What is Low Testosterone?

Alright, buddy, let me break this down for you in the gym lingo we both understand. You know how every good workout needs a foundation? Well, testosterone is the foundational hormone in a man’s body, just like bench presses are to your chest day. It’s brewed up in the testicles and plays a massive role in a male’s sexual development and functionality.

Think of puberty as your initial training days, when you start seeing those beginner gains. Testosterone acts like your first-ever protein shake here, helping teenage boys develop typical masculine traits such as body and facial hair, a more resonant voice, and most importantly for us, muscle strength.

Just as essential, testosterone acts like your personal little sperm factory, helping to create those swimmers. But here’s the kicker, just like your gains might plateau with age, testosterone levels also typically decrease as you get older. So, older gents often end up having lower testosterone levels in their blood.

Some guys, unfortunately, have these levels lower than the norm – this is what we call Testosterone Deficiency Syndrome (TD) or simply Low-T. Think of it as the body not getting enough of a crucial supplement – a deficiency, if you will. And a syndrome, just like a tough training regime, is a group of symptoms suggesting a health issue.

So how do you know if you’re dealing with Low-T? The American Urology Association (AUA) flags anything less than 300 nanograms per deciliter (ng/dL) as a low testosterone level. Symptoms can vary, but typically they’re not too different from overtraining:

  • Lower-than-normal libido
  • Feeling tired all the time
  • Decrease in lean muscle mass
  • Increased irritability
  • Trouble with getting or maintaining an erection
  • Feelings of depression

But remember, these signs could be because of various other reasons too, like using opioids, congenital conditions (those you’re born with), testicle injuries or loss, diabetes, and obesity. So, if you’re experiencing any of these, don’t self-diagnose. Instead, make an appointment with your doctor to get things checked out.

Why Testosterone Therapy (TT)?

Alright, so why would someone like you or me consider Testosterone Therapy (TT)? Think of TT as a personalized training program for your hormone levels. You may need to enroll in this program if you’re dealing with Low-T. Both the food and drug gurus at the FDA and the AUA suggest using TT for conditions you’re born with, like Klinefelter syndrome, which is like having a genetic disadvantage when it comes to muscle growth.

You might also need TT if you damage or lose your testicles, just as you’d need physical therapy if you injure a muscle or lose an essential function. Say, if your testicles are removed due to an illness such as cancer, TT may be your go-to. Most dudes with Low-T, no matter what the root cause is, will be treated if they have the symptoms of Low-T and blood tests backing up those low testosterone levels. If you think you might need TT, have a chat with your doc.

Now, like any intense training regimen, TT could be beneficial but it can also come with its own set of downsides. (We’ll get to those in a bit.) The Federal Drug Administration (FDA) has flagged that testosterone products may come with a risk for heart disease and stroke for some men. Just like how you’d get a health check before embarking on a new workout plan, all men should be screened for heart disease and stroke before starting, and periodically while on, TT. The AUA, however, after going through tons of studies, has stated there’s no concrete evidence that TT either ramps up or slashes the risk of cardiovascular events.

The FDA also raised an eyebrow when they saw guys getting treated for Low-T just because they were getting older. There’s ongoing research about the role of TT in aging men, much like how there’s always new workout trends being studied. Your doc will have a thorough discussion with you about the pros and cons of TT and consider carefully how to tackle your symptoms.

How Common is Low Testosterone in Men?

Alright, mate, you’re probably wondering how common this Low-T thing is among the brotherhood, right? Well, it’s kind of tricky to pinpoint the exact number of dudes dealing with TD, much like it’s hard to know exactly how many guys are nailing their macros every day. However, the numbers suggest that roughly 2.1% – or about 2 in every 100 guys – might have TD. It’s a bit like knowing only a few people in the gym who can squat twice their body weight.

In younger fellas, like those fresh to the iron game, as few as 1% might have TD. But as guys get older, the numbers can skyrocket, with as many as half of the men over 80 years old possibly dealing with TD. That’s like the rate of injuries going up as you age if you don’t take care of your form and recovery. Keep in mind, though, different folks who study this condition might use different benchmarks, so you might hear different stats thrown around.

