Signs of low testosterone: symptoms, causes, and treatment

The main signs of low testosterone (hypogonadism), or low T, include low sex drive, erectile dysfunction (ED), fatigue, decreased muscle mass, increased body fat, and mood changes. Symptoms of low T can affect sexual, physical, and emotional health and can overlap with other conditions, so blood tests from a healthcare provider are needed to confirm low levels.

Signs of low testosterone in a man fall into three main categories: sexual, physical, and emotional and cognitive. Low testosterone symptoms in men can also stem from other conditions, so these signs alone do not confirm low T. Sexual symptoms are typically the most closely linked to low T.

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1. Sexual signs

Low testosterone can affect sexual function in men, causing symptoms such as:

• Low libido: A noticeable, persistent drop in sexual desire. Libido, or sex drive, is influenced by a range of factors, including testosterone levels.

• Erectile dysfunction: Trouble getting or keeping an erection. Many conditions can cause ED, including low testosterone levels. Studies suggest that testosterone replacement therapy (TRT) may improve erectile function in men with low T that has been confirmed by a healthcare provider, though individual experiences may vary.

• Loss of erections: Fewer or no spontaneous erections, including “morning wood.”

• Reduced fertility: Lower sperm count and reduced semen volume. Low T may also be linked to changes in the morphology (size and shape) of sperm, which may make conceiving more difficult.

2. Physical signs

Low testosterone can also cause physical signs in men beyond sexual dysfunction, such as:

• Decreased muscle mass: A reduction in lean muscle mass and strength. Testosterone plays a key role in building and maintaining muscle mass by stimulating protein synthesis. As testosterone declines, muscle strength and size may gradually decrease.

• Increased body fat: A change in body composition that involves gaining fat, typically around the abdomen. Low T can also contribute to gynecomastia, a condition in which male breast tissue enlarges.

• Fatigue: A persistent lack of energy, even after getting enough sleep. Fatigue can be a sign of low T, but it is a common symptom with many possible causes. Poor sleep quality and conditions such as  sleep apnea can also cause fatigue, and severe sleep apnea in particular is associated with lower testosterone. However, research on the relationship between sleep and testosterone is mixed.

• Reduced bone density: A loss of minerals in the bone, which increases the risk of fractures. Low T can lead to weaker bones because testosterone plays a key role in maintaining bone density, both directly and after the body converts some of it to estrogen.  If reduced bone density is suspected, a healthcare provider can order a bone mineral density (BMD) test.

• Anemia: A condition in which the blood does not have enough healthy red blood cells to carry oxygen throughout the body. Testosterone helps the body make red blood cells, a process called erythropoiesis, so a decline in testosterone may reduce red blood cell numbers and contribute to anemia.That being said, anemia has many possible causes, so it should be investigated before it is attributed to low T. 

• Hair loss: Thinning or loss of face or body hair. When testosterone declines, so does the hormone’s ability to stimulate hair follicles on the face and body, which may lead to a reduction in hair density and growth. This usually happens if low T has persisted for a long time in the body without treatment. This type of hair loss is different from male pattern baldness, which affects the scalp and is driven by dihydrotestosterone (DHT), a hormone made from testosterone.

3. Emotional and cognitive signs

Low testosterone can also affect mood and cognitive health in men, causing symptoms such as:

• Depression: A mood disorder that causes persistent sadness. Testosterone has an impact on the brain’s limbic system, which is involved in mood regulation. Low T is linked to a higher risk of depression, possibly through effects on brain chemicals such as serotonin and dopamine. A drop in mood can also be the result of fatigue related to low T.

• Anxiety: A state of excessive, persistent worry. Some research suggests that men with low free testosterone may have a higher risk of developing anxiety, though findings are mixed and the relationship appears to be complex.

• Cognitive impairment: A gradual decline of cognitive skills, such as memory and focus. Research suggests that low testosterone is linked to a higher risk of cognitive impairment in older men, especially when combined with insufficient sleep.

Several factors can contribute to low testosterone levels in men. Common low testosterone causes include:

• Age: Testosterone levels naturally decline gradually with age, starting around age 30.

• Obesity: Excess body fat can lead to lower testosterone levels. Body fat converts some testosterone into estrogen and can release hormones and other signals that tell the brain to produce less testosterone. Obesity is one of the most common causes of low T that is reversible, and losing weight can help raise testosterone levels. 

