Do I Have Low Testosterone? What Your Symptoms Might Really Mean

I am feeling tired, low in mood, energy lacking energy with low libido, is my testosterone level low?

The answer is, yes, it could be.  However these symptoms are common across many undiagnosed illnesses such as low thyroid, anaemia, type 2 diabetes and high levels of stress.  What's happening at work and at home? Lifestyle factors have an enormous impact and how we feel.  It is important to fully understand your symptoms, to carry out a physical examination and perform tests to screen for other causes as well as checking testosterone levels.

If my testosterone is low, should I start testosterone replacement therapy?

The answer is, Maybe.  Results need to be carefully interpreted.  If testosterone levels are slightly low but the regulatory hormones (LH and FSH) are normal then testosterone replacement would only be an option after making lifestyle changes, including weight loss, resistance training and dietary changes.  We can track your diet and activity with Continuous Glucose Monitoring and a Smart Watch.  Repeat testosterone tests at 3 and 6 months would show how your levels are improving.  Being overweight or obese can causes fatty liver changes and insulin resistance.  This makes it hard for the liver to produce the protein (Sex Hormone Binding Hormone) that carries Testosterone in the circulation.  So, if lifestyle changes are not causing weight loss or increasing testosterone then weight loss injections such as, Mounjaro or Wegovy, can work well for both weight loss and increasing the body's own testosterone level.

What are the risks a benefits of testosterone therapy?

Testosterone can make you feel on top of the world.  Energy levels, libido, muscle bulk and recovery from exercise can all improve significantly.  However there are some significant side effects.  Acne and low mood are common. Testosterone, being the male hormone, has a significant effect on the prostate, causing it to enlarge and after years of treatment this can make it difficult to pass urine.  The prostate blood test, PSA, needs to be check before and monitored during treatment. Testosterone also stimulates the bone marrow increasing red blood cells, thicker blood is more likely to clot which can cause heart attack, stroke or DVT.  Prolonged testosterone use can reduce fertility.  For these reasons testosterone dosing needs to be monitored carefully with full blood count and PSA.  

How is testosterone prescribed?

Testosterone can be given in many formulations.  Daily gel or 3 monthly injections are the most common.  Testosterone injections into the muscle have the strongest effect.  Testosterone gel can give more gradual improvements and this gives the patient an opportunity to see how they respond to therapy, adjust doses or discontinue as they required.

When should I stop testosterone replacement therapy?

This is the really important question.  Stopping testosterone if difficult.  If you take testosterone replacement long term then your testicles stop making testosterone.  After you stop replacement then your testicles may not be able to produce testosterone again naturally in the future.  This can make you dependent on testosterone replacement for life.  Male fertility is interlinked with natural testosterone production and will be negatively effected.   It is therefore vital that you only start using testosterone for the right reasons and under medical supervision.

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Testosterone replacement therapy can have life changing benefit for patients that have genuine medical need for it.  Many men have slightly low testosterone due to overweight, poor diet and inactivity and here we need to take a lifestyle approach first.  Many younger men would like to build more muscle and feel more virile with testosterone replacement therapy.  This is completely understandable and it is increasingly common.  If you are interested in learning more about your testosterone level then please book to see a GP.

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