In short
A TRT consultation with Dr. Felix is the diagnostic step that decides whether testosterone treatment is justified. Low testosterone is diagnosed when symptoms occur together with a low fasting total testosterone measured between 8 and 10 in the morning on at least two separate days. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) then show whether the cause lies in the testes or the pituitary gland. In the European Male Ageing Study, low testosterone with sexual symptoms affected about 2 in 100 men aged 40 to 79.
Treatment Overview
Why does the diagnosis come before any testosterone prescription?
The diagnosis comes first because testosterone treatment suppresses the body’s own production, and the symptoms that bring men in usually have another cause. Testosterone from outside the body switches off the pituitary signal to the testes, so sperm production falls and stopping means months of low testosterone while the body recovers. Genuine deficiency is uncommon: the European Male Ageing Study found low testosterone with three sexual symptoms in about 2 in 100 men aged 40 to 79.
The symptoms of low testosterone, and which of them are specific, are explained on the low testosterone page. Tiredness on its own has many causes, covered under male hormonal fatigue.
Who should have a testosterone test?
A testosterone test is appropriate for men with symptoms of low testosterone, or with a condition in which low testosterone is common. Screening men without symptoms is not recommended. The Endocrine Society clinical practice guideline lists these conditions:
- Pituitary disease: disease of the pituitary gland, hypothalamus or the surrounding region.
- Medicines: long-term high-dose glucocorticoids or sustained-release opioids.
- Metabolic disease: type 2 diabetes.
- Bone disease: osteoporosis or a fracture from a minor fall, especially in a younger man.
- Fertility: male infertility.
- Chronic illness: moderate to severe chronic obstructive lung disease, end-stage kidney disease on dialysis, or weight loss related to HIV.
Men with an acute or recent illness are not tested until recovery, because illness causes a temporary and misleading fall in testosterone.
How is low testosterone diagnosed?
Low testosterone is diagnosed from a fasting total testosterone taken between 8 and 10 in the morning on at least two separate days, together with symptoms. The table lists the five conditions a testosterone result meets before it counts.
| Element | Requirement | Reason |
|---|---|---|
| Time of day | Between 8 and 10 in the morning | Testosterone peaks around 8 in the morning and falls to about 70 percent of that by 8 in the evening |
| Food | Fasting | Food, and glucose in particular, lowers the measured level |
| Repeats | At least two mornings | A borderline value often normalises on repeat |
| Health | No acute illness | Illness causes a temporary fall |
| Laboratory method | Mass spectrometry or a certified immunoassay | Methods differ enough to change the answer |
A single morning value well inside the normal range shows normal testosterone production, and the search moves to other causes. A low, borderline or unexpected value is repeated once or twice before any diagnosis.
What counts as a low testosterone level?
A low testosterone level is a value below the lower limit of the laboratory that measured it, because normal ranges depend on the assay. Most laboratories report roughly 300 to 800 ng/dL for adult men. In the harmonised reference ranges from four cohorts in the United States and Europe, healthy young men of normal weight, aged 19 to 39, had values between 264 and 916 ng/dL. The lower limit drops with age: for men over 60 of normal weight it was 219 ng/dL.
A value near the bottom of the range in a man without specific symptoms is not a diagnosis. Sleep, weight, alcohol and medicines are assessed first.
When is free testosterone worth measuring?
Free testosterone is worth measuring only when the binding protein sex hormone-binding globulin (SHBG) is likely to be abnormal, most often in obesity (BMI 30 or more) and in men aged 70 or more. Obesity lowers SHBG and therefore total testosterone, usually without lowering free testosterone. A man with a high BMI and a low total testosterone can therefore have a normal free testosterone and no deficiency. The binding change is proportional to body weight and improves with weight loss.
The measurement method decides whether free testosterone is useful. Equilibrium dialysis in a specialist endocrine laboratory is reliable. The analog (“direct”) free testosterone assay offered by most routine laboratories gives misleading results. Calculated free testosterone depends on the equation used, so each result is read against the range of the laboratory that calculated it.
