Struggling with diagnosis

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It can be difficult for men with testosterone deficiency to pinpoint what's causing their symptoms. They can experience issues with libido (sex drive), or with sexual performance, and often experience other symptoms. These can make it harder for hypogonadal men to go about their day-to-day lives.

Hypogonadism (testosterone deficiency)

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What is testosterone deficiency?

Testosterone deficiency (the medical term is hypogonadism) simply means having a very low testosterone level. Testosterone is responsible for typical male sexual characteristics and is required by all men for a healthy life physically and psychologically.

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It can be difficult for men with testosterone deficiency to pinpoint what's causing their symptoms. They can experience issues with libido (sex drive), or with sexual performance, and often experience other symptoms. These can make it harder for hypogonadal men to go about their day-to-day lives.

Frequently asked questions (FAQs) about hypogonadism

For quick reference we have provided answers to the most commonly asked questions on testosterone deficiency. From diagnosis through to treatment options, you should find the answers to your questions here.

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View the glossary for definitions of all of the commonly used terms associated with testosterone deficiency.

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What is low testosterone?

As you get older, you will likely experience typical aging-related physical and mental changes. You may gain weight and belly fat, lose muscle, and start noticing a gradual loss of vigour and sex drive, and get the feeling that you have passed your peak. But what if this isn’t just because of aging?

Aging is accompanied by gradual deterioration in general measures of health and well-being, which may be related to low testosterone levels.1 Low testosterone, also called testosterone deficiency or hypogonadism, is a medical condition in which the testes (testicles, the male reproductive glands) do not produce enough testosterone (the male sex hormone).2-5 While it is common for testosterone levels to progressively decline in men as they get older,6 low testosterone can occur even in young men, especially if they have developed a belly or have an excess amount of total body fat.7 Other causes of low testosterone in younger men is life/work stress8,9 and use of medications, such as opioids,10 selective serotonin reuptake inhibitors (SSRIs)11 and statins.12 Therefore, low testosterone is not just an “old man’s problem”. Less common causes of low testosterone in young men include testicular trauma, concussion and congenital (present at birth) disease caused by chromosomal abnormalities or gene mutations.

So why is testosterone important? Testosterone not only gives you sexual desire (libido) and enables you to have an erection,13 it also provides a wide range of health benefits, such as improvement in wellbeing/quality of life, blood sugar control, cholesterol profile, body composition (reduced body fat and increased muscle mass) and bone density, that might be expected to reduce long-term sickness and prevent premature death.14,15 In fact, it is well documented that men with low testosterone have increased risk of the metabolic syndrome, diabetes, heart disease and death.14-16

Talking to your doctor

CONCERNED ABOUT TALKING TO YOUR DOCTOR? Read our tips on talking to your doctor about your symptoms

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Do you have TD symptoms?

Find out if you may have symptoms of TD by completing our SYMPTOM CHECKER...

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What are the signs of & symptoms of low testosterone?

Signs & symptoms

Symptoms and signs of testosterone deficiency (hypogonadism) occur as a result of low testosterone levels.1-6 Due to the multiple effects of testosterone, the health consequences of hypogonadism are wide-ranging with signs and symptoms affecting sexual, physical, metabolic and psychological functions (Figure).

Figure: Common symptoms and signs of hypogonadism (low testosterone) in men.1,3-6

symptoms / signs

  • Obesity (BMI 30 or higher)
  • Abdominal (belly) obesity (waist circumference 94-102 cm or higher)
  • Metabolic syndrome
  • Insulin resistance, prediabetes or type 2 diabetes

Sexual symptoms

  • Decreased sexual desire and activity
  • Decreased frequency of sexual thoughts
  • Erectile dysfunction
  • Delayed ejaculation
  • Decreased volume of ejaculate
  • Decreased frequency or absent morning or night-time erections
  • Small testes
  • Infertility
Marek on his own

Psychological symptoms

  • Depressed mood
  • Loss of energy
  • Reduced motivation
  • Poor concentration
  • Decreased well-being and/or poor self-rated health
  • Irritability
  • Sadness
  • Impaired memory
  • Decreased cognitive function (including impaired concentration, verbal memory, and spatial performance)

