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Testosterone levels—or “T levels” as they are popularly known—are a health concern for men. A sex hormone, testosterone produces the biological characteristics associated with “maleness,” such as muscularity, body hair, and a low voice. So when testosterone begins to decline, a process that starts at the age of 30, men begin to worry about the consequences of their health and quality of life. Sometimes, however, testosterone may decline so low that it substantially affects men’s health. Medicine can step in at that point and provide help.
What is low testosterone?
Low testosterone is not a number. Low testosterone is a combination of lower than normal testosterone levels in the blood along with physical symptoms or changes that pointedly affect men’s health, well-being, and lifestyle.
The normal range for total testosterone levels in men is 270 to 1070 nanograms per deciliter. Dipping below 270 ng/dL may be reasonably considered to be low testosterone, but it is not enough for a diagnosis. Depending on the healthcare provider, testosterone levels will be considered “low” if they are anywhere from 230 to 300 ng/dL. Measuring total testosterone levels is complex, deceptive, and unreliable, so a definitive diagnosis of low testosterone—or hypogonadism—always requires physical symptoms.
No one is certain how many men have low testosterone. Most men don’t report it or seek treatment. In the United States, approximately 40% of men over the age of 45 and 50% of men in their 80s have low testosterone. However, low testosterone is not a condition confined to older men. Young men and even adolescents can have testosterone deficiency. In fact, low testosterone is becoming more common among young men due to higher rates of obesity, obstructive sleep apnea, diabetes, and drug use.
Low testosterone can happen when either the testes do not produce enough testosterone, called primary hypogonadism, or the hypothalamus (brain) and pituitary gland do not produce the hormones to stimulate testicular production of testosterone, called secondary hypogonadism.
Low testosterone is due to a number of possible causes:
- Age
- Obesity
- Diabetes
- Obstructive sleep apnea
- Drug or anabolic steroid use
- Cancer treatment
- Stress
- Malnutrition
- Pituitary gland disorders
- Underactive thyroid
- Genetic conditions
How is low testosterone diagnosed?
Diagnosis starts with a history and physical examination to determine if there are classic symptoms of low testosterone, such as:
- Low sex drive
- Erectile dysfunction
- Low sperm production
- Declining ejaculate volume
- Loss of underarm, pubic, and body hair
- Hot flashes
Other symptoms might include memory problems, concentration problems, decreased energy levels, reduced muscle strength, reduced muscle mass, depression, and fatigue.
If a man shows symptoms of low testosterone, a blood test will determine the total amount of testosterone in the blood. Total testosterone levels can vary widely throughout the day and from day-to-day. The levels are highest in the morning, so a blood draw will be performed between 7 a.m. and 9 a.m. on at least two different days. Both blood tests must show reduced testosterone to support a low testosterone diagnosis. In obese patients, free testosterone is checked/calculated as total testosterone levels can be falsely low.
The healthcare provider will interpret the total blood testosterone levels in light of the symptoms. Sometimes even a normal level of blood testosterone will result in a diagnosis depending on the severity of physical symptoms.
If testosterone is low, the healthcare professional will conduct more blood tests to measure hormones that are responsible for signaling testosterone production as well as to measure substances that may affect testosterone production. Other tests may be required to determine an underlying cause.
Low testosterone treatment options
When a particular cause has been identified for low testosterone, treatment will generally focus on the underlying condition, which could involve surgery, medications, or lifestyle changes. For men who have low testosterone directly caused by underproduction of hormones or testosterone, the most common treatment is testosterone replacement therapy.
Testosterone replacement therapy
Testosterone replacement therapy (TRT) is often the first line of treatment for low testosterone when the only cause for low testosterone is a problem with testosterone production in the testes or hormone production in the pituitary gland or brain. There is no consensus on appropriate candidates for testosterone replacement therapy, the potential benefits, or the possible health risks, so TRT treatment will depend on the healthcare provider. Even though it does increase serum testosterone levels, testosterone replacement therapy does not always improve symptoms.
Medications
Alternatively, medications may help increase testosterone in the body or manage the symptoms of low testosterone, such as estrogen blockers and aromatase inhibitors. However, these medications are rarely used due to limited efficacy and risk of side effects.
Low testosterone medications
Testosterone
Testosterone products include patches, topical gels, nasal gel, intramuscular injections, and pellets. Testosterone gel and transdermal patches are the most widely used on account of cost, ease of use, insurance coverage, and their ability to keep testosterone levels more or less stable. Testosterone injections are usually administered every two weeks. Testosterone undecanoate, a long-acting version of testosterone, is injected every 10 weeks. A testosterone pellet is inserted under the skin and provides continual testosterone release for up to six months.