What do LH and FSH show?
LH and FSH show whether low testosterone comes from the testes (primary hypogonadism) or from the pituitary gland or hypothalamus (secondary hypogonadism). The table lists the two patterns.
| Pattern | Location of the problem | Next steps |
|---|---|---|
| LH and FSH high | Testes (primary hypogonadism) | Causes in the testes are assessed; a chromosome test for Klinefelter syndrome is considered |
| LH and FSH normal or low | Pituitary gland or hypothalamus (secondary hypogonadism) | Prolactin, iron studies, morning cortisol and thyroid hormone are measured |
Magnetic resonance imaging (MRI) of the pituitary gland is arranged when other pituitary hormones are abnormal, vision is affected, or testosterone is very low: below about 250 ng/dL in a man under 40, or below about 150 ng/dL in a man over 60. A semen analysis is added when fertility is a question.
When is testosterone treatment considered?
Testosterone treatment is considered only when specific symptoms and repeatedly low morning testosterone are both present. Symptoms with a normal testosterone do not qualify, because raising a normal level does not relieve them, and a single low reading does not qualify either. The US Food and Drug Administration (FDA) does not approve testosterone for men whose level is low for no reason other than age. Which preparations are used, and their benefits and risks, are explained on the testosterone replacement therapy page.
What happens after the testosterone results?
The testosterone results lead to one of three answers, and only one of them ends in a testosterone prescription:
- Confirmed deficiency: the cause is identified, fertility plans are discussed and a treatment plan is set.
- Another cause: sleep apnoea, excess weight, alcohol, thyroid disease, iron deficiency, medicines or low mood are treated, and testosterone is often rechecked afterwards.
- Unclear result: testing is repeated correctly, or free testosterone is added, before any decision.
Testosterone testing in Dubai and the UAE
How is a correct morning testosterone test arranged in Dubai?
A correct testosterone test in Dubai is a fasting blood draw between 8 and 10 in the morning on a normal working day. Early commutes push many men into laboratories at 6 or 7 in the morning. A window from 7 to 10 in the morning is accepted by some experts for men who wake very early, while night-shift work changes the daily rhythm and is taken into account when results are read.
During Ramadan the fasting requirement is easy to meet, but sleep is shorter and shifted. Borderline results from Ramadan are therefore repeated after the month.
Does the laboratory matter for a testosterone test?
Yes, the laboratory matters, because testosterone assays differ enough to move a borderline result across the diagnostic line. Liquid chromatography with tandem mass spectrometry, or an immunoassay certified by the US Centers for Disease Control standardisation programme, is preferred. The reference range on a report belongs to that laboratory only, so results from clinics in different countries are not compared directly, and repeat tests come from the same laboratory.
Who Is a Good Candidate?
- Men with low libido, fewer morning erections or loss of body hair who want a clear answer.
- Men with type 2 diabetes, osteoporosis, infertility, chronic kidney or lung disease, or long-term opioids or steroids.
- Men with a single low or borderline reading elsewhere who want it interpreted correctly.
- Men already on testosterone who want the original diagnosis reviewed.
- Acute or recent illness: testing waits until recovery, because illness temporarily lowers testosterone.
- A prescription at the first visit without blood tests: not offered, the diagnosis comes first.
- Screening without symptoms or a risk condition: not recommended.
What Happens During the Consultation
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1
Symptoms in detail
Dr. Felix separates libido, erections, energy, mood, concentration, training response and body composition, and asks when and how fast each changed.
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2
Other causes
Sleep and snoring, weight and waist, alcohol, medicines including opioids and steroids, chronic illness and plans for children are reviewed, because these decide the diagnosis as often as blood tests do.
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3
Examination and blood tests
The examination covers testes, breast tissue and body hair. Blood tests include morning fasting testosterone on two days, LH, FSH, prolactin, thyroid, haematocrit, iron, HbA1c and PSA where age-appropriate.