• Stress: Chronic stress can negatively impact testosterone production and contribute to low T levels. 

• Lack of sleep: Sleeping five hours or less each night is associated with lower testosterone levels. 

• Medications: Certain medications, such as corticosteroids or opioids, may interfere with testosterone production or function, leading to lower levels of the hormone.

• Nutritional deficiencies: The body uses nutrients from food to support different organ systems, including the endocrine system, which makes and regulates hormones such as testosterone. Low levels of some nutrients, such as zinc and vitamin D, have been linked to lower levels of testosterone, but it isn’t clear whether correcting them raises testosterone in most men. As a result, eating habits that are low in essential vitamins and minerals, such as zinc, vitamin D, and magnesium, may contribute to low testosterone levels.

• Chronic conditions: Long-term medical conditions, such as diabetes, hypothyroidism, and liver disease, may affect hormone production and metabolism, leading to low T levels.

The likelihood of having low testosterone increases with age. Your healthcare provider can check your testosterone levels with a blood test.

Typically, normal testosterone levels are between about 260 ng/dL and 1,000 ng/dL, though the exact cutoff varies by lab and medical organization. However, testosterone levels vary throughout the day. They are highest in the morning and can change from one day to the next. That is why healthcare providers usually require two early-morning testosterone tests on separate days before diagnosing low T. They will check for matching symptoms as well. 

Can you test for testosterone at home?

Yes, you can collect a sample for a testosterone test at home using at-home test kits. These kits are designed for convenience and privacy, allowing you to measure testosterone without visiting a healthcare provider. They typically involve collecting a saliva or finger-prick blood sample and sending it to a lab for analysis. However, at-home tests, especially saliva tests, may not be as accurate as a blood draw at a certified lab. 

Results are often available online within a few days, depending on the kit. A healthcare provider can interpret the results and discuss next steps, which may include confirming the results with morning blood tests at a lab. 

If you notice signs of low T, talk to a healthcare provider, who can order tests to get a complete picture and recommend an appropriate treatment plan.

Testosterone replacement therapy

If tests confirm low T, a healthcare provider may recommend testosterone replacement therapy (TRT), a treatment approved by the US Food and Drug Administration (FDA) that replaces missing testosterone with a pharmaceutical version of the hormone. TRT comes in several forms, including:

• Topical gels

• Transdermal (skin) patches

• Injections

• Pellets implanted under the skin

• Oral capsules (pills) 

Other medications  

Testosterone replacement therapy can interfere with sperm production and is not recommended in men who want to father a child now or in the near future. 

While TRT is often considered the primary treatment for low T, there are other medications that may help increase testosterone levels, especially for those who desire fertility. Some of these medications are not FDA-approved for treating low T in men and are used off-label. If you have further questions, discuss with your healthcare provider who can help decide the best treatment for you. 

• Clomid (clomiphene citrate) acts on the pituitary gland to increase the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which signal the testes to produce more testosterone.

• Human chorionic gonadotropin (hCG) mimics LH, which helps stimulate natural testosterone production and maintain testicular function.

• Anastrozole can help reduce the conversion of testosterone to estrogen, which may raise testosterone levels. Because estrogen is essential in the body and helps maintain healthy bones, this medication is typically not used long term. 

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Lifestyle changes 

Certain lifestyle changes may help increase testosterone levels and improve overall health. For men with overweight or obesity, losing weight is one of the most effective lifestyle changes to help with testosterone levels. Combining a healthier diet with more physical activity seems to work better than either one alone.  Regular exercise, particularly strength training and high-intensity interval training (HIIT), may help support testosterone levels by increasing muscle mass and reducing body fat.

A healthy diet with a balanced intake of proteins, healthy fats, and essential vitamins and minerals may support hormone production and help maintain a healthy weight.

Getting enough sleep may also help support testosterone levels, as poor sleep patterns can decrease them. Stress management techniques, such as mindfulness and relaxation exercises, may help lower cortisol levels, which can otherwise inhibit testosterone production, though more research is needed to see if these methods are able to increase your T.

While lifestyle changes may not completely reverse low testosterone, they may improve symptoms and overall wellbeing. Before starting any treatment for low testosterone, talk to a healthcare provider. Symptoms of low T can mimic other conditions, and it can be challenging to determine their true cause on your own.