Low Testosterone FAQ

Testosterone is the primary male sex hormone. It is necessary for muscle growth and strength, body fat distribution, bone density, and the production of red blood cells and sperm. Every major organ in the body has testosterone receptors and needs testosterone to function normally. 

Testosterone plays a major role in a man’s mood, as well as his sex drive (libido). In men, it is produced by the testicles (testes). While both men and women have testosterone, men have 10-20 times as much as women, on average.

Testosterone is responsible for the male characteristics that develop during puberty, such as a deeper voice, greater muscle mass, and body hair. 

When a man’s testosterone level is low, he basically feels terrible. He feels lazy, unmotivated, and depressed. He packs on belly fat, drops muscle mass, and loses interest in sex – or it’s difficult to perform. His brain is foggy and it’s harder for him to pay attention. He doesn’t sleep well. In addition, he’s at greater risk of developing cardiovascular disease, diabetes, and other health problems.​

Often, these symptoms are attributed to getting older when really, an abnormally low testosterone level is the problem. The truth is, men should be able to feel healthy and alive at any age. 

Hypogonadism is the medical term for low testosterone. 

A man’s testosterone level starts to drop significantly after age 30, and decreases progressively throughout his life. This condition is known as “andropause” and contributes to the loss of strength, muscle, and energy that many men experience as they age. 

In modern times, this problem has been made even worse by pollution, unhealthy food, and an inactive lifestyle. Sadly, low testosterone is a vicious cycle. As testosterone levels decrease, body fat increases, which increases estrogen and drives down testosterone even more. Testosterone optimization therapy can help reverse this cycle. 

Common causes of low testosterone include obesity, diabetes, sleep apnea, hypothyroidism, chronic kidney disease, alcohol abuse, liver disease, testicular injury, brain injury, congenital defects, other endocrine problems, certain medications, opioid use, and chemotherapy. 

It’s been estimated that 1 in 4 men today have less-than-optimal testosterone levels. Unfortunately, this problem is seriously underdiagnosed because “normal” testosterone ranges are based off of averages in our unhealthy population, and not what is actually normal for men. For example, a typical testosterone level for an 80-year-old man is around 400 ng/dL. Would you think it was normal if a 40-year-old man had the same testosterone level? Of course not! And yet, his doctor would likely tell him it was normal because the normal range is considered to be between 300-1100 ng/dL. In reality, the “normal” testosterone level depends on the man, but typically, men feel best with levels in the middle to upper end of the range.

Testosterone replacement therapy reverses the effects of low testosterone. That means it can help men to lose weight, increase their motivation and outlook on life, give them more energy, increase sex drive, cause firmer and longer-lasting erections, make it easier to increase muscle mass and strength, improve athletic performance, help them think more clearly, and basically make men feel like themselves again. Optimizing men’s testosterone levels will often help to reduce their risk of obesity, diabetes, hypertension, and heart disease. 

No studies have shown that TRT shortens lifespan, and many have shown that it benefits men’s health. In fact, low testosterone actually increases men’s risk of cardiovascular disease, stroke, obesity, diabetes, and osteoporosis. The few studies that have shown a correlation between TRT and increased risk of cardiovascular disease were poorly designed. For example, in one study, all of the participants were in their 70s and already had health problems. Multiple medical societies called for the retraction of these studies. That said, there are always potential risks with any medical treatment, and it’s important to be aware of those before starting. 

The most significant side-effect of TRT is a condition called erythrocytosis (or polycythemia), which is an abnormally high level of red blood cells (RBCs). Left untreated, this condition could potentially lead to a blood clot. That’s why we closely monitor your blood counts when you are on testosterone. If your RBCs go too high, you’ll need to donate blood to normalize your level. 

Other possible side effects include acne, fluid retention, hair loss, and testicular shrinkage.

A medication called clomiphene (Clomid) can help prevent testicular shrinkage, as well as maintain fertility. Clomid is taken orally once or twice a week and has a low incidence of side-effects. 

Without Clomid, most men who are on testosterone therapy experience testicular shrinkage to some degree. This happens because when you are giving your body testosterone from outside, your testicles won’t be producing as much on their own. They are less active, so they get smaller. Most men on TRT consider this a small price to pay for their increased libido and better erections, as well as other benefits, that they get while on testosterone therapy.

Yes. If you stop testosterone (or take Clomid), your testicles will go back to their normal size. 

Taking testosterone on its own will reduce the body’s production of sperm, which leads to infertility. If fertility is desired, you can take Clomid to maintain sperm production.

Yes. If you stop testosterone (or take Clomid), your fertility will return. 

It varies, but approximately 125 mg per week is typical. This is split into two injections every 3.5 days to maintain a consistent testosterone level. 

Yes. A healthy lifestyle, including a healthy diet, regular exercise (especially weightlifting), maintaining a healthy weight, and getting good sleep will all help to increase testosterone levels. It’s also important to avoid unnecessary exposure to toxins.

Testosterone replacement therapy can help you to start and maintain these healthy habits by making it easier to lose weight, increasing energy and motivation, and helping you sleep better. 

No. If you stop testosterone, your body will start producing it on its own again, but your levels may not be as high as they were while on TRT. Many men simply feel better when their testosterone is at a higher level than what their body produces naturally. 

The so-called “normal” range of testosterone, for men, is considered to be between 300-1100 ng/dL. However, this range actually has little-to-no evidence behind it. It also doesn’t take into consideration the man’s age or body size. A 35-year-old man should have a higher testosterone level than a 65-year-old man. A guy who is 6’3”, 250 lbs needs more testosterone than a man who is 5’8”, 165 lbs. Makes sense, right? 

Most men feel better when their level is at the higher end of the range. If your natural total testosterone level is above 550 ng/dL, you likely do not need testosterone replacement therapy. That said, every man is different, and it’s worthwhile to look into TRT if you have symptoms of hypogonadism. 

The reality is, men’s average testosterone levels were much higher 1-2 generations ago than they are now, because men were healthier then. A 2007 study showed that American men’s testosterone levels had been declining by about 1% per year since 1987, even when adjusted for age. Assuming this trend has continued, that means a 45-year-old man today would have a testosterone level 20% lower than that of a 45-year-old man 20 years ago. A Danish study from 2010 had similar findings, showing that men who were born in the 1960s had testosterone levels 14% lower, on average, than men born in the 1920s. 

Men today are not as strong as their fathers and grandfathers were, which is likely related to the fact that their testosterone levels are lower. Average grip strength among men in the U.S. decreased from 117 pounds of force in 1985 to just 98 pounds of force in 2016. This has major health implications. In fact, weak grip strength has been found to be a greater predictor of mortality than high blood pressure.