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4
The written answer
The result is one of three: a confirmed deficiency with its cause, another cause to treat, or a clear reason why testing is repeated.
Program Structure & Follow-Up
How long does the testosterone assessment take?
The testosterone assessment usually takes two to three weeks, because the repeat morning sample needs a separate day:
- Visit one: history, examination and the first morning blood draw.
- Within two weeks: the second morning fasting sample on a different day.
- Visit two: results, diagnosis and plan.
A clearly normal first value makes the second sample unnecessary, and the assessment moves to the actual cause.
What happens if testosterone is normal?
A normal testosterone with real symptoms redirects the assessment to sleep, weight, alcohol, thyroid, iron, mood and medicines, which respond to treatment. Contact between appointments runs through the membership programmes.
Benefits, Limits & Safety
What can a testosterone test not tell you?
A testosterone result does not measure how a man feels and does not predict who responds to treatment. Two men with the same level can have different symptoms, so the number is always read together with the history and examination.
Why are so many men told they have low testosterone?
Many men are told they have low testosterone because a single afternoon or non-fasting reading often comes back low in a man without deficiency. Testing without LH, FSH and a search for other causes then turns a laboratory fluctuation into a diagnosis, and treatment started on that basis is difficult to stop.
How is testosterone started elsewhere reviewed?
Testosterone started elsewhere is reviewed from the original records, the current testosterone level and the haematocrit, because the body’s own level cannot be measured while treatment continues. When the original evaluation did not confirm hypogonadism, the clinical guidance is to stop testosterone and re-evaluate about 2 months later. Conditions that exclude testosterone are listed under when testosterone is not used.
What you get from the assessment
A diagnosis or a clear reason why one is not yet possible, the cause located in the testes or the pituitary gland, and a plan naming what to treat.
How testing is done
Fasting total testosterone between 8 and 10 in the morning on at least two days, with LH, FSH, prolactin, thyroid, haematocrit, iron and metabolic blood tests.
When testing is postponed
During or just after an acute illness, because the fall in testosterone is temporary. Screening men without symptoms or a risk condition is not recommended.
Cost & Program Investment
The cost of the testosterone assessment covers the consultation, examination, blood tests and the results appointment. Dr. Felix explains the full cost before anything is booked. Ongoing care runs through the membership programmes.
Frequently Asked Questions
Two testosterone tests are needed because a single value fluctuates and a borderline reading often normalises on repeat. Both samples are taken fasting between 8 and 10 in the morning on separate days, as the Endocrine Society guideline recommends.
Testosterone peaks around 8 in the morning and falls to about 70 percent of that by 8 in the evening. Reference ranges are based on morning values, so a low afternoon reading can be normal.
Yes, the testosterone test is taken fasting, because food and glucose in particular lower the measured testosterone.
Most laboratories report roughly 300 to 800 ng/dL for adult men, and each report is read against its own laboratory range. In standardised data, healthy young men of normal weight had values between 264 and 916 ng/dL. For men over 60, the lower limit was 219 ng/dL.
Free testosterone is needed only when SHBG is likely to be abnormal, mainly with obesity or age 70 and over. Only equilibrium dialysis or a carefully calculated value is reliable; the analog assay gives misleading results.
High LH and FSH with low testosterone point to the testes. Normal or low LH and FSH point to the pituitary gland or hypothalamus, where reversible causes are common and fertility can often be restored.
A normal testosterone with exhaustion points to other causes such as sleep apnoea, short sleep, excess weight, alcohol, thyroid disease, iron deficiency, medicines or low mood, which all respond to treatment.
The key tests are usually repeated: morning fasting testosterone on two days, with LH and FSH. Men already on testosterone are reviewed differently, because their own production is suppressed during treatment.
Testing during Ramadan is possible, and fasting is easy. Sleep is shorter and shifted during the month, so borderline results are repeated after Ramadan before any decision.
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 booked.
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
- Harmonized Reference Ranges for Circulating Testosterone Levels in Men of Four Cohort Studies in the United States and Europe
- 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.