The most common and reliable symptoms of hypogonadism are sexual symptoms.8 These include reduced or absent libido, erectile dysfunction, difficulty achieving orgasm, reduced intensity of orgasm, and reduced sexual sensation in the genital region. Common non-sexual symptoms include fatigue, lack of energy, decreased vitality, inability to perform vigorous activity, depressed mood, irritability, “brain fog” (memory problems, a lack of mental clarity, inability to focus), and decreased motivation. These symptoms may occur singly or in any combination. Decreased libido is one of the primary symptoms of hypogonadism. It may occur, with or without any of other symptoms or signs, and is strongly suggestive of hypogonadism in men >50 years without obvious other causes, such as relationship issues and stress. Increased probability of low sexual desire, poor morning erections, erectile dysfunction and reduced physical vigor is seen with testosterone levels below 13 nmol/L (370 ng/dL),8 however, these symptoms can also occur in men with higher testosterone levels.