In short
Low testosterone (male hypogonadism) is too little testosterone together with symptoms caused by it, confirmed by a low fasting morning testosterone on at least two separate days. The more specific symptoms are low libido, fewer morning erections, loss of body hair and small testes; tiredness and low mood are common but non-specific. The cause lies either in the testes (primary) or in the pituitary gland or hypothalamus (secondary), and obesity, opioids and high-dose steroids are frequent contributors.
Condition Overview
What is low testosterone?
Low testosterone (male hypogonadism) is a reduced function of the testes, with too little testosterone, too little sperm production or both. Testosterone is produced in the testes under the control of luteinizing hormone (LH) from the pituitary gland. A problem at either level lowers testosterone. A low number without symptoms is not a diagnosis, and symptoms with a normal number point to another cause.
What are the symptoms of low testosterone?
The symptoms of low testosterone in adult men are reduced libido, fewer morning erections, lower energy and low mood, which begin within a few weeks of the fall. Loss of muscle mass and body hair takes a year or longer. Hot flushes appear only with severe and rapid falls. Symptoms are stronger when testosterone falls over weeks or months than when it drifts down over years. The table separates the symptoms that point to low testosterone from those with many other causes.
| More specific for low testosterone | Common, many other causes |
|---|---|
| Low sexual desire | Tiredness and low energy |
| Fewer morning erections | Low mood |
| Loss of body and facial hair | Poor concentration |
| Breast tissue growth (gynaecomastia) | Reduced muscle strength |
| Small testes | More body fat |
| Low bone density or a fracture from a minor fall | Anaemia |
Most men start with the right-hand column. These symptoms are also typical of sleep problems, thyroid disease, iron deficiency, alcohol and low mood, covered under male hormonal fatigue.
What causes low testosterone?
Low testosterone is caused by disease of the testes, disease of the pituitary gland or hypothalamus, medicines, obesity or chronic illness. Common causes include:
- Medicines: sustained-release opioids and long-term high-dose glucocorticoids suppress the pituitary signal.
- Obesity: excess weight lowers the binding protein and, at severe obesity, the pituitary signal as well.
- Testicular damage: chemotherapy, radiation, heavy alcohol use, injury, torsion or mumps affecting the testes.
- Pituitary disease: tumours of the pituitary region, including prolactin-producing tumours, and iron overload.
- Genetic causes: Klinefelter syndrome, with small firm testes and breast tissue.
- Illness: acute illness causes a temporary fall; type 2 diabetes, chronic kidney disease and chronic lung disease cause lasting falls more often.
What is the difference between primary and secondary hypogonadism?
Primary hypogonadism means the testes fail, so LH and follicle-stimulating hormone (FSH) are high, while secondary hypogonadism means the pituitary gland or hypothalamus fails, so LH and FSH are normal or low. Sperm production can often be restored with hormone treatment in secondary hypogonadism, but not in primary hypogonadism. Primary hypogonadism more often causes breast tissue growth, shrinking testes and infertility.
Does excess weight cause low testosterone?
Excess weight lowers the measured total testosterone mainly by lowering sex hormone-binding globulin (SHBG), usually without lowering the active free testosterone. The effect is proportional to the degree of obesity and reverses with weight loss. Only severe obesity, above a BMI of about 40, suppresses the pituitary signal as well. A man with a high BMI and a low total testosterone therefore often has no true deficiency. Belly fat treatment for men addresses the weight itself.
How is low testosterone diagnosed?
Low testosterone is diagnosed from symptoms plus a low fasting total testosterone between 8 and 10 in the morning on at least two separate days, followed by LH and FSH to find the level of the problem. The test itself, the normal ranges and when free testosterone helps are explained on the TRT consultation page. Men with an acute illness are tested after recovery.
How common is low testosterone?
Genuine low testosterone is uncommon: 2.1 percent of men aged 40 to 79 had a low testosterone together with three sexual symptoms in the European Male Ageing Study. Those men were older and heavier on average, and had lower haemoglobin, bone density and muscle mass. Treatment options for a confirmed deficiency are explained on the testosterone replacement therapy page.
When to See a Doctor
- Libido has clearly dropped over months and has not recovered with rest.
- Morning erections have become rare, or body hair has thinned.
- Muscle and strength are falling, or abdominal fat is rising, despite unchanged training and diet.
- Type 2 diabetes, osteoporosis, infertility, or long-term opioids or steroids are present.
- Headaches, changes in side vision, or breast growth or discharge: a pituitary problem needs prompt assessment.
- Shrinking testes, testicular pain or a lump: examination without delay.