Now, TD seems to be more common in men who have diabetes or are packing some extra weight. In one research study, akin to a gym survey, 30% of the heavier dudes had Low-T, compared to just 6.4% of guys with a normal weight. Think of it as more folks struggling with form when they’re carrying around extra body fat. That same study flagged diabetes as a risk factor for TD. In another survey, 24.5% of the men with diabetes were dealing with Low-T, compared to only 12.6% of guys without diabetes. So keeping a healthy weight and managing conditions like diabetes are just as crucial for your hormone health as they are for your gym performance.


Alright, just like knowing the signs your body is overtraining, it’s essential to recognize the symptoms of Low Testosterone. Now, some of these are directly tied to having Low-T levels – let’s call them the specific signs and symptoms, like not making any gains despite training hard and eating right. Other symptoms might not necessarily be linked to Low-T – these are non-specific signs and symptoms, sort of like feeling tired all the time, which could be due to overtraining, poor sleep, or stress, not just Low-T.

Think of your doctor as your personal trainer in this situation. They’ll help you make sense of your symptoms, determine what’s likely due to Low-T, and what might be due to other factors. Just like how a trainer helps you figure out what’s going wrong with your form or your workout regimen.

Specific Signs/Symptoms of Testosterone Deficiency (TD)

So let’s dive into these specific signs and symptoms of Testosterone Deficiency (TD), bro. These are like those undeniable signs you’re overdoing it at the gym, like persistent muscle soreness or injuries. The symptoms more likely or directly linked to TD include:

  • A dwindling sex drive – think of it like losing your motivation to hit the gym.
  • Reduced erectile function – it’s like not being able to lift as heavy as you used to.
  • Loss of body hair – sort of like losing grip strength unexpectedly.
  • Less beard growth – like your facial gains are stalling.
  • Loss of lean muscle mass – this one’s self-explanatory in our world, it’s like your gains are slipping away.
  • Feeling beat all the time – as if you’ve been hitting a grueling workout every day without recovery.
  • Obesity – just like it sounds, it’s carrying around too much body fat.
  • Signs of depression – like losing interest in stuff you usually enjoy, like pumping iron.

Remember, if you’re experiencing these symptoms, it’s essential to consult your doc just as you’d check in with your trainer if your workout progress stalls or goes downhill.

Non-specific Signs/Symptoms of Testosterone Deficiency (TD)

Alright, let’s now talk about non-specific signs and symptoms of Testosterone Deficiency (TD), mate. These are more like those ambiguous signs in the gym where you’re not sure if you’re hitting a plateau or just having an off day. These symptoms may or may not be linked to TD and include:

  • A dip in energy levels, endurance, and physical strength – it’s like not being able to maintain your usual workout intensity or getting winded easily.
  • Struggling with memory – similar to forgetting your set or rep count during a workout.
  • Having a tough time finding the right words to say – akin to being unable to recall the names of exercises.
  • Difficulty focusing – like not being able to keep your mind on your form or workout routine.
  • Not performing up to par at work – sort of like when your gym performance starts slipping.

Now, experiencing any one of these specific or non-specific symptoms doesn’t necessarily mean you’re dealing with TD. It’s like one bad workout doesn’t mean you’re overtraining. However, if you start noticing a cocktail of these symptoms, like feeling perpetually drained and down over a period, and this isn’t normal for you, you might want to check for TD.

Having a low sex drive on its own might not mean you’re dealing with TD, just like one low-energy workout doesn’t mean you’re overdoing it. But if you’re dealing with a combination of issues like low sexual desire, difficulty with erections, and feelings of fatigue and sadness, it’s like noticing multiple signs of overtraining – that’s when you should have a chat with your doctor.


Alright, let’s talk about the causes behind this Testosterone Deficiency (TD) thing, just like we discuss what causes muscle imbalances or injuries in the gym. Some people are born with conditions that set them up for TD, kinda like some folks are naturally more flexible or less prone to injuries. These include:

  • Klinefelter syndrome
  • Noonan syndrome
  • Ambiguous genitalia, which is when the sex organs develop in ways that aren’t typical – think of it like having a unique body type that doesn’t fit the classic ectomorph, mesomorph, or endomorph categories.

