A man reaches his 40s and notices that workouts feel harder. He is more tired in the afternoon. His sleep is inconsistent, his libido is lower, and he has gained weight despite making few obvious lifestyle changes.
It is easy to connect those symptoms to testosterone. Sometimes that connection is correct. Sometimes it is not.
Low Testosterone Has Nonspecific Symptoms
Low testosterone may be associated with changes in sexual function, energy, body composition, muscle mass, mood, and other areas. But none of these symptoms exists only in men with testosterone deficiency.
Sleep apnea can contribute to fatigue. Stress can affect libido and sleep. Certain medications can influence hormone levels and sexual function. Obesity and chronic illness can also affect testosterone.
A thoughtful low testosterone evaluation therefore looks beyond a symptom checklist.
Laboratory Testing Matters
A provider may order testosterone testing when symptoms and medical history make it appropriate. Even then, one abnormal result may not be enough. MedlinePlus notes that testosterone testing is generally most informative in the morning and that a second sample is often needed when an initial measurement is lower than expected.
The Endocrine Society recommends diagnosing hypogonadism only in men who have symptoms or signs of testosterone deficiency along with unequivocally and consistently low testosterone concentrations.
Age Isn’t a Diagnosis Either
Testosterone tends to decline gradually with age, but aging itself does not establish a medical testosterone deficiency. Feeling different at 48 than at 28 does not automatically mean that TRT is appropriate.
What Else May Be Considered?
Depending on the patient, evaluation may include sleep quality, medications, weight and metabolic health, exercise and recovery, sexual health, chronic disease, stress, mental health, and other laboratory information.
Treatment Should Follow the Evidence
When a man is appropriately diagnosed with hypogonadism, testosterone therapy can be a legitimate medical treatment. But the decision is stronger when it follows a real diagnostic process.
Medical review: Adam Russell, PA-C, Hormone Balance Centers.