Estrogen blockers
Testosterone replacement typically reduces sperm counts and lowers testosterone production in the body; both of which can be a problem for younger men who would like to start a family. Estrogen, a female sex hormone, naturally occurs in men. It works in the brain to inhibit testosterone production. Estrogen blockers prevent this from happening, so the brain provides more hormonal stimulation of testosterone production. Healthcare providers typically prescribe clomiphene citrate off-label to younger men with low testosterone. These medications are also used in older men who are not candidates for testosterone therapy. This medication is also used for treating infertility.
Aromatase inhibitors
People with low testosterone and excess weight often can produce normal levels of testosterone. However, an enzyme in body fat, called aromatase, converts testosterone to estrogen, a female sex hormone. High estrogen levels, in turn, inhibit testosterone production. Aromatase inhibitors are breast cancer drugs that are used off-label to prevent this process. Aromatase inhibitors can dramatically increase serum testosterone and decrease estrogen in men with age-related or obesity-related low testosterone.
What is the best medication for low testosterone?
The medical community itself cannot fully agree on what the best medication or treatment for low testosterone. For now, the most widely used medical intervention for low testosterone is testosterone replacement.
| Best medications for low testosterone | ||||
|---|---|---|---|---|
| Drug name | Drug class | Administration route | Standard dosage | Common side effects |
| Androderm (testosterone) | Hormone replacement therapy | Transdermal patch | 1, 2 mg patch applied to the skin daily | Skin reactions, back pain, acne |
| Aveed (testosterone undecanoate) | Hormone replacement therapy | Injection | 3 ml of 750 mg / 3 ml every 10 weeks | Acne, hypogonadism, fatigue |
| Natesto (testosterone) | Hormone replacement therapy | Nasal gel | 2 pumps per nostril 3x a day | Headache, runny nose, nasal hemorrhage |
| Clomid (clomiphene citrate) | Estrogen blocker | Oral | 1, 50 mg tablet daily | Abdominal pain, nausea, vomiting |
| Arimidex (anastrozole) | Aromatase inhibitor | Oral | 1, 1 mg tablet daily | Joint pain, high blood pressure, nausea |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA). Dosage is determined by your healthcare provider based on your medical condition, response to treatment, age, and weight. Other possible side effects exist.
What are the common side effects of low testosterone medication?
Different classes of medications have different side effects. However, this is not a complete list, and you should consult with a healthcare professional for possible side effects and drug interactions based on your specific situation.
Testosterone
Commonly experienced side effects of testosterone include lowered sperm counts, breast growth, shrinkage of the testicles, and acne. Testosterone therapy may worsen sleep apnea. Testosterone puts patients at an increased risk for blood clots, heart disease, and worsening prostate cancer.
Estrogen blockers
Estrogen blockers have been well-studied in women, but their off-label use for men has not been as well documented. They may cause acne or mood changes in men as well as posing a possible risk for prostate cancer.
Aromatase inhibitors
Aromatase inhibitors are relatively safe drugs without substantial risk for serious side effects. Aromatase inhibitors can raise blood pressure and affect bone density.
What are the best home remedies for low testosterone?
The best home remedies are lifestyle changes that either help to increase testosterone levels or help to manage or reduce the symptoms by improving sexual function, muscle strength, energy levels, concentration, and mood.
1. Lose the extra weight
Excess weight reduces testosterone in the body. An enzyme in fat tissue converts testosterone into estrogen, a female hormone. Estrogen, in turn, inhibits testosterone production. Weight loss is hands down the first and most effective home treatment for low testosterone.
2. Exercise more
Exercise increases the body’s production of testosterone in men. Testosterone production goes up once exercise reaches a certain intensity level and continues to increase until exercise stops. Exercise also significantly prevents or reverses the effects of low testosterone. Exercise increases muscle strength, prevents bone loss, boosts energy levels, and improves physical performance. Intensity is the key. Weight training and intense interval training seem to have the greatest effect on testosterone, but any level of exercise will raise testosterone.
3. Eat a balanced and nutritious diet
There is no magic food or dietary supplement that increases testosterone. Some foods or nutrients, such as vitamin D or zinc, may help increase total testosterone levels, but not in a clinically significant way. However, both excess weight and malnutrition do lower testosterone levels in the body. The common-sense diet for low testosterone is a balanced and moderate diet of nutrient-rich foods.
4. Practice good sleep hygiene
The body’s production of testosterone peaks during sleep and falls off during the active hours of the day. Not getting enough sleep can have a dramatic effect on testosterone levels, particularly for young men or adolescents. Practice good sleep hygiene by going to bed at the same time every night, eliminate all distractions, and turn off the light.
5. Lower stress levels
Stress reduces testosterone levels in the blood. The body responds to stress by producing cortisol, a steroid that breaks down proteins and fats into sugar to provide more energy. Cortisol also inhibits the production of testosterone. Avoiding stress is not always possible, but stress can be reduced through relaxation activities, exercise, good sleep hygiene, and avoiding stimulants such as caffeine and nicotine.