Physical symptoms

  • Decreased muscle mass and strength
  • Reduced physical performance
  • Hot flushes or sweats
  • Sleep disturbances
  • Fatigue
  • Reduced bone mineral density, osteoporosis,
    low trauma fractures
  • Decreased body hair
  • Gynecomastia (enlarged breasts)

However, these symptoms are not just bothersome. If you also have low testosterone, these symptoms may signal that your overall health is at risk. Men who have both bothersome symptoms and low testosterone also commonly have “invisible symptoms” - such as elevated blood sugar levels, cholesterol abnormalities and high blood pressure - which are important risk factors that can lead to metabolic syndrome, type 2 diabetes and heart disease if left unchecked.19-21 Therefore, if you experience bothersome symptoms it is important that you get your testosterone level checked.

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See if you should have your testosterone level checked

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What causes low testosterone?

Many people think that the main cause of low testosterone is aging. This is wrong. The most common and strongest risk factor for low testosterone, more so than aging itself, is actually obesity.6,22,23

This means that by living a healthy lifestyle with regular exercise and healthy food habits, you can maintain your testosterone level in the healthy range even as you get older. In other words, low testosterone – while common - is not inevitable in men as they get older, as menopause is in women.

Other common causes of low testosterone are the metabolic syndrome24-26 and type 2 diabetes.27-30 Chronic diseases, such as high blood pressure, heart disease, liver disease, kidney disease, arthritis, stroke, emphysema, rheumatoid arthritis and depression may also be risk factors for low testosterone.1,28,31

Which men are most at risk of TD?

Men with...

Up to 80% of men with obesity have low testosterone.32,33 Medical guidelines state that all men who have an increased waist circumference - 94 cm (37 inches) or higher - or who have obesity (BMI 30 or higher) should be checked for low testosterone by having testosterone levels measured.34

Men with...
Erectile dysfunction

Among men with erectile dysfunction, over one third (36%) have low testosterone levels.9 Low testosterone can cause erectile dysfunction and/or non-responsiveness to treatment with PDE5i (phosphodiesterase 5 inhibitors) such as Viagra. Therefore, according to medical guidelines is it mandatory that men with erectile dysfunction have testosterone levels measured.38,39 This is particularly important if your erectile dysfunction treatment doesn’t appear to be working well.

Men who...
Take medications

Certain medications, especially opioids,10 selective serotonin reuptake inhibitors (SSRIs)11 and statins,12 can reduce your testosterone level.

Men with...
Type 2 diabetes

Half of men with type 2 diabetes have low testosterone.35 Obesity is common among men with type 2 diabetes,36 but even non-obese men with type 2 diabetes commonly have low testosterone.35 The frequent occurrence of low testosterone in men with type 2 diabetes prompted medical guidelines to recommend that testosterone levels are measured in men with type 2 diabetes who have symptoms.37

Men with...
Heart disease

Nearly one in four (24%) men with heart disease have low testosterone.40 Men with heart disease who also have low testosterone have a higher risk of death compared to men with heart disease who have healthy testosterone levels.40

Men with...
High life/work stress

Nearly half of men who report having a high degree of life/work stress have low testosterone.9

How are men affected by low testosterone?

The essential role of testosterone in the health and well-being of males is well established. Testosterone is responsible for typical male sexual characteristics and is required for a healthy life physically and psychologically, enabling and maintaining erectile function, libido, and overall sexual satisfaction. Testosterone also helps to maintain body composition and bone mass, positive mood, and physical energy. Accordingly, the health consequences of hypogonadism can be quite wide-ranging, and include fatigue, depression, erectile dysfunction, loss of libido, loss of facial and body hair, decrease in muscle mass, development of gynecomastia, and osteoporosis.


Low testosterone can be diagnosed by an assessment of symptoms and a blood test  to measure testosterone levels. If tests confirm hypogonadism, a range of different testosterone replacement therapies and formulations are available to normalize testosterone levels.

Low testosterone?

Think you’ve got low testosterone?

Regardless of age, if you’re rarely in the mood for sex and perhaps have difficulties getting an erection, often feel tired/lethargic and have a depressed mood, you may be experiencing symptoms of low testosterone.

If you are concerned that you may have low testosterone, COMPLETE OUR SYMPTOM CHECKER AND TALK TO YOUR DOCTOR. With a simple blood test, it is possible to find out your testosterone level and establish whether or not you have the diagnosis of testosterone deficiency (hypogonadism).

