Signs of low testosterone: What to look for and when to act

Telehealth clinics, social media influencers, and old mate down the gym all seem to be talking about testosterone. It’s the latest social media trend claiming that testosterone treatment is the answer to all your problems, whether it’s gym performance or performance in the bedroom.

But do you actually have low testosterone levels?

It depends on who you ask, but the truth is probably not. Anywhere between 10% and 40% of blokes have low testosterone levels, but most of this group are above the age of 45 [1]. That matters because testosterone naturally declines with age anyway.

With that in mind, let’s discuss what you must know about low testosterone and what to look for.

What is low testosterone?

Low testosterone levels, known as “low-t” or the medical term “hypogonadism”, isn’t a relative term. It’s where your testicles fail to produce enough testosterone, which is the male sex hormone.

Australia follows international guidelines on testosterone deficiency syndrome, classifying low testosterone as reaching a level below eight nanomoles per litre (nmol/L) [2]. Your testosterone will decline with age, and you might have a medical condition that causes it, but the vast majority of men have perfectly healthy levels of testosterone.

It’s estimated that hypogonadism is present in just five out of every 1,000 men, a far cry from the panic you’ll find on social media [3].

Primary hypogonadism vs. secondary hypogonadism vs. functional hypogonadism 

All forms of male hypogonadism are a threat to your quality of life, but there’s no single type of hypogonadism that your doctor might be diagnosed with. Here’s a breakdown of the three types [4]:

1. Primary Hypogonadism – The problem is in the testicles. Even when your brain is sending out the signals, your testicles aren’t producing enough testosterone. Reasons vary, including increased risk due to genetic reasons, existing medical treatments, and injuries to the sex organs.
2. Secondary Hypogonadism – In this case, your goolies are working fine, but the problem is in the brain’s signalling system. Again, it can be genetic or due to another medical condition.
3. Functional Hypogonadism – Functional hypogonadism is most common in older men [5]. Otherwise known as late-onset hypogonadism, it usually relates to other health conditions. The good news is that it’s often reversible with medical and lifestyle changes.

Why testosterone matters for men’s health

Testosterone is vital to the male reproductive system and men’s health as a whole. We still don’t fully understand everything it does. However, as the main male sex hormone, these chemical messengers are responsible for multiple functions, including [6]: 

• Penis and testicle development.
• Facial and body hair growth.
• Muscle size.
• Muscle strength.
• Bone growth.
• Sexual function.
• Sperm production.

In other words, testosterone’s role doesn’t stop with puberty. It carries on throughout your life, with massive impacts on physical strength and your sex life. There’s also emerging research that it’s more important than we thought in managing mood, motivation, and self-perception [7].

What causes low testosterone levels?

Low testosterone levels are not the crisis you might think. Studies from the University of Sydney found influencers pushing testosterone-related fears and tests using fear and blatant misinformation [8]. The truth is, a minuscule number of young people have low T levels because aging is the main cause of low testosterone.

However, there are other potential causes, including:

• Lifestyle issues, including stress and alcohol use
• Testicle injury
• Existing medical treatments
• Underlying medical conditions
• Being overweight or obese
• Genetic factors

Beyond just getting older, any number of reasons could be causing you to have decreased testosterone levels. That’s why the only way to really find out is to get a test done with your doctor.

What are the signs and symptoms of low testosterone?

Testosterone is such an essential part of the male body that lower-than-normal levels can manifest in any number of ways. That includes physical, emotional, cognitive, and sexual symptoms.

Here’s a rundown of the most common symptoms to be aware of before you start thinking about whether you need to schedule a consultation with your GP.

Sexual symptoms

Testosterone has an enormous influence on your sex function [9]. It’s part of the reason why older blokes tend to have a lower sex drive than your average teenager. However, this is perfectly normal. What can send alarm bells ringing is a drastic drop in libido.

Another prominent sexual symptom is being unable to achieve and maintain an erection, known as erectile dysfunction, or ED. Testosterone signals to the brain that it’s time to have a good time. It’s why one study found that 35% of men with ED also have low T levels [10].

