Low Testosterone in Men: What to Know About Symptoms, Testing and Testosterone Therapy
By Dr. Rebecca Moragne, ND, MS
Hormone therapy has been having a moment. Much of that conversation focuses on women’s health, particularly menopause and menopausal hormone therapy. In February 2026, the FDA approved labeling changes for several menopausal hormone therapy products, removing certain risks from the boxed warning and reflecting how the evidence and understanding of hormone therapy have evolved.
But there’s another hormone conversation worth having: men’s testosterone health. Men’s hormone health deserves the same thoughtful, individualized approach that has finally become part of the conversation around women’s hormones.
Testosterone naturally changes as men age, but persistent low testosterone isn’t something that should automatically be dismissed as “just getting older.” For some men, low testosterone is associated with symptoms that affect energy, sexual health, mood, muscle mass and overall quality of life.
However, testosterone therapy isn’t appropriate for every man who feels tired or notices changes with age. A thoughtful evaluation looks beyond a single lab value to understand symptoms, testosterone levels, contributing factors and the individual’s overall health. That’s where an individualized approach matters.
What Is Low Testosterone?
Low testosterone, or male hypogonadism, occurs when the body doesn’t produce adequate testosterone and is accompanied by signs or symptoms of testosterone deficiency.
Andropause is the gradual decline in testosterone production that happens as men age. Unlike menopause, which unfolds over a relatively defined window, andropause creeps in slowly: total testosterone declines by less than half a percent per year starting in a man’s thirties, while the luteinizing hormone that signals the testes to produce it actually rises. It’s subtle by design, which is exactly why it so often gets waved off as “just getting older” rather than investigated.
While testosterone production naturally changes with age, levels can also be affected by a variety of health and lifestyle factors, including obesity, certain medications, chronic illness, sleep problems and disorders affecting the testes, pituitary gland or hypothalamus.
The question most men ask is “Am I just getting older?” A better question is “Could low testosterone or another underlying health issue be contributing to the changes I’m experiencing?”
Signs and Symptoms of Low Testosterone in Men
Low testosterone can look different from one person to another, and many of its symptoms overlap with other health conditions. Potential symptoms include:
- Low libido or decreased sexual desire
- Erectile difficulties
- Persistent fatigue or low energy
- Reduced motivation
- Low mood or irritability
- Difficulty concentrating or “brain fog”
- Loss of muscle mass or strength
- Increased body fat
- Reduced exercise capacity
- Decreased bone density
- Fewer spontaneous or morning erections
Symptoms alone don’t diagnose low testosterone. Fatigue, low mood, changes in libido and difficulty concentrating are common and can have many causes. Sleep disorders, metabolic health, medications, thyroid problems, psychological stress and other conditions can produce similar symptoms. That’s why testing and a broader clinical evaluation matter.
Could Low Testosterone Be Part of the Picture?
If you’ve recognized several of these symptoms in yourself, you may be wondering whether testosterone could be contributing. But symptoms such as fatigue, low mood, changes in body composition and difficulty concentrating can have many possible causes. Take our free 2-minute Men’s Hormone Health Quiz to reflect on your symptoms and learn whether it may be worth having a conversation with a healthcare provider about your hormone health.
What Causes Low Testosterone?
Age is only one piece of the picture. Testosterone production can be affected by conditions involving the testes or the hypothalamus and pituitary gland, as well as potentially reversible factors such as obesity, certain medications, poor sleep and chronic illness. Some factors worth investigating include:
1. Excess body fat and metabolic health
Obesity is associated with lower testosterone levels in some men. When excess weight is contributing to hypogonadism, addressing metabolic health and weight can be an important part of treatment. The Endocrine Society specifically identifies weight loss as a typical first-line approach for appropriately diagnosed hypogonadism associated with overweight or obesity when another cause hasn’t been identified.
2. Poor sleep and sleep apnea
Sleep quality matters for overall hormone and metabolic health. Untreated severe obstructive sleep apnea is also an important consideration when evaluating whether testosterone therapy is appropriate.
3. Medications and other health conditions
Certain medications, including opioids and corticosteroids, can contribute to low testosterone. Chronic illness and disorders affecting the thyroid, pituitary or testes may also play a role.
4. Stress and lifestyle
Chronic stress, inadequate nutrition, excessive alcohol use, smoking and insufficient physical activity can all affect overall health and may contribute to symptoms that overlap with low testosterone.
This is one reason I don’t recommend looking at testosterone in isolation.
How Is Low Testosterone Diagnosed?
This is one of the most important parts of the conversation. A single testosterone test usually isn’t enough to diagnose hypogonadism. Testosterone levels fluctuate throughout the day and are generally highest in the morning. The Endocrine Society recommends confirming a diagnosis by repeating a morning fasting total testosterone measurement when an initial result is low. Its 2026 statement emphasizes that diagnosis requires symptoms plus consistently low, accurately measured testosterone levels.
Depending on the individual, a more complete evaluation may include:
- Total testosterone
- Free testosterone when appropriate
- LH and FSH
- Prolactin
- Thyroid testing
- Complete blood count
- Metabolic markers
- Additional testing based on symptoms and medical history
The goal isn’t simply to answer “Is testosterone low?” It’s also to understand why. For example, LH and FSH can help distinguish between testosterone production problems originating in the testes and problems involving the hypothalamus or pituitary.