6. Avoid medications that lower testosterone
Many drugs and medications reduce testosterone. Some, like opioids and anabolic steroids, greatly reduce the body’s production of testosterone. Corticoid steroids and taking too many NSAIDs contribute to reduced testosterone levels. Some drugs, like caffeine, actually may increase serum testosterone in men, but they also contribute to stress and interfere with sleep. Several over the counter, testosterone boosters/supplements may actually decrease testosterone production and can result in infertility.
Frequently asked questions about low testosterone
What is considered low testosterone?
For a healthcare practitioner, low testosterone is not a number. It is a combination of lower than normal testosterone levels in the blood accompanied by significant physical symptoms such as reduced muscle strength, physical performance, energy levels, sexual desire, erectile function, and other symptoms.
What does low testosterone do to a man?
The classic symptoms of low testosterone are a decreased interest in sex and a decline in the ability to have spontaneous erections. Low testosterone can also cause hair loss in the underarms and pubic area, decrease sperm count, lower the volume of ejaculate, and produce hot flashes. Men with low testosterone may also complain of loss of muscle strength, bone fragility, fatigue, depression, weight gain, trouble concentrating, memory problems, and reduced physical performance and energy.
Is it dangerous to have low testosterone?
Low testosterone is usually not dangerous, but very low levels of testosterone will result in muscle and bone loss, leaving men more at risk for fractures. Low testosterone in general is associated with a decrease in quality of life. Extremely low testosterone may increase the risk of cardiovascular events. However, it reduces the risk of an enlarged prostate or progression of prostate cancer.
Is low testosterone curable?
Low testosterone caused by a curable condition, such as obesity, alcoholism, drug use, or hypothyroidism, is curable. Fixing the underlying condition will often if not always bring testosterone levels back to normal. Low testosterone due to age or inherited disorders is not curable but can be managed with testosterone replacement therapy.
How do you fix low testosterone?
If caused by a condition such as an underactive thyroid, stress, obesity, malnourishment, or similar problems, low testosterone can be fixed by fixing the underlying condition. Low testosterone due to the testes, pituitary gland, or brain, usually cannot be fixed. However, in some cases, treating the primary issue does help with the recovery of the testosterone axis. Testosterone replacement therapy will help manage the condition and reduce the symptoms.
What is the best treatment for low testosterone?
There is no best treatment for low testosterone. The condition can be due to several causes, each of which will have treatments to manage the condition. The most common treatment for low testosterone is testosterone therapy, but this treatment has potential side effects and may not be right for every person. If someone is started on testosterone treatment, a serial set of labs are done every three to six months to monitor any complications from therapy.
What is the best natural supplement for low testosterone?
Fenugreek and ashwagandha, a principal botanical in Ayurvedic medicine, are frequently singled out as effective testosterone boosters. Ashwagandha has been shown to slightly raise testosterone levels in saliva. This may be due to its ability to lower stress and cortisol levels in the body, both of which reduce testosterone levels. Fenugreek supplementation has been associated with higher scores on self-assessment questionnaires related to low testosterone. No supplement has been shown to increase testosterone at a clinically significant level for people with low testosterone.
Which drugs help to increase testosterone production?
Estrogen blockers are used to increase testosterone production. An alternative to testosterone replacement, estrogen blockers are used in young men with low testosterone and older men with age-related low testosterone. For young men, estrogen blockers don’t reduce fertility in the same way as testosterone replacement. For older men, estrogen blockers are used when they aren’t candidates for testosterone because of heart disease or prostate cancer.
Which foods increase testosterone the most?
Many foods increase testosterone levels. None of them, however, increase testosterone in clinically significant ways for men with low testosterone. And many foods that people claim “raise testosterone,” such as pomegranates or milk, instead reduce the symptoms of low testosterone by increasing energy levels, erectile function, muscle strength, and sexual function. The common-sense alternative for men with testosterone deficiency is to eat a balanced diet with nutrient-rich foods.
Which foods kill testosterone?
No food has been shown to lower serum testosterone in humans in a clinically significant way. Many foods that are high in sugars, carbohydrates, and fats can lead to either obesity or insulin insensitivity, both of which unambiguously can cause lower testosterone. Continual alcohol consumption can dramatically lower serum testosterone.
Related resources for low testosterone
- Diagnosing and managing low serum testosterone
- Diagnosis and management of testosterone deficiency syndrome in men: clinical practice guideline
- Hypogonadism
- Hypogonadism (low testosterone)
- Low Testosterone in Adolescents & Young Adults
- Review of health risks of low testosterone and testosterone administration
- Testosterone for the aging male; current evidence and recommended practice
- Aromatase inhibitors in men: effects and therapeutic options
- The effects of caffeinated and decaffeinated coffee on sex hormone-binding globulin and endogenous sex hormone levels: a randomized controlled trial