Physical symptoms

Physical symptoms of low testosterone levels are wide-ranging, which is why it can be hard to immediately connect these symptoms directly to how much testosterone your body is producing.

Here are the main physical symptoms that could indicate below-average testosterone readings:

• Lower Muscle Mass – Less muscle is what many influencers push. Some research suggests it causes decreased muscle mass, but findings are mixed [11].
• Fatigue – Having low energy levels isn’t uncommon. If you’re constantly getting tired even though you’re eating right and getting enough sleep, you might have low testosterone [12].
• Smaller Bone Mass – Testosterone directly influences bone density and strength. Since it produces and strengthens bones, you could have lower bone volume, making fractures likelier [13].
• Higher Body Fat – Many blokes are worried about their body fat percentages. When the body doesn’t have the right hormonal balance, it can lead to increased body fat, with male breast development being possible when estrogen is taken into account [14].
• Hair Loss – Male pattern baldness is hardly out of the ordinary. It can happen for any number of reasons, with genetics playing a pivotal role in whether you’ll keep those luscious locks. Testosterone plays a role in all hair production, but if you’re losing facial and body hair, your testosterone levels could be to blame.
• Smaller Testicle Size – When you reach puberty, your body uses testosterone to develop the penis and testicles. As your testosterone production drops, though, you can actually see a decrease in testicle size.

As already mentioned, we still don’t have the full picture of testosterone and the effects of not having enough. The University of Western Australia did find that men with very low testosterone concentrations saw heightened risks of death generally, which is why this isn’t something you should just ignore [15].

Emotional and cognitive symptoms

We’re also seeing that testosterone could impact how you feel. The latest research shows how testosterone can influence your mood across the day, with feelings like [16]:

• Stress
• Low self-esteem
• Low motivation
• Mood changes
• Irritability

There’s also a theory that it could affect memory, with a small review finding a possible improvement in memory with testosterone replacement therapy [17]. Note that this is still something being investigated, though.

How is low testosterone diagnosed?

Getting diagnosed for low testosterone isn’t something you can do without the help of a registered clinician. There are no DIY tests you can order online to get a reliable reading, despite what TikTok influencers say.

Generally, your doctor will evaluate reported symptoms, go over your medical history to assess your overall health, and might ask you to fill out an Androgen Deficiency in Aging Men (ADAM) questionnaire. Likewise, you might receive a physical examination.

The main test will be a blood test. Under Australian guidelines, you’ll need two separate blood tests done on different days to confirm that you’ve got a testosterone deficiency. If you’ve got under 8 nmol/L, you’ll be diagnosed with low T levels, and interventions will be recommended if your readings are between 8 and 12 nmol/L, which may include testosterone injections, supplements, or lifestyle changes.

Note that prior to these blood tests, you’ll be asked to fast, and your blood will need to be drawn before 9:00 am, since this is when testosterone levels tend to peak.

After this, your doctor will work to find the underlying cause of why your total testosterone level is lower than expected.

Lifestyle factors that support healthy testosterone 

Maintaining or improving testosterone levels in otherwise healthy blokes is possible with lifestyle changes (no T-maxxing required). Since your lifestyle influences testosterone levels, making positive changes could help.

Examples of proven lifestyle factors to support healthy testosterone include [18]:

• Maintaining a healthy weight
• Regular physical activity
• Adopting a well-rounded diet
• Reducing alcohol consumption
• Quitting smoking
• Combatting poor sleep
• Reducing your stress levels

There’s nothing magical about any of these lifestyle changes. Living a healthy lifestyle, regardless of age, can support your testosterone levels.

Does it mean you can counteract a testosterone deficiency? Not necessarily, but when it comes to staving off natural testosterone declines with age, living healthier can go a long way.

When to speak to a doctor about low testosterone

Are you worried about low T?

Speak to your healthcare provider if you’re experiencing symptoms of low testosterone, including low sex drive, fatigue, and erectile dysfunction.

Your GP can discuss your symptoms, perform a blood test, and provide answers, including information on clinician-led treatments, like testosterone therapy, and general well-being support, including Pilot’s Testosterone Support supplement.

If you’d like to learn more, schedule your consultation with your GP today. 

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