Now, some dudes might develop Low-T due to certain circumstances, like:

  • An accident damaging their testicles – like how a gym injury can hinder your workout routine.
  • Removing the testicles due to cancer – like having to cut certain exercises out of your routine because of health issues.
  • Chemotherapy or radiation – this is like a brutal training program that exhausts you and impacts your performance.
  • Diseases of the pituitary gland leading to a deficiency in hormones – it’s like your body’s command center for hormones going off the rails.
  • Infection or autoimmune disease, when the body’s defense system starts attacking its own cells – similar to overtraining, where your body’s systems start to break down instead of building you up.

The gist is, if your testicles start producing less testosterone than usual, your blood testosterone levels will drop, like your strength levels dwindling if you stop lifting weights. Many men who develop TD have Low-T levels linked to factors like:

  • Aging – like how flexibility and recovery capacity can decline as we get older.
  • Obesity – just like being overweight can impact your overall performance in the gym.
  • Metabolic syndrome, which includes things like high blood pressure, high blood sugar, unhealthy cholesterol levels, and belly fat – think of it as a combo of health issues that can mess with your fitness game.
  • Use of certain medications, such as antidepressants and narcotic pain medications – similar to how some supplements can have side effects that hinder your progress.

Men with certain health conditions also tend to have low testosterone. For example, about 30 out of 100 guys with HIV and about 50 out of 100 with AIDS also have low testosterone. That’s like having a chronic health issue that makes sticking to your workout routine more challenging.


Alright, buddy, let’s chat about how this Low Testosterone (Low-T) stuff gets diagnosed. This is like getting a full assessment before starting a new fitness regimen, except it’s for your hormones. While many symptoms can hint at Low-T, the most accurate measure is your total blood testosterone level, kind of like how your one-rep max is a crucial indicator of your strength level. Your doctor will use this in conjunction with other specific signs and symptoms to pin down the diagnosis.

During your medical visit, your health history will be taken, kinda like the initial questionnaire you fill out at the gym, and the doc will do a physical examination, looking for some of the signs and symptoms we’ve talked about.

Health History

Your doc might ask you about:

  • Headaches, changes in your visual field (possible symptoms of a brain mass like a pituitary tumor)
  • How you developed during puberty – think of it like your first gains when you started lifting.
  • Any history of head trauma
  • Any cranial (head) surgery/brain tumor or cranial irradiation
  • Anosmia (loss of ability to smell)
  • Any history of infection or injury to your testicles – kind of like previous muscle or joint injuries.
  • If you had mumps after puberty
  • Past or present use of anabolic steroids – like a history of supplement use.
  • Use of opiates or glucocorticoids (medicines like cortisone used to treat inflammation)
  • History of chemotherapy or irradiation
  • Family history of diseases linked to Low-T
  • History of stroke or heart attack
  • History of unexplained anemia – it’s like a sudden drop in performance at the gym with no apparent reason.

Physical Examination

The doc will check for:

  • BMI or waist circumference for obesity – similar to how a trainer would measure your body composition.
  • Signs of metabolic syndrome, which includes symptoms like increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels – it’s a bit like having a combination of fitness issues.
  • Hair pattern, amount, and location
  • Gynecomastia (enlarged breasts)
  • Presence and size of testicles – sort of like checking your muscle symmetry and size.
  • Prostate size and any abnormalities – like a trainer checking your form for any issues.


Alright, buddy, let’s get into the nitty-gritty of how we’re gonna test for this Low Testosterone (Low-T) situation. Think of it like tracking your gym progress – checking the weights, reps, sets, and the physique. Here’s the rundown:

Your doc might order these blood tests:

1. Total testosterone level: This is like measuring your max lift. It should be done twice on samples taken before noon since testosterone levels drop in the afternoon. If you’re feeling under the weather, the doc will wait till you’re better because sickness can mess up the results.

2. Luteinizing hormone (LH): This one’s important because it controls how you produce testosterone. Abnormal levels could indicate a pituitary gland issue – that’s the hormone control center in your brain.

3. Blood prolactin level: If this one comes back high, the doc might retest to double-check. High prolactin can be a sign of problems or tumors in the pituitary gland.

4. Blood hemoglobin or Hgb: Before this test, the doc will rule out other reasons for low Hgb like altitude, sleep apnea, or smoking.

For a more comprehensive diagnosis, the doc might also do:

1. Follicle-stimulating hormone (FSH): This test checks your sperm-making function, important if you’re planning on having kids. Semen tests may be needed before any hormone therapy starts.

