 nanograms per deciliter and 750 ng/dL. According to the American Urological Association (AUA), the cutoff is the 300 ng/dL line—that is, men who have testosterone levels that fall below 300 ng/dL could experience potential benefits from treatment. 

In order to correctly make a low T diagnosis, it is important to check the testosterone levels correctly i.e., between 8 a.m. to 9 a.m. after an overnight fast.

What is the main cause of low testosterone?

One of the biggest causes of low T is age. Usually a man’s testosterone levels peak during his late teens or early 20s, then gradually drop after that. However, low T is not a foregone conclusion for all men after a certain birthday. Many older men never experience a drop that’s significant enough to cause any symptoms. (The AUA estimates that about 2.1% of men may have a testosterone deficiency.) 

Also, many experts note that age alone may not be responsible­; some of the health conditions that men are more likely to acquire as they age may contribute to a decline in testosterone production, such as diabetes and obesity. 

But there are other factors that can cause your testosterone levels to drop:

• Sleep apnea 
• Injury to the testes
• Dysfunction of the pituitary gland
• Metabolic syndrome
• Chemotherapy or radiation treatment
• Genetic conditions like Klinefelter syndrome
• Some medications
• HIV/AIDS

There is some evidence suggesting certain foods can contribute to low T levels, such as: soy products, alcohol, mint, licorice, flaxseeds, and certain processed foods that are high in trans-fats or sugars. More research is needed, but it can’t hurt to try to eliminate some of these from your diet.

Low T treatment

When untreated, low testosterone can lead to a decline in the quality of life or low bone density. Fortunately, testosterone therapy and natural treatments are available and help many men counteract the effects of their low testosterone levels and return to normal sexual function.

“I think it’s important to discuss the different options with your healthcare provider,” says Dr. Newmark.

Testosterone therapy

The testosterone products approved by the United States Food and Drug Administration (FDA) include:

• Topical gels: You can apply testosterone gel, such as Androgel, to your shoulder or your upper arm at the same time each day.
• Creams: You can also apply a testosterone-containing cream to the skin of the scrotum.
• Nasal gels: The amount and number of times you need to use this gel varies. Many men need to put this testosterone gel in their nostrils three times a day to boost their testosterone levels.
• Patches: Apply this transdermal patch once a day, varying the locations each day.  
• Injections: You can inject a testosterone solution under your skin (subcutaneous) or into your muscle (intramuscular).
• Pellets: The pellets, which are surgically implanted under your skin, release testosterone into your body over the course of several months. One drawback: You can’t adjust the levels once they’ve been implanted until it’s time to remove them, says Dr. Gapin.
• Oral treatments: You can get a prescription for an oral capsule, if appropriate, or a small patch that you put on your gum above one of your canine teeth.

Many men do just fine with one of these treatments. But it’s important to note: Testosterone therapy isn’t for everyone. These treatments can have side effects ranging from acne to breast enlargement to mood swings. 

Additionally, it can have other, potentially serious downsides. Testosterone treatments can interfere with other medications that you may be taking. Testosterone therapy can lead to infertility, which, although it’s usually temporary in a majority of the cases, may be a dealbreaker for some men, especially younger men. And there can be increased risks from long-term use, too. For example, particularly in people over 65 years of age, long-term testosterone therapy has been linked to an increase in cardiovascular disease or heart attack.

Dr. Newmark notes that men with an enlarged prostate who experience difficulty urinating may find that testosterone therapy makes their situation worse. “Testosterone is the main driver for the growth of prostate cancer,” adds Dr. Nissola. “That is why the testosterone replacement therapy [TRT] is not recommended for men with prostate cancer, a nodule on the prostate, or a PSA greater than three ng/ML.”

Endocrine Society recommends that if someone has sleep apnea, it should be treated prior to testosterone treatment. The society also recommends screening for sleep apnea in overweight people and those who snore at night. 

Lifestyle changes

Dr. Gapin often tells his patients to think beyond testosterone therapy. “Testosterone therapy alone is not going to give you what you need,” he says. “We need to focus on a whole-body comprehensive approach.”

Some areas of your health that you can work on improving that may help your testosterone levels:

• Get more sleep. “Good quality sleep,” qualifies Dr. Gapin. “Studies show that poor quality sleep can crush testosterone levels.”
• Reduce your stress levels. When you’re chronically stressed, your body is producing a lot of the hormone called cortisol. “That crushes testosterone levels, too,” says Dr. Gapin, who suggests that his patients consider a wide range of possibilities, including mindfulness meditation.
• Exercise regularly. But don’t just run or bike, says Dr. Gapin. Fit in some weight or strength training to build muscle mass and reduce body fat.
• Eat a healthy diet. Some research suggests that dialing back on the heavy, processed foods might be useful, while other research has documented a decline in testosterone levels among men eating a low-fat diet. In general, though eating a healthy, well-balanced diet can help you maintain a healthy body weight.

John Martinez, MD, also recommends that his patients reduce or avoid alcohol, since research shows that alcohol use can impair the body’s production of testosterone. 

No one wants to be diagnosed with low testosterone, but the good news is that most cases are treatable. Work with your healthcare provider to find the treatment plan that’s right for you.