The Truth About Low Testosterone

by | Aug 6, 2020 | MENS HEALTH

This is a picture of a clip board with a diagnosis on it that reads "low testosterone."

Hypogonadism or low testosterone is a common condition seen in men as they age. Testosterone is the male sex hormone produced primarily by the testicles. The testicles are stimulated by secretion of LH and FSH by the pituitary gland to produce testosterone (T) and sperm respectively. Women also have testosterone, but in much lower levels.

What are the Symptoms of Low Testosterone?

Signs and symptoms of low T in older men include lack of energy, focus, increased body fat, depression, diminished muscle mass and most commonly low libido and poor erectile function.

The Endocrine Society and AUA guidelines define Hypogonadism as T levels less than 300 ng/dL and symptoms consistent with low T. The diagnosis needs to be confirmed with two morning blood tests, on different days. Low T is defined as primary or secondary depending on the source of the problem. Primary Hypogonadism, being testicular dysfunction, is seen with testes cancer, or genetic conditions such a Klinefelter’s. Secondary Hypogonadism is due to pituitary dysfunction. The vast majority of hypogonadal men have a hybrid form commonly called Hypogonadism of aging men. This has also been referred to as andropause or male menopause. It differs from menopause in that in men the hormone levels drop much more gradually over time and many men maintain normal levels. Conditions that are associated with low T include Type 2 Diabetes, obesity, HIV disease, metabolic syndrome, and opioid use.

Do Effective Treatments Exist?

There are many treatments for low T that can either stimulate the pituitary gland (Clomid, HCG) or replace T directly. The first oral T, Jatenzo was recently approved, other treatments include weekly injections, long acting pellets or daily gels. The T Trial published in the New England Journal of Medicine was the largest placebo controlled trial, and it looked at the benefits of T replacement. It showed improved aspects of sexual function, improved walking distance, and slightly improved mood.

Testosterone therapy is not without potential risks and men on testosterone must be monitored. While men with low T have many increased risk factors for cardiac disease, several retrospective trials have shown increased adverse cardiac events in men on T replacement. Despite the many questions about the veracity of these trials, the FDA released a warning statement about the potential cardiac risk associated with testosterone replacement. A large randomized trial, the traverse trial, is presently underway to evaluate potential cardiac risk.

There is a black box warning on labels of recently approved T products regarding increased blood pressure seen in a small number of men receiving T replacement. The gels have a black box warning about possible transference of the gel to others.

Other concerns or side effects of T replacement include decreased fertility, as exogenous T suppresses testicular function including sperm production. There is potential for increased red blood cells which can thicken the blood. There is a theoretical concern of increased prostate cancer or enlargement of the prostate. Morgentaler et al has written extensively about this potential risk and has largely debunked this concern. That said, men on testosterone replacement should have regular PSA blood tests and digital rectal exams.

Who Should get Screened for Low T?

According to the aforementioned guidelines, men with erectile dysfunction, infertility, low libido, Type 2 diabetes, obesity, depression and atrophic or small testicles should be screened with a morning T level.

Men should speak to their doctor about what treatment for low T is most appropriate for them. Non-pharmacological ways to boost testosterone include weight loss, healthy diet, improved sleep, and weight training. Long distance running, some medicines such as statins, and diets high in estrogenic foods, such as soy products, can in some cases lower T levels.

Testosterone should always be administered by a medical practitioner trained and focused on men’s health and never use testosterone obtained in the gym or from friends or trainers.

While T is not a panacea or fountain of youth, it can be transformative in many men if used properly. It can boost libido, improve sex drive and erections and improve the quality of orgasm. Many men report improved energy and vigor. Levels should be followed and dosage changed according to levels and improvement of symptoms.


The content provided in this article is provided for information purposes only and is not a substitute for professional advice and consultation, including professional medical advice and consultation. It is provided with the understanding that Modern Intimacy is not engaged in the provision or rendering of medical advice or services. The opinions and content included in the article are the views of the author only, and Modern Intimacy (or Dr. Kate Balestrieri) does not endorse or recommend any such content or information, or any product or service mentioned in the article. In reading this, you acknowledge and understand that Modern Intimacy shall not be liable for any claim, loss, or damage arising out of the use of, or reliance upon any content or information in the article.

Modern Intimacy is a group therapy practice, founded by renowned Psychologist and Sex Therapist, Dr. Kate Balestrieri. This inclusive blog is designed to provide a wealth of information and resources for mental health, relationships, and sexuality. Subscribe today to get the latest information from our expert contributors from all around the world.



Author Bio

Dr. Jed Kaminetsky is a Board Certified Urologist on the faculty of NYU School of Medicine. He has been recognized annually by Castle Connelly as one of the top doctors in NYC. As Medical Director of Manhattan Medical Research. He has been a principle investigator in over 100 clinical trials, has co-authored many papers in medical journals and has presented his research at national and international meetings. Dr. Kaminetsky is widely recognized as a key opinion leader in various areas on men’s health including sexual dysfunction, hypogonadism and benign diseases of the prostate. For more information, see www.Universityurology.com.



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