Understanding Testosterone Deficiency and Treatment

Testosterone is often linked to male energy, but its role in health goes beyond just libido or muscle mass. Testosterone deficiency, or male hypogonadism, is a serious and increasingly recognised medical issue that can greatly affect well-being. Thankfully, with accurate diagnosis and treatment, it is manageable.

In this article, I’ll explain what testosterone does, how to recognise deficiency, how it’s diagnosed, and the available treatment options, including testosterone replacement therapy (TRT).

What is testosterone, and why does it matter?

Testosterone is a hormone made mainly in the testicles of men and in small amounts in women’s ovaries and adrenal glands. It plays an important role in:

• Regulating sex drive and erectile function
• Supporting muscle mass and strength
• Maintaining bone density
• Contributing to mood and mental clarity
• Influencing energy levels and stamina
• Supporting red blood cell production

In men, testosterone levels generally decline with age, usually by about 1% each year after age 30. However, some men may see their levels drop too low, causing symptoms that can impact quality of life.

What are the signs and symptoms of testosterone deficiency?

Testosterone deficiency can show up in different ways and is often underdiagnosed because symptoms can be subtle or mistaken for normal aging or stress.

Common symptoms include:

• Reduced sex drive or erectile dysfunction
• Ongoing fatigue or low energy
• Loss of muscle mass and increased body fat
• Low mood, irritability or depression
• Difficulty concentrating (often called “brain fog”)
• Decreased motivation or confidence
• Poor sleep
• Infertility or reduced sperm count
• Thinning body hair or less frequent shaving

Not every man with these symptoms has low testosterone, but if several are present, it’s worth looking into.

How is testosterone deficiency diagnosed?

Diagnosis involves a mix of medical assessment and blood tests. Your GP will usually:

• Take a detailed medical history that covers symptoms, lifestyle, stress, and medication use.
• Check overall health, including signs of other hormonal issues.
• Arrange blood tests that specifically look at:
  • Total testosterone (best measured early in the morning)
  • Free testosterone (if needed)
  • Luteinising hormone (LH) and follicle-stimulating hormone (FSH)
  • Prolactin and oestradiol (in selected cases)
  • Thyroid function, glucose, and cholesterol (to rule out other causes)

Blood tests should ideally be done fasting, between 7-11 am, because testosterone levels are highest in the morning.

A diagnosis of testosterone deficiency is confirmed when there are consistent symptoms along with low levels shown in blood tests.

What causes low testosterone?

There are two main types:

• Primary hypogonadism, where the testicles don’t produce enough testosterone. This may happen due to genetic conditions, trauma, chemotherapy, or infection.
• Secondary hypogonadism occurs when the brain (pituitary or hypothalamus) does not signal the testicles to produce testosterone. This can result from obesity, stress, alcohol misuse, anabolic steroid use, certain medications, or pituitary issues.

Often, the cause is a mix of factors, so a full health assessment is crucial.

Treatment: What is testosterone replacement therapy (TRT)?

If lifestyle factors have been improved and blood tests confirm a genuine deficiency, TRT may be an option.

TRT involves providing testosterone in one of several forms:

• Topical gel, applied to the skin daily.
• Injections, either long-acting intramuscular injections every 10-12 weeks or shorter-acting injections every 1-2 weeks.
• Implants or patches, which are less commonly used in the UK.

TRT aims to restore testosterone to normal levels and relieve symptoms. Regular monitoring through blood tests and follow-up visits is important.

What are the benefits of TRT for men with low testosterone?

When prescribed properly, TRT can enhance:

• Energy and mood
• Sex drive and sexual performance
• Muscle mass and strength
• Bone density
• Motivation and focus
• Sleep quality

However, it’s not a solution for everything and doesn’t work for everyone. It should not be used as a quick fix for ageing or for performance boosting in healthy individuals with normal testosterone levels.

What are the risks or side effects of TRT?

TRT is generally safe when prescribed and monitored by a healthcare professional. However, it may cause:

• Acne or oily skin
• Increased red blood cell count (polycythemia)
• Mild breast enlargement or tenderness
• Fluid retention
• Fertility suppression (TRT can reduce sperm production)
• Concerns related to the prostate (though TRT hasn’t been proven to cause prostate cancer)

Monitoring includes checking PSA levels, blood count, and testosterone levels regularly.

TRT isn’t suitable for everyone, especially men with untreated sleep apnoea, prostate cancer, or certain blood disorders.

How important are lifestyle factors?

Before starting TRT, it’s essential to tackle lifestyle factors, such as:

• Losing weight (if overweight)
• Reducing alcohol intake and stress
• Improving sleep habits
• Engaging in resistance training
• Avoiding illegal anabolic steroids

In some cases, these changes alone can restore normal testosterone levels.

Final thoughts on treating low testosterone

Testosterone deficiency is a real condition that can often be treated, but it requires careful diagnosis and management. TRT can make a significant difference for the right patients, but it isn’t suitable for everyone and should always be managed by a qualified healthcare provider.

At Sloane Street Surgery, we provide a thorough assessment of symptoms, blood testing, and evidence-based management of low testosterone, including personalised TRT plans when needed.

If you’re worried about low testosterone or want to discuss your symptoms in more detail, please get in touch to schedule a confidential consultation. You can book an appointment online here or call us on 0207 245 9333.