Testosterone plays a part in energy, mood, muscle and sex drive, so when levels fall the changes tend to arrive slowly and blend into ordinary life. Many men put them down to stress, a busy year or getting older.
Age does play a part. Cleveland Clinic notes that testosterone can drop about 1% a year starting in the late 30s. But low testosterone is also a medical condition with known causes and a clear way to check for it.
This article is for education and is not medical advice. Talk with a licensed provider about your health. Talk to us
What are the signs of low testosterone?
The most specific signs involve sex. Cleveland Clinic lists a lower sex drive, fewer morning or spontaneous erections, and trouble getting or keeping an erection.
Other signs are easier to miss because each one has an everyday explanation: less endurance, less muscle strength and mass, more body fat, a low or depressed mood, and trouble concentrating or remembering things. Cleveland Clinic also lists less armpit and pubic hair, hot flashes, a low sperm count and, in some men, enlarged breast tissue.
None of these on its own means testosterone is low. The pattern matters, and so does how long it has lasted.
Common signs of low testosterone
- Lower sex drive
- Fewer morning erections
- Less endurance
- Less muscle strength
- More body fat
- Low or depressed mood
- Trouble concentrating
- Hot flashes
- Less body hair
Can low testosterone make you tired, anxious or gain weight?
It can play a part in all three, which is why it is so easy to overlook. Lower endurance, a depressed mood and more body fat are all on Cleveland Clinic's list of signs.
Weight works in both directions. Obesity and diabetes are among the most common causes of low testosterone, and extra body fat is also one of its signs, so each can make the other worse. There is more on this in why belly fat gets harder to lose after 40.
Sleep matters too. Obstructive sleep apnea is a known cause, and Cleveland Clinic recommends about seven hours of sleep a night and treatment for sleep apnea if you have it.
Tiredness, anxiety and low mood also come from depression, long periods of stress and many other conditions. The American Urological Association says this plainly: many symptoms linked to low testosterone are not specific to it, so symptoms alone cannot settle the question.
What causes low testosterone in men over 40?
Age is the cause most men expect, but it is rarely the whole story. Cleveland Clinic describes two kinds of low testosterone.
One kind starts with the signals the brain sends to the testicles, through the pituitary gland and hypothalamus. It is linked to:
- Obesity or diabetes, the most common causes in men who have symptoms
- Obstructive sleep apnea
- Certain medicines, including some used for prostate cancer, digestive problems or pain
- Opioid use, and some medicines used to treat opioid dependence
- Alcohol use disorder
- Long term conditions such as cirrhosis of the liver or kidney failure
The other kind starts in the testicles themselves, after an injury, chemotherapy or radiation, iron overload or a genetic condition.
Low testosterone can happen at any age, and men under 40 can have it too. Cleveland Clinic says it is more likely with poorly managed type 2 diabetes, sleep apnea, overweight, or chronic kidney or liver disease.
How is low testosterone diagnosed?
With symptoms and blood tests together. The American Urological Association defines testosterone deficiency as low testosterone levels combined with symptoms or signs, so a number on its own is not enough.
Testosterone is highest in the morning, so the blood draw is early. MedlinePlus puts it between 7 and 10 am, and Cleveland Clinic notes that confirming low testosterone usually takes two separate morning samples. Levels below 300 nanograms per deciliter (ng/dL) are generally considered low in adults.
A recent illness can lower testosterone for a while, so tell your provider if you have been sick. Other blood tests, such as luteinizing hormone (LH) and prolactin, help find the cause, for example a problem with the pituitary gland. And as MedlinePlus points out, testosterone normally falls with age, so a result outside the usual range does not always mean something needs treatment.
What to know before any treatment
Cleveland Clinic lists nutritious food and regular physical activity as the first treatments for low testosterone. Other options come in if those have not helped after six to 12 months, or if symptoms are severe. It also advises against over the counter supplements.
Two things deserve a conversation before testosterone therapy starts. The first is children. Testosterone therapy raises testosterone in the blood but not inside the testicles, where sperm is made, so it can lower sperm count further. Cleveland Clinic does not recommend it for men who want to start a family.
The second is your health history. Cleveland Clinic notes that therapy may not be an option with an untreated prostate lump, poorly controlled blood pressure, a recent heart attack or stroke, unmanaged heart failure or untreated sleep apnea. Anyone on therapy also needs regular follow up visits, often once or twice a year.
The American Urological Association notes that testosterone prescriptions have nearly tripled in recent years and that many men use testosterone without a clear medical reason. A proper diagnosis protects you from becoming one of them.
When to get checked
It is worth asking for a testosterone check if:
- Your sex drive or erections have changed and the change has lasted
- You feel worn down, weaker or less sharp and cannot point to a reason
- You have type 2 diabetes, sleep apnea or extra weight, or you take opioids
- You and your partner are having trouble conceiving
If low mood is part of what you feel, say so plainly. Depression deserves care in its own right, whatever your testosterone level turns out to be.
