Medication for Symptoms of Low Testosterone

Experts say that up to a third of men older than 45 and half of men with obesity or type 2 diabetes have a shortage of testosterone. Here's what you should know.

You see the testosterone medication ads everywhere: Men, do you have “low T”?

Low testosterone in men is called hypogonadism, a condition in which the body produces too little testosterone. According to the Endocrine Society, a 100-year old international organization of researchers and doctors specializing in hormones, it’s quite common, affecting up to half of men with obesity or type 2 diabetes. The symptoms include erectile dysfunction, low sex drive, and low energy.

For some time, there was debate about whether the problem of low testosterone had been exaggerated. Testosterone production naturally slows in men over their lifespan. The hormone’s levels peak in the late teens and remain high through mid-age, but by age 70 most men are producing 30 percent less testosterone than they did in their teens.

There’s evidence, however, that testosterone levels are declining in teen and young adult men in the U.S. because of poor nutrition and lack of exercise. In some research, your chances of low testosterone more than double if you have obesity or type 2 diabetes and nearly double with high blood pressure.

Since these conditions are increasing, more men may be suffering the effects of low testosterone. What’s more, some men who don’t have those conditions do have a testosterone problem.  

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How to measure low testosterone

Testosterone levels vary during a given day (it’s usually highest in the morning, which is why men often wake up with erections). Endocrinologists agree that a total blood testosterone level of less than 300 ng/dl on two mornings indicates a problem.

The test won’t be part of routine bloodwork, so talk to your doctor if you’re concerned about your sex drive. That might be embarrassing, but you’d put yourself in the elite club of men who man up to a possible problem.

Your doctor may also check levels of other related hormones to find the cause. If your testosterone level is 300 to 350, you might be a candidate for treatment, depending upon your symptoms, according to Sriram Eleswarapu, MD, PhD, a urologist at the University of California, Los Angeles.

Researchers have developed a questionnaire that you can take yourself. You may be a candidate for androgen medication if you have had a drop in sex drive and are experiencing softer erections, as well as three of these symptoms of low testosterone:

• Low energy
• A drop in strength, height, mood, work, or sports performance
• Falling asleep after dinner

Be aware, however, that depression may cause some of those symptoms.  

Other symptoms of low testosterone

A severe case may have dramatic effects — shrinking or very small testes, hot flushes, sweating, and gynecomastia (growth of breasts).

Other less well-known possible symptoms are fuzzy thinking, irritability, shrinking bone mass, loss of muscle, and low sperm production, notes Culley Carson II, MD, at Boston University.

Is testosterone medication safe?

Testosterone medication prescriptions rose between 2002 and 2012, most likely in response to direct marketing campaigns, but then decreased from 2013 to 2016, after news emerged that the treatment has risks.

In a large study of veterans, for example, therapy was linked to an increase in death, heart attacks, and stroke. In 2015, the study of veterans and other evidence led the Food and Drug Administration to require testosterone medication to have a warning label. In addition, there has been concern that testosterone therapy could increase the risk of prostate cancer, which is common in older men.

More recent research, however, suggests that the medication may actually reduce the risk of an aggressive cancer.

What you can do

Start with the basics. Do you eat badly and avoid exercise? Increasing your health game could give you back your energy and sex drive.

But if you’ve tried and your symptoms haven’t changed, and you think you need a boost in testosterone, having a conversation with a doctor can’t hurt.

You can weigh your overall risk of heart attack and stroke against the chance that your sex life and daily living are being weighed down by a correctable problem.

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