- Testosterone or anabolic steroids started without medical supervision, especially with headaches or high blood pressure.
How Dr. Felix Assesses This
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1
Symptom history
Dr. Felix maps libido, erections, energy, mood, sleep, concentration, training response and body composition, and when each changed.
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2
Causes and medicines
Weight, sleep, alcohol, opioids, steroids, chronic illness and plans for children are reviewed, because each changes the diagnosis and the plan.
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3
Examination and blood tests
The examination covers testes, breast tissue and body hair. Morning fasting testosterone is taken on two days, with LH, FSH, prolactin, thyroid, blood count and metabolic tests.
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4
Diagnosis and plan
The result is a confirmed deficiency with its cause, another cause to treat, or a clear reason to repeat testing.
Treatment Options
TRT Consultation
The diagnosis comes first because testosterone treatment suppresses the body’s own production, and the symptoms that bring men in usually…
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Testosterone Replacement Therapy
Testosterone replacement therapy (TRT) is a prescription treatment that raises a low testosterone level into the normal range for adult…
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Testosterone Gel
Testosterone gel is a daily skin gel and the usual first choice for testosterone replacement therapy, because it gives normal…
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Testosterone Injections
Testosterone injections are testosterone enanthate or cypionate injected into the muscle every 1 to 2 weeks, or weekly under the…
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Why Early Treatment Can Matter
Early assessment of low testosterone finds the linked problems while they are easy to influence. Severe low testosterone is associated with insulin resistance and the metabolic syndrome, and low testosterone in men often occurs together with weight gain and poor sleep.
An early and correct diagnosis also prevents years of unnecessary treatment. Thyroid disease, iron deficiency and sleep problems do not respond to testosterone, and treating the actual cause works better.
Why Early Treatment Can Matter
Early assessment of low testosterone finds the linked problems while they are easy to influence. Severe low testosterone is associated with insulin resistance and the metabolic syndrome, and low testosterone in men often occurs together with weight gain and poor sleep.
An early and correct diagnosis also prevents years of unnecessary treatment. Thyroid disease, iron deficiency and sleep problems do not respond to testosterone, and treating the actual cause works better.
The right cause treated
Energy, libido and mood improve when the actual cause is treated, hormonal or not.
Linked problems found
Insulin resistance, metabolic syndrome, low bone density and anaemia are checked alongside.
One clear assessment
History, examination and correctly timed blood tests settle the question.
Cost & Consultation Investment
The cost of a low testosterone assessment covers consultation time with Dr. Felix, the examination, interpretation of the blood tests and the written plan. Laboratory tests and any medicine are separate. Dr. Felix explains the full cost before anything is arranged.
Frequently Asked Questions
The first signs of low testosterone in adult men are reduced libido, lower energy and low mood, which appear within weeks of the fall. Loss of muscle and body hair takes a year or longer.
Low libido, fewer morning erections, loss of body hair, small testes, breast tissue growth and low bone density point most clearly to low testosterone. Tiredness, low mood and weight gain are common but have many other causes.
Low testosterone in young men is caused by testicular problems such as Klinefelter syndrome or injury, pituitary disease, opioids, high-dose steroids, anabolic steroid use or severe obesity. A confirmed level below 250 ng/dL with normal or low LH in a man under 40 leads to a pituitary MRI.
Excess weight lowers total testosterone mainly by lowering the binding protein SHBG, usually without lowering free testosterone. The effect reverses with weight loss, and only severe obesity also suppresses the pituitary signal.
Primary hypogonadism is a failure of the testes, with high LH and FSH. Secondary hypogonadism is a failure of the pituitary gland or hypothalamus, with normal or low LH and FSH, and fertility can often be restored.
Yes, sustained-release opioids and long-term high-dose glucocorticoids suppress testosterone, and ketoconazole affects the testes directly. The full medication list is reviewed at the first appointment.
No, a low or borderline morning value is repeated on a separate day before diagnosis, because testosterone fluctuates and a single sample is not enough for long-term treatment.
Total testosterone falls slightly with age and free testosterone falls more. Whether that decline causes symptoms is covered on the andropause page.
The cost of a low testosterone assessment in Dubai depends on the blood tests and repeat samples needed. Dr. Felix explains the full cost before anything is arranged.
Evidence
Where this information comes from
Every figure on this page is taken from the sources below. All of them are free to read, so you can check them yourself.
- Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline
- Identification of late-onset hypogonadism in middle-aged and elderly men (European Male Ageing Study)
This page is general medical information and does not replace a personal consultation. Trial results are averages across large groups, not a prediction for any one person.