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The signs of low testosterone

As a man, testosterone is essential for optimal health, impacting muscle size and strength, cardiovascular fitness, and libido and sexual function. Yet if your level of the critical primary male sex hormone is too low you’ll suffer a range of severe symptoms, ranging from infertility, erectile dysfunction, chronic fatigue, obesity, cardiovascular disease and mental health problems. Use our low signs of testosterone checklist to identify whether you’re at risk from low T

Testosterone is a vital hormone for men’s health, supporting everything from muscle mass and bone density to red blood cell production, heart health, fertility and sexual function. No wonder abnormally low testosterone levels are linked to serious medical problems, including infertility, erectile dysfunction, diabetes, anaemia, osteoporosis, fatigue, obesity, heart disease – and even a 35% to 40% higher risk of an early death.

Low testosterone (also known as testosterone deficiency or hypogonadism) is diagnosed by a combination of blood tests (the ‘normal’ range is 8-10nmol/L to 30-31nmol/L) and symptoms. But what symptoms should men look out for? As testosterone has such a pervasive role in men’s health, symptoms of low testosterone can easily be mistaken for other health issues. But thanks to the work of researchers and medical organisations, it is now possible to provide some additional clarity for men.

The top 3 signs of low testosterone

The good news is that extensive data from the European Male Ageing Study suggests that only 2.1% of men will suffer from low testosterone, with the prevalence rising from 0.1% of men aged 49 or younger to 5.1% of men in their 70s. So for the majority of men, it is highly likely that any symptoms are not the result of low testosterone. But they could be. So watch out for these symptoms – and seek medical help if symptoms persist.

However, when you pool together all the detailed guidelines from the various specialist medical organisations, and factor in the data from extensive studies like the European Male Ageing Study, there appears to be three big symptoms to look out for which are very commonly associated with low testosterone. These three symptoms are:  

  1. Loss of morning erections
  2. Decreased sexual interest/libido
  3. Erectile dysfunction

All the other symptoms on the long list below remain entirely valid. But these three appear to be most strongly indicative of low testosterone levels, which may require treatment.

“Early morning erections, in particular, are the best predictor,” says Dr Geoffrey Hackett, a consultant in urology at Spire Little Aston Hospital. “Because what goes on in a sexual relationship can be affected by a lot of things – the emotion, the relationship, and whether the partner is enjoying it. But with morning erections, this is nature’s way of keeping the tissues perfused. But widowed or single