2. Estradiol hormone test if you have breast symptoms.

3. HbA1C blood test to check for diabetes.

4. MRI of the pituitary gland.

5. Bone density tests.

6. Karyotype (Chromosome tests).

You might hear about free testosterone or bioavailable tests. These aren’t the same as total testosterone tests. Ask your doc about the differences and whether you need these tests.


Treatment-wise, it’s like changing up your workout routine when you’re not getting the results you want. The American Urological Association recommends that Testosterone Therapy (TT) be prescribed only to guys who meet both the clinical and laboratory definition of testosterone deficiency (Testosterone level of less than 300 ng/dL). So, it’s crucial that your testosterone level is tested before starting any TT. Think of it as a baseline before starting a new workout routine. Here’s what you gotta know:

1. The doc will likely measure your testosterone level if you have certain conditions, such as unexplained anemia, diabetes, bone density loss, low-trauma bone fracture, radiation to your testicles, HIV/AIDS, chronic narcotic use, history of infertility, or pituitary gland disorders.

2. Even without specific signs and symptoms, your total testosterone level might be tested for conditions like insulin resistance, history of chemotherapy, or if you’ve been using corticosteroid meds.

3. Health changes like losing weight and upping your physical activity can naturally boost your testosterone levels. Think of it as your body naturally responding to a more intense workout regimen.

4. Your doc will want to monitor your hemoglobin/hematocrit (Hgb/Hct) levels while you’re on TT. This is to check for blood thickening which could lead to blood clots. It’s like making sure you’re not overdoing it at the gym and risking injury.

5. If you’re at risk for heart disease, your doc will keep a closer eye on you while you’re on TT. It’s also vital to make health changes to lessen the chances for heart and blood vessel disease.

6. The goal of your TT will be to raise your Low-T level to above 300ng/dl, but the exact target might vary.

7. Your doc will watch for signs of improvement, like a trainer looking for progress in your gym performance. Any changes will likely show up within three to six months of starting treatment.

8. If your total testosterone levels return to normal but you still have symptoms, it’s possible that there are other factors at play. Just like plateauing at the gym, your doctor may need to reassess and figure out what the real problem is.

How Do I Take Testosterone?

Alright bro, when it comes to pumping your system with Testosterone Therapy (TT), there are five main methods you can use, kinda like the variety in your workout – you’ve got: transdermal (through the skin), injection, oral/buccal (by mouth), intranasal (through the nose), and by pellets under the skin. There’s no one-size-fits-all method here, just like with lifting. You gotta find what works best for you. While you’re on TT, your doc will keep checking your blood to track testosterone levels, like measuring your progress at the gym.

Here’s the breakdown of these methods:

1. Transdermal (Topical): Think of this as applying a protein-infused lotion. There are gels, creams, liquids, and patches that get absorbed through your skin. They usually last for about four days and absorb better under a dressing. Just remember, apply them on dry skin without any cuts or scratches, don’t wash off until the next dose, and wash your hands after application. And hey, don’t let others, especially women and kids, touch these products.

A topical patch is like a band-aid pumped with your medicine. You slap it on and leave it until the next dose. It’s less likely to transfer to others, so it’s a safer bet around other people.

2. Injection: This is like your protein shot. There are short-acting and long-acting forms, given under the skin or into the muscle. The frequency of these injections can vary – weekly, every two weeks, or monthly.

3. Oral/buccal (by mouth): This is like popping a testosterone gum into your mouth, but don’t chew or swallow it. You stick the patch above your incisor (“eyetooth”) and let the drug release over 12 hours. It’s easier on the liver than swallowed drugs but might cause headaches or irritation where you place it.

4. Intranasal: This is a testosterone gel for your nostrils, think of it as your nasal power pump. The dose goes into each nostril as directed, typically three times daily.

5. Pellets: This one is a bit more hardcore, like going under the knife for bigger gains. The doc will numb your upper hip or buttocks and make a small incision. Then, they’ll place testosterone pellets in the fatty tissues under your skin. This testosterone dissolves slowly, releasing over 3-6 months, depending on the number of pellets.

So, bro, choosing your method of taking testosterone is like picking your workout routine, it’s gotta be what works best for you. In some cases, your insurance might dictate the order of the methods. Be sure to chat about all your options with your doc before you decide.

Are There Side Effects of TT?

