Testosterone affects sex drive, erections, energy, muscle strength, bone density and mood. Low testosterone (male hypogonadism) is often missed, or treated without proper testing. Diagnosis needs the right tests at the right time of day, and treatment needs monitoring.
Common symptoms
- Low sex drive and fewer morning erections
- Erectile problems
- Tiredness, low mood and poor concentration
- Loss of muscle and strength, and increased body fat
- Breast enlargement (gynecomastia)
- Reduced body or facial hair, small or soft testes
- Infertility, and weak bones or fractures
Common causes
- Testicular causes: Klinefelter syndrome, mumps orchitis, injury, chemotherapy or radiation, undescended testes
- Pituitary or brain causes: pituitary tumours, high prolactin, Kallmann syndrome
- Obesity, type 2 diabetes and sleep apnoea, which commonly lower testosterone and often improve with weight loss
- Medicines: opioids, steroids, and misuse of anabolic steroids or "gym supplements", which can shut down natural testosterone production for months
Testing the right way
- Testosterone is highest in the morning, so blood should be taken before 10 AM, preferably fasting.
- A low result should be confirmed with a second test.
- LH, FSH and prolactin tests show whether the problem is in the testes or the pituitary.
- Further tests may include a semen analysis, a karyotype (chromosome test) or a pituitary MRI.
Treatment
- Treat reversible causes first: weight loss, better diabetes control, treatment of sleep apnoea, and stopping medicines that suppress testosterone.
- Testosterone replacement (injections or gel) for confirmed hypogonadism, with regular checks of blood count, testosterone level and, at older ages, prostate health.
Planning to have children? Testosterone treatment lowers sperm production. Men who want fertility are treated differently, for example with hCG injections, so tell your doctor before starting.
Adult gynecomastia
Breast enlargement in adult men can be caused by medicines, liver or kidney disease, thyroid excess, low testosterone or, rarely, hormone-producing tumours. A hard, one-sided lump needs prompt examination.
Consulting Dr. Prasadh Rao L
Dr. Prasadh Rao L (MBBS, MD (General Medicine), DM (Endocrinology)) is an Assistant Professor of Endocrinology at Madras Medical College, where these conditions are seen and managed regularly. Treatment is planned individually, because the right choice depends on the cause, your age, other health conditions and your plans, such as pregnancy. Consultations are available at Dr. PD's Diabetes and Endocrine Speciality Clinic, Maduravoyal (Mon – Sat, 7:30 – 9:30 PM), at Dr. RK Podiatric Institute, Kolathur (4:00 – 6:30 PM), and by appointment at partner hospitals and clinics. See all locations or read the doctor’s profile.
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Written by Dr. Prasadh Rao L, MBBS, MD (General Medicine), DM (Endocrinology). Assistant Professor of Endocrinology, Madras Medical College. Tamil Nadu Medical Council Reg. No. 96520.
This article is for general information. It is not a diagnosis or a treatment plan. Please don't start, stop or change any medicine without speaking to your doctor.