Low testosterone in men: symptoms and management

Persistent fatigue, reduced sexual desire, loss of muscle mass despite training, depressed mood for no obvious reason. Taken together, these symptoms can indicate testosterone deficiency, a condition that is more common than we think, and often goes unrecognized in men. Andropause, the term sometimes used to describe this phenomenon, is not a media myth: the decline of testosterone with age is a documented physiological reality, even if its extent and consequences vary considerably from one man to another.

After the age of 40, testosterone levels fall by an average of 1 to 2 % per year. This decline is gradual and silent, unlike the female menopause.

The role of testosterone in the male body

Testosterone is the main androgenic hormone in men. It is produced mainly by the testes, under the regulation of the hypothalamo-hypophyseal axis. It influences libido, erectile function, muscle mass and bone density, body fat distribution, red blood cell production, mood and general energy. Testosterone deficiency can therefore manifest itself as a variable combination of these dimensions.

Symptoms to recognize

Decreased libido is often the first symptom mentioned, but is not specific. Chronic fatigue, difficult to distinguish from overwork or sleep disorders, is common. Erectile dysfunction may be associated, although it often has multiple causes. Loss of muscle mass and increase in abdominal fat, despite an unchanged diet, reflect the metabolic effects of androgen deficiency.

Less typical symptoms such as increased irritability, difficulty concentrating, reduced body hair, reduced testicular size or mild anemia may also be present. The presentation is variable and often non-specific, which explains why diagnosis is sometimes delayed.

Diagnosis

Diagnosis is based on a combination of clinical symptoms and a blood test for total testosterone, taken in the morning between 8 and 10 a.m., when levels are naturally highest. A result of less than 8 to 12 nmol/L, depending on the laboratory and guidelines used, may indicate hypogonadism. Measurement of free or bioavailable testosterone is sometimes more informative than total testosterone, particularly in obese men or those with high levels of sex hormone-binding globulin.

The workup also includes LH and FSH to distinguish primary testicular hypogonadism from secondary hypogonadism of pituitary origin, as well as prolactin, hemoglobin and hematocrit. A full metabolic workup is usually associated.

Treatment options

Before considering hormone replacement therapy, modifiable causes of testosterone deficiency need to be addressed. Obesity, lack of physical activity, sleep deprivation, excess alcohol and chronic stress all lower testosterone and can be improved by lifestyle changes with measurable effects on hormone levels.

For men with documented, symptomatic deficiency who do not respond to behavioral measures, testosterone replacement therapy, in gel, injection or patch form, may be considered. This treatment requires regular medical follow-up to adjust the dose, monitor hematocrit, PSA and effects on fertility, as substitution suppresses endogenous testosterone production and may reduce spermatogenesis.

Frequently asked questions about low testosterone

Does testosterone treatment increase the risk of prostate cancer?
Current data do not confirm a causal link between testosterone substitution and prostate cancer. However, substitution is contraindicated in men with untreated prostate cancer. PSA monitoring is recommended during treatment.

Are testosterone supplements sold online effective?
Non-pharmaceutical supplements sold as testosterone boosters have unproven efficacy and sometimes carry the risk of contaminants or drug interactions. Documented, medically monitored hormone therapy is the only validated approach.

Does lack of testosterone affect mental health?
Yes, testosterone deficiency is associated with an increased risk of depression, anxiety and irritability. These symptoms are part of the clinical picture of hypogonadism and can improve with appropriate treatment.

When to consult a healthcare professional

If you have several of the symptoms described, if you're over 45 with a significant drop in energy and libido, or if you'd like to check your hormonal status, a medical consultation is essential.

A doctor can assess your clinical picture, prescribe a hormone test and discuss options based on the results. A face-to-face or online teleconsultation at one of our Omicron Clinic in Quebec gives you quick access.

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