Check your symptoms

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  • Yeap BB. Are declining testosterone levels a major risk factor for ill-health in aging men? Int J Impot Res. 2009;21(1):24-36. Return to content
  • Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. J Urol. 2018;200(2):423-432. Return to content
  • Bhasin S, Brito JP, Cunningham GR, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5): 1715-1744. 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
  • Dohle GR, Arver S, Bettocchi C, Jones TH, Kliesch S. 2018 European Association of Urology (EAU) Guidelines on Male Hypogonadism. Available at Return to content
  • Travison TG, Araujo AB, Kupelian V, O’Donnell AB, McKinlay JB. The relative contributions of aging, health, and lifestyle factors to serum testosterone decline in men. J Clin Endocrinol Metab. 2007;92(2):549-555. Return to content
  • Gapstur SM, Gann PH, Kopp P, Colangelo L, Longcope C, Liu K. Serum androgen concentrations in young men: a longitudinal analysis of associations with age, obesity, and race. The CARDIA male hormone study. Cancer Epidemiol Biomarkers Prev. 2002;11(10 Pt 1):1041-1047. Return to content
  • Kreuz LE, Rose RM, Jennings JR. Suppression of plasma testosterone levels and psychological stress. A longitudinal study of young men in Officer Candidate School. Arch Gen Psychiatry. 1972;26(5):479-482 Return to content
  • Guay A, Seftel AD, Traish A. Hypogonadism in men with erectile dysfunction may be related to a host of chronic illnesses. Int J Impot Res. 2010;22(1):9-19. Return to content
  • Bawor M, Bami H, Dennis BB, et al. Testosterone suppression in opioid users: a systematic review and meta-analysis. Drug Alcohol Depend. 2015;149:1-9. Return to content
  • Corona G, Ricca V, Bandini E, et al. Selective serotonin reuptake inhibitor-induced sexual dysfunction. The journal of sexual medicine. 2009;6(5):1259-1269. Return to content
  • Corona G, Boddi V, Balercia G, et al. The effect of statin therapy on testosterone levels in subjects consulting for erectile dysfunction. The journal of sexual medicine. 2010;7(4 Pt 1):1547-1556 Return to content
  • Corona G, Rastrelli G, Morgentaler A, Sforza A, Mannucci E, Maggi M. Meta-analysis of Results of Testosterone Therapy on Sexual Function Based on International Index of Erectile Function Scores. Eur Urol. 2017;72(6):1000-1011. Return to content
  • Hackett G. Metabolic Effects of Testosterone Therapy in Men with Type 2 Diabetes and Metabolic Syndrome. Sex Med Rev. 2019;7(3):476-490. Return to content
  • Hackett GI. Testosterone Replacement Therapy and Mortality in Older Men. Drug Saf. 2016;39(2):117-130. Return to content
  • Morgentaler A, Miner MM, Caliber M, Guay AT, Khera M, Traish AM. Testosterone therapy and cardiovascular risk: advances and controversies. Mayo Clin Proc. 2015;90(2):224-251. Return to content
  • Dean JD, McMahon CG, Guay AT, et al. The International Society for Sexual Medicine’s Process of Care for the Assessment and Management of Testosterone Deficiency in Adult Men. The journal of sexual medicine. 2015;12(8):1660-1686. Return to content
  • Morales A, Bebb RA, Manjoo P, et al. Diagnosis and management of testosterone deficiency syndrome in men: clinical practice guideline. Appendix available at: (accessed Sept 17, 2019). CMAJ. 2015;187(18):1369-1377 Return to content
  • Traish AM, Guay A, Feeley R, Saad F. The dark side of testosterone deficiency: I. Metabolic syndrome and erectile dysfunction. J Androl. 2009;30(1):10-22. Return to content
  • Traish AM, Saad F, Guay A. The dark side of testosterone deficiency: II. Type 2 diabetes and insulin resistance. J Androl. 2009;30(1):23-32. Return to content
  • Traish AM, Saad F, Feeley RJ, Guay A. The dark side of testosterone deficiency: III. Cardiovascular disease. J Androl. 2009;30(5):477-494 Return to content
  • Wu FC, Tajar A, Pye SR, et al. Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European Male Aging Study. J Clin Endocrinol Metab. 2008;93(7):2737- 2745. Return to content
