Low testosterone, also known as male hypogonadism, occurs when the body’s testicles do not produce enough testosterone, a primary male sex hormone. This deficiency can cause symptoms like reduced sex drive, erectile dysfunction, fatigue, and mood changes. If you experience these signs, seeking medical guidance is crucial.
Starting Your Journey: Your Primary Care Provider
A primary care provider (PCP) is often the initial healthcare professional to consult if you suspect low testosterone. PCPs can assess your symptoms and order preliminary blood tests to measure testosterone levels. They can also help rule out other conditions that mimic low testosterone, such as diabetes or sleep apnea. In some cases, PCPs can manage mild cases or provide initial guidance on lifestyle changes.
Specialized Care: Urologists and Endocrinologists
For complex or persistent cases, your PCP may refer you to a specialist like a urologist or an endocrinologist. Urologists focus on male reproductive and urinary health. They are well-suited for evaluating testicular function, fertility concerns, and issues related to testosterone production within the testes, including erectile dysfunction. A urologist referral is recommended for persistent symptoms confirmed by low blood levels, especially with male reproductive health concerns.
Endocrinologists specialize in hormonal systems, diagnosing and managing complex imbalances, including those from the pituitary gland or other endocrine organs. They are helpful when low testosterone is part of a broader endocrine disorder or when the cause is not directly testicular. Their expertise includes conditions like diabetes and thyroid disorders, which can influence hormone levels. Both specialists can prescribe and monitor testosterone replacement therapy to restore hormone levels and alleviate symptoms.
The Diagnostic Process
Diagnosing low testosterone involves a thorough medical history, physical examination, and essential blood tests. The American Urological Association (AUA) considers a total testosterone level below 300 nanograms per deciliter (ng/dL) as low. Blood samples are typically drawn in the morning, ideally between 8 a.m. and 10 a.m., as testosterone levels are highest then. Two separate morning blood tests are often recommended to confirm consistently low levels, as acute illness or other factors can temporarily affect results.
Further blood tests may determine the cause of low testosterone. These include luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which can indicate pituitary gland or testicular issues. Prolactin levels might also be checked for pituitary problems. A low testosterone diagnosis relies on consistent symptoms combined with unequivocally low blood levels, not solely on a low number.
Understanding Treatment Options
Once diagnosed, low testosterone treatment is individualized. Testosterone Replacement Therapy (TRT) is a primary medical intervention, administering manufactured testosterone to regulate hormone levels. TRT is available in various forms, including injections, topical gels, skin patches, and implanted pellets.
Beyond medical therapy, lifestyle modifications can support overall health and potentially improve testosterone levels. These include maintaining a healthy weight, regular exercise, adequate sleep, and stress management. For example, weight loss can increase testosterone, and strength training can temporarily boost it. Treatment decisions are made collaboratively with ongoing monitoring to assess effectiveness and make adjustments.