Bro, just like with any supplement or treatment, TT has its side effects. They can range from mild to serious, kind of like how you can have a mild muscle cramp or a serious injury. You gotta chat with your doc or pharmacist about these possible side effects, and stay alert to them while you’re on TT. Here’s what you might encounter:

– With gels and liquids, you could see some redness where you apply it, like a post-workout flush. Patches might cause itching or a rash, and a few folks have reported back pain, but that’s quite rare.
– Short-acting injections can cause reactions at the injection site, like a post-injection soreness. For the long-acting shots, some people have had serious allergic reactions, so the medical team will keep an eye on you in the office for a bit after you get one.
– Testosterone pellets can come with some side effects too – think swelling, pain, bruising, and rarely, a hematoma (kind of like a clot of blood under your skin).
– During TT, there’s a risk of erythrocytosis – that’s when your blood gets too thick because of an increase in hemoglobin and hematocrit, kinda like trying to pump sludge instead of water.
– TT can mess with your sperm production. If you’re planning to have kids soon, you might wanna skip the TT. If you’re getting treated for Low-T, your doc might suggest additional treatment to keep your swimmers in good shape.
– Topical testosterone, like gels, creams, and liquids, can rub off on others, especially women and children. It’s like spilling your protein shake on someone else – not cool. Make sure to cover the area after application, wash your hands thoroughly, and don’t let the treated area touch others.
– The FDA suggests watching for signs of early puberty in kids you live with or have contact with if you’re using topical testosterone. Don’t let kids touch the unwashed or unclothed area where you’ve applied the drug.

Now, here’s some stuff you should know, bro:

– There’s no evidence linking TT to prostate cancer. That’s like saying lifting weights causes hair loss, bro, it just ain’t true.
– There’s no strong evidence linking TT to an increase in vein clots.
– As of now, there’s no strong evidence that TT either ups or downs your risk of cardiovascular events. But, while you’re on TT, if you notice any signs or symptoms of a stroke or heart attack, like how you’d feel if you tried to deadlift three times your max, call your doc immediately.

After Treatment

Alright, buddy, let’s talk about what happens after treatment. You know, just like with our bodies in the gym, everyone responds differently to treatment. TT might help with things like your sexual performance, desire, bone density, anemia, lean muscle mass, and even symptoms of feeling low. But, bro, don’t expect miracles. There’s no solid proof that TT will help with your memory, diabetes control, energy levels, tiredness, cholesterol profiles, or overall quality of life.

Just like with regular gym check-ins to monitor your progress, you’ll need routine medical checkups to ensure your testosterone level remains in the sweet spot. If you’re stable on TT, your total testosterone and some other lab tests should be checked every 6-12 months, like a regular tune-up for your body.

And bro, if you’re carrying around a bit of extra weight, let’s work on bringing that down to a healthy range. Hitting the weights, cardio, maybe some high-intensity interval training might help you drop those extra pounds, and these physical activities could also help bump up your testosterone levels. Remember, consistency is key in both training and treatment.

More Information

Some Questions You Might Ask Your Health Care Provider about Low Testosterone

Alright, my friend, I see you’re eager to learn more about Low Testosterone and that’s a great attitude! When you hit up your doc, you might get a bit jittery – it happens to all of us, even the biggest dudes in the gym. It’s a good idea to prep a list of what’s been bugging you. Here are some things you might wanna ask:

  • What sort of tests are we talking about here to figure out if I need this Testosterone Therapy (TT) thing?
  • Are these tests a one-time thing or do I need to redo them? How often?
  • This Low-T level, is it making it tougher for me to produce sperm?
  • Will this TT help me increase my fertility game?
  • What are the different ways to get TT? Which one do you think is the best fit for me and why?
  • I’ve got diabetes. Does this mean I’m gonna need TT?
  • I’m having trouble pitching a tent, if you know what I mean. Will TT help with that?
  • During or after this treatment, any lifestyle changes or routines I can add to help keep my testosterone level in check?
  • My kid was born with low testosterone. Is he gonna need TT his whole life?
  • Are there any support groups out there that could help my boy deal with his TD?
  • I’ve got a history of heart disease in my family. Is it safe for me to go for TT?

These are just starting points, bro. Remember, no question is a dumb question when it comes to your health. Speak up, be honest and you and your doc can come up with the best game plan for you.