  • Camacho EM, Huhtaniemi IT, O’Neill TW, et al. Age-associated changes in hypothalamic-pituitary-testicular function in middle-aged and older men are modified by weight change and lifestyle factors: longitudinal results from the European Male Ageing Study. Eur J Endocrinol. 2013;168(3):445-455. Return to content
  • Caldas AD, Porto AL, Motta LD, Casulari LA. Relationship between insulin and hypogonadism in men with metabolic syndrome. Arq Bras Endocrinol Metabol. 2009;53(8):1005-1011. Return to content
  • Laaksonen DE, Niskanen L, Punnonen K, et al. The metabolic syndrome and smoking in relation to hypogonadism in middle-aged men: a prospective cohort study. J Clin Endocrinol Metab. 2005;90(2):712-719. Return to content
  • Singh SK, Goyal R, Pratyush DD. Is hypoandrogenemia a component of metabolic syndrome in males? Exp Clin Endocrinol Diabetes. 2011;119(1):30-35. Return to content
  • Biswas M, Hampton D, Newcombe RG, Rees DA. Total and free testosterone concentrations are strongly influenced by age and central obesity in men with type 1 and type 2 diabetes but correlate weakly with symptoms of androgen deficiency and diabetes-related quality of life. Clin Endocrinol (Oxf). 2012;76(5):665-673. Return to content
  • Mulligan T, Frick MF, Zuraw QC, Stemhagen A, McWhirter C. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract. 2006;60(7):762-769. Return to content
  • Rezvani MR, Saadatjou SA, Sorouri S, Hassanpour Fard M. Comparison of serum free testosterone, luteinizing hormone and follicle stimulating hormone levels in diabetics and non-diabetics men- a case-control study. J Res Health Sci. 2012;12(2):98-100. Return to content
  • Hackett GI, Cole NS, Deshpande AA, Popple MD, Kennedy D, Wilkinson P. Biochemical hypogonadism in men with type 2 diabetes in primary care practice. The British Journal of Diabetes & Vascular Disease. 2009;9(5):226-231. Return to content
  • Peterson MD, Belakovskiy A, McGrath R, Yarrow JF. Testosterone Deficiency, Weakness, and Multimorbidity in Men. Scientific reports. 2018;8(1):5897. Return to content
  • Molina-Vega M, Asenjo-Plaza M, García-Ruiz MC, et al. Cross-Sectional, Primary Care-Based Study of the Prevalence of Hypoandrogenemia in Nondiabetic Young Men with Obesity. Obesity (Silver Spring). 2019;27(10):1584-1590. Return to content
  • Pellitero S, Olaizola I, Alastrue A, et al. Hypogonadotropic hypogonadism in morbidly obese males is reversed after bariatric surgery. Obes Surg. 2012;22(12):1835-1842. Return to content
  • Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. Available at (accessed 8 May, 2020) Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2016;22 Suppl 3:1-203. Return to content
  • Dhindsa S, Miller MG, McWhirter CL, et al. Testosterone concentrations in diabetic and nondiabetic obese men. Diabetes Care. 2010;33(6):1186-1192. Return to content
  • Cloostermans L, Wendel-Vos W, Doornbos G, et al. Independent and combined effects of physical activity and body mass index on the development of Type 2 Diabetes - a metaanalysis of 9 prospective cohort studies. The international journal of behavioral nutrition and physical activity. 2015;12:147. Return to content
  • American Diabetes Association. Standards of Medical Care in Diabetes 2020. Diabetes Care.43(Supplement 1). Return to content
  • Hackett G, Kirby M, Wylie K, et al. British Society for Sexual Medicine Guidelines on the Management of Erectile Dysfunction in Men-2017. The journal of sexual medicine. 2018;15(4):430-457. Return to content
  • European Association of Urology. 2020 EAU Guidelines on Sexual and Reproductive Health. Available at (accessed May 19, 2020). Return to content
  • Malkin CJ, Pugh PJ, Morris PD, Asif S, Jones TH, Channer KS. Low serum testosterone and increased mortality in men with coronary heart disease. Heart. 2010;96(22):1821-1825. Return to content