Symptoms
- Low sex drive and erectile problems, including fewer morning erections
- Tiredness and low mood
- Reduced muscle and strength, more belly fat
- Less body hair, hot flushes, infertility and weaker bones
Many of these also come from poor sleep, obesity, diabetes, depression or stress, so testing matters.
How it is tested
- A total testosterone level taken in the morning, usually between 8 and 10 am
- Repeated on at least two occasions
- SHBG and free testosterone when needed, as obesity and diabetes lower SHBG
- LH and FSH to show whether the testes or the pituitary is the source
- Prolactin and other tests when a pituitary cause is suspected
Common causes
- Obesity, type 2 diabetes and sleep apnoea
- Some medicines, including opioids and long-term steroids
- Past anabolic steroid use
- Pituitary problems, including high prolactin
- Conditions of the testes, such as Klinefelter syndrome, injury or past mumps
Treatment
Treating the cause, such as losing weight or treating sleep apnoea, can raise testosterone. Testosterone replacement is considered when the diagnosis is confirmed, with regular blood tests and prostate checks.
Testosterone treatment can lower sperm count. If you are planning children, discuss this first, as other options may suit you better. Avoid over-the-counter boosters and testosterone bought without a prescription.
When to see a specialist
Consider an endocrinology opinion for symptoms with a low result, infertility, or a pituitary or prolactin problem.
This guide is general information and is not a substitute for a consultation.