Frequently asked questions about testosterone deficiency

Diagnosis of testosterone deficiency

    Depending on the health system of the country you are living in, there are several ways to get a diagnosis for testosterone deficiency. Visiting your family doctor is always a good first step. If necessary, they can refer you to a specialist. Those specialising in men’s health are generally urologists and endocrinologists. However, increasingly, many general practitioners and internists are also specialising in male health issues.

    Urologists specialise in disorders of the reproductive organs, kidneys and urinary tract. Erection problems, screening for prostate cancer and the treatment of prostate diseases are also the province of the urologist.

    Endocrinology is the branch of medicine dealing with hormone function and hormone-related diseases. Physicians therefore often refer patients to an endocrinologist for further investigations, e.g. in the case of testosterone-related developmental disorders in puberty.

    The doctor will begin with a medical interview. He/she will ask about your symptoms and take a full medical history. A physical examination follows where the doctor will look out for physical features of hypogonadism such as body hair, dry skin, body fat and posture. After this, laboratory tests will be ordered, particularly for the determination of hormone levels.

    • any previous diseases (e.g. inflammation of the testes)
    • any previous relevant operations which can influence your testosterone production
    • any risk factors such as systemic diseases and certain types of medication
    • your lifestyle, including exercise, diet, stress and alcohol consumption
    • your ability to maintain an erection
    • the occurrence of morning erections
    • your sexual satisfaction
    • the amount of ejaculate
    • the frequency of sexual intercourse or masturbation

    The doctor may also check the body hair pattern, muscle mass and strength, and the hardness and size of your testicles. Your doctor may want to determine your blood testosterone level more accurately. For this, you will need to give a small amount of blood to be sent off to a laboratory for analysis. This is best taken in the morning, as blood testosterone levels are at their highest then. If you have a testosterone concentration between 12 and 35 nmol/l, you are considered normal. Testosterone treatment is recommended if your morning testosterone is below 12 nmol/l.

    Treatment of low testosterone

      The effectiveness of testosterone treatment has been proven in several studies and more than 50 years of experience. The treatment can considerably improve mental and physical well-being and performance in men with testosterone deficiency and associated symptoms. Many patients report positive effects on general mood, self-esteem and vitality. Body shape and proportions become more masculine again. Muscle mass and muscle strength increase, whereas fat decreases. Long term effects of a testosterone deficiency (such as osteoporosis) can be prevented. Testosterone treatment leads to a marked improvement in sexual desire and erections.

      No. Only men with testosterone deficiency and related symptoms will notice improvements in their general health and well-being from testosterone treatment. Furthermore, as any medical product can have side effects, regular monitoring is essential while testosterone treatment is taking place.

      Any drug can have side effects and testosterone preparations are no exception. However, many years of experience with testosterone preparations have shown that the treatment is generally well tolerated.

      The following possible side effects do not occur in every patient. It should also be taken into account that the different preparations and application forms (injection, gel, patches, capsules, implants) can vary in their effectiveness and side effects. You should always read the product information of the preparation you have been prescribed.

      Occasionally mild acne occurs at the beginning of treatment. Testosterone stimulates the activity of the sebaceous glands in the skin. This has the desired effect of increasing the oil supply to the skin and counteracting dry and wrinkled skin. However, overproduction of an oily substance called sebum – which can result in acne – can occur at the beginning of treatment. This is almost always a passing phase at the beginning of treatment and usually normalises by itself.

      In rare cases, frequent or sustained painful erections (priapism) can occur. In these cases, the dosage must be reduced or discontinued to avoid permanent damage.

      In very rare cases, men with an appropriate disposition (e.g. obesity or chronic lung disease) may develop sleep apnoea (temporary breathing arrest). Sleep apnoea disappears again when testosterone treatment is discontinued.

      If there is an increase in the production of red blood cells (polyglobuly), circulation may be affected due to an increased blood viscosity. In this case treatment is discontinued until blood cell production normalises.

      High doses of testosterone, or doses over long periods can increase the tendency to retain water in the tissues (edema) and can affect the breakdown of fat by the body.