What Is a “Normal” Testosterone Level?
This is where testosterone testing can become confusing. Laboratory reference ranges are based on the population and testing method used by that laboratory. A testosterone value shouldn’t be interpreted in isolation or without considering symptoms, the timing of the test, the assay and the individual’s overall clinical picture.
In other words, a number being inside the laboratory reference range doesn’t automatically mean that everything is optimal, nor does a single low number automatically mean testosterone therapy is necessary. A qualified clinician should interpret the result in context.
An Integrative Approach to Low Testosterone: Foundations First
Testosterone replacement therapy can be an appropriate treatment for men with properly diagnosed hypogonadism. But treatment shouldn’t begin and end with a prescription.
An integrative approach asks: What factors may be contributing to the problem, and what can we address alongside hormone therapy? That may include:
1. Prioritize sleep
Poor sleep can affect energy, mood, metabolism and overall well-being. If you regularly wake feeling unrefreshed, snore heavily or have other symptoms of sleep apnea, evaluating sleep may be an important part of the picture.
2. Support metabolic health
Body composition, insulin sensitivity, physical activity and nutrition all influence overall hormone and metabolic health. For men whose low testosterone is associated with overweight or obesity, improving metabolic health may be an important first step.
3. Build strength
Resistance training can support muscle mass, strength, metabolic health and healthy aging. Rather than focusing exclusively on trying to “boost testosterone,” the goal is to build the physiological foundation for long-term health.
4. Evaluate medications and underlying conditions
Sometimes the most important intervention isn’t adding another treatment. It’s identifying something that is already interfering with hormone health. A careful review of medications, sleep, thyroid function, metabolic health, pituitary function and other potential contributors can help clarify the picture.
5. Address nutritional needs
Adequate nutrition is important for hormone production and overall health. If testing or dietary history suggests a nutrient deficiency or other digestive issues, correcting it may be appropriate.
Supplements and botanicals sometimes enter the conversation around testosterone as well. Compounds such as ashwagandha, tongkat ali and maca have been studied, but evidence varies by supplement, preparation and clinical situation. They shouldn’t be treated as interchangeable with medically indicated testosterone therapy, and “natural” doesn’t automatically mean appropriate or risk-free.
When Does Testosterone Replacement Therapy Make Sense?
Testosterone replacement therapy (TRT) may be appropriate for men who have symptoms and consistently low testosterone confirmed through appropriate testing.
The decision should be individualized. Before starting TRT, a clinician should consider the potential benefits, risks, fertility plans, prostate health, hematocrit and other medical factors. The Endocrine Society recommends against starting testosterone therapy in certain situations, including men planning fertility in the near term and men with several significant prostate, cardiovascular, hematologic and sleep-related conditions.
TRT also requires ongoing monitoring. Depending on the treatment and individual circumstances, monitoring may include testosterone levels, blood counts and assessment of prostate health.
And while recent evidence has helped clarify some questions about cardiovascular safety, testosterone therapy isn’t risk-free and important long-term questions remain. The FDA reported that the TRAVERSE trial did not demonstrate an increase in major cardiovascular events, while the Endocrine Society’s 2026 statement notes that longer-term safety remains incompletely established. That’s why TRT should be treated as a medical therapy, not a wellness shortcut.
Considering Testosterone Therapy?
Testosterone replacement therapy can be an appropriate option for some men with confirmed testosterone deficiency, but deciding whether it’s right for you requires more than a single lab result. If you’re wondering whether your symptoms and health history warrant a closer look, take our free Men’s Hormone Health Quiz.
[Take the 2-Minute Quiz →]
What About Testosterone and Fertility?
This deserves special attention for men who may want to have children. Testosterone replacement can suppress the body’s own testosterone production and sperm production. For that reason, men who are planning fertility in the near term should discuss this before starting TRT. The Endocrine Society specifically recommends against testosterone therapy in men planning fertility in the near term.
If fertility is a priority, the treatment conversation may look very different.
Men’s Hormone Health Deserves a Thoughtful Conversation
Women’s hormone health is finally receiving the attention it has long deserved. Men’s hormone health deserves that same thoughtful approach.
That doesn’t mean assuming every symptom is caused by low testosterone. And it doesn’t mean treating a lab number simply because it’s lower than it once was. It means taking symptoms seriously, testing appropriately, looking for underlying causes and considering treatment options in the context of the whole person. Fatigue, low libido, changes in body composition and declining vitality may be common as men age. But “common” doesn’t necessarily mean something you have to ignore.
Partner with a PIM Provider
If you’re experiencing symptoms that concern you, consider talking with a qualified healthcare provider about whether testosterone testing and a broader evaluation make sense for you.
At Peninsula Integrative Medicine, we look at hormone health in the context of the whole person, including lifestyle, nutrition, metabolic health, sleep and other factors that may influence how you feel. The following PIM providers practice men’s health and hormone optimization: Dr. Rebecca Moragne, Dr. Meghan Kemnec, Dr. Nicole McCarter, Dr. Rebecca Green, and Dr. Tyler Wuthmann.
Explore their bios before requesting a New Patient appointment online. Alternatively, request a 10-minute complimentary consultation, call our office, or send us a message if you are unsure which doctor might be the best fit for you. Our Patient Care Coordinators are happy to help you find the right fit!
