Worried your testosterone levels might be lower than average? Discover the signs and symptoms of low testosterone, plus the best treatment options available, with this expert advice from Boots’s Marc Donovan
What is testosterone?
Testosterone is a hormone produced by the testicles. It stimulates the development and maintenance of male characteristics, including appearance and body hair, sexual development and sex drive, as well as muscle and bone mass. It also plays a role in mood, motivation and energy levels, which is why low testosterone can sometimes affect both physical and mental wellbeing.
Why do testosterone levels drop?
As men age, testosterone levels can start to fall and a gradual decline is considered normal. According to the NHS, it’s usually a steady decline at less than 2% a year from around the age of 30 to 40.
However, age is not the only factor. Lifestyle habits and underlying health conditions can also influence testosterone levels. Carrying excess body fat, having poor sleep, drinking lots of alcohol, bad diet, high stress levels and certain long-term conditions may all contribute to hormonal changes over time.
What are the symptoms of low testosterone?
When men reach their late 40s to early 50s, some may experience depression and loss of sex drive as their testosterone levels fall. This is commonly known as the ‘male menopause’.
Other key symptoms of low testosterone include: changes in mood and irritability, a lack of energy and enthusiasm, difficulty sleeping or increased tiredness, loss of muscle mass and reduced ability to exercise, fat redistribution, poor concentration and short-term memory loss.
Sex therapist and intimacy coach Leigh Noren says it’s important to remember that libido is influenced by far more than hormones alone. “The biological causes are things like testosterone, but then there are things like diabetes or high blood pressure,” she explains. “Sometimes that affects the erectile function more than the desire itself, but those two can kind of go hand in hand as well.”
Noren also points out that mental health and medication can have a major impact. “Common antidepressants, SSRIs, are very well known for reducing desire and making erectile function more unpredictable,” she says. “Sometimes people are even prescribed SSRIs by doctors to delay how quickly they ejaculate, because that’s how much they can affect sexual function overall.”
Importantly, she reassures us that stress and fluctuations in libido are extremely common. “It’s definitely common to experience dips,” says Noren. “It’s also OK to not want sex when you experience that dip. It’s not something you have to work on getting back.”
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Does low testosterone affect erectile dysfunction (ED)?
Low testosterone can cause erectile dysfunction (ED). However, erectile dysfunction can also be a result of stress, tiredness, anxiety or drinking too much alcohol. It affects most men at some point in their lives.
If you’re having problems getting and keeping an erection, it does not necessarily mean you have low levels of testosterone. Immediate ways to address it include maintaining a healthy weight by eating a balanced diet and regular exercise. You should also take steps to reduce your stress levels, lower your alcohol intake, get more sleep and stop smoking.
Noren says understanding the wider context of low libido can also help men work out whether the issue is physical, emotional or relationship-related. “Is this a general thing? Do I experience low libido in general? Like I don’t wanna have sex and I don’t want to masturbate, or is it more, I’m fine with masturbating, I have the desire for that, but not with my partner?” she explains. “That’s gonna start to clue you into if there might be something with the relationship going on.”
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How serious is low testosterone?
Significantly low testosterone levels that develop later in life, particularly in men who are obese or have type 2 diabetes, may be a result of late-onset hypogonadism and can cause symptoms of the ‘male menopause’.
Hypogonadism is where the testes produce few or no hormones. It’s an uncommon and specific medical condition that’s not a normal part of ageing. Your doctor can diagnose hypogonadism by measuring your testosterone levels through a blood test.
Dr Weinstein, GP and founder of his own men’s health clinic, believes low testosterone has historically been under-discussed. “I think [the causes of low libido] can be really multifactorial and there’s all sorts that come in,” he says. “Historically we’ve maybe ignored testosterone, certainly in the NHS, not really thought about it, and doctors maybe haven’t asked the question. Patients might feel awkward about talking about it, and doctors may feel awkward about talking about it too.”
According to Weinstein, this reluctance to discuss sexual health openly can sometimes delay diagnosis and treatment. “It’s been kind of ignored and not spoken about, and therefore we miss the opportunity to test for testosterone or think about it,” he adds.
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What is the best treatment for low testosterone?
If your GP thinks you might have a testosterone deficiency and the results back that up, they may refer you to a specialist. Your specialist may then recommend testosterone replacement to correct the hormone deficiency and help with the symptoms.
Before treatment is considered, doctors will usually look at your overall health and lifestyle too. Improving sleep quality, increasing exercise levels, managing stress and maintaining a healthy body weight can all support healthy testosterone production and improve symptoms linked to low libido.
“My advice to anyone with symptoms that are interfering with everyday life and happiness – especially men under 40 – is to speak to a pharmacist or GP as soon as possible,” says Marc Donovan. “There are several options or treatments that can help. A discussion with a healthcare professional can ensure that you get the right support depending on your personal circumstances.“
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