      Your doctor will regularly monitor the progress of your treatment and check for any side effects. If you experience any discomfort or inconveniences during treatment, please report it to your doctor as soon as possible.

      No. As long as there are no other contraindications, there is no age limit to receiving testosterone treatment.

      Yes. Some studies even suggest that testosterone treatment received in combination with ED medication may improve how your ED drug works. However, discuss with your doctor before combining therapies.

      How long should patients with hypogonadism (testosterone deficiency) be on testosterone therapy?

      Several studies have demonstrated that the beneficial effects of testosterone therapy are not maintained after cessation of treatment.1-7 This applies to improvements in body composition (loss of body fat and gain of muscle mass), erectile function, sex drive, blood sugar control (HbA1c), cholesterol profile, blood fats (triglycerides), Aging Males' Symptoms (AMS), International Prostate Symptom Score (IPSS), The International Index of Erectile Function (IIEF), residual voiding volume and urinary bladder wall thickness, and quality of life, and likely most – if not all - other testosterone-related outcomes.1-4,6

      If testosterone therapy is discontinued, beneficial effects will appear again when testosterone therapy is resumed1

      As pointed out in the British Society for Sexual Medicine guidelines on Adult Testosterone Deficiency, termination of testosterone therapy results in reappearance of symptoms and reversal of benefits within 6 months; therefore, testosterone therapy is likely to be required lifelong for persistent symptom resolution and maintenance of health benefits in most men.8


        Not only menopausal women have hot flushes. Men with testosterone deficiency may experience hot flushes too, sometimes with sweating attacks too, though it is more rare than that in women.

        No, testosterone deficiency does not have any effect on penis size. However, it can have a negative effect on sexual performance, libido and erectile function.

        No. All men suffer declining testosterone levels with age. How quickly the levels decline depends on various factors, including genetics, lifestyle and predisposing medical conditions.

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        • Yassin A, Almehmadi Y, Saad F, Doros G, Gooren L. Effects of intermission and resumption of long-term testosterone replacement therapy on body weight and metabolic parameters in hypogonadal in middle-aged and elderly men. Clin Endocrinol (Oxf). 2016;84(1):107-114. Return to content
        • Hackett G, Cole N, Mulay A, Strange RC, Ramachandran S. Long-Term Testosterone Therapy in Type 2 Diabetes Is Associated with Decreasing Waist Circumference and Improving Erectile Function. The world journal of men's health. 2018. Return to content
        • O'Connell MD, Roberts SA, Srinivas-Shankar U, et al. Do the effects of testosterone on muscle strength, physical function, body composition, and quality of life persist six months after treatment in intermediate-frail and frail elderly men? J Clin Endocrinol Metab. 2011;96(2):454-458. Return to content
        • Morgunov LY, Denisova IA, Rozhkova TI, Stakhovskaya LV, Skvortsova VI. Hypogonadism and its treatment following ischaemic stroke in men with type 2 diabetes mellitus. The aging male: the official journal of the International Society for the Study of the Aging Male. 2018:1-10. Return to content
        • Francomano D, Bruzziches R, Barbaro G, Lenzi A, Aversa A. Effects of testosterone undecanoate replacement and withdrawal on cardio-metabolic, hormonal and body composition outcomes in severely obese hypogonadal men: a pilot study. J Endocrinol Invest. 2014;37(4):401-411. Return to content
        • Yassin A, Nettleship JE, Talib RA, Almehmadi Y, Doros G. Effects of testosterone replacement therapy withdrawal and re-treatment in hypogonadal elderly men upon obesity, voiding function and prostate safety parameters. The aging male: the official journal of the International Society for the Study of the Aging Male. 2016;19(1):64-69. Return to content
        • Ng Tang Fui M, Hoermann R, Zajac JD, Grossmann M. The effects of testosterone on body composition in obese men are not sustained after cessation of testosterone treatment. Clin Endocrinol (Oxf). 2017;87(4):336-343. Return to content
        • Hackett G, Kirby M, Edwards D, et al. British Society for Sexual Medicine Guidelines on Adult Testosterone Deficiency, With Statements for UK Practice. The journal of sexual medicine. 2017;14(12):1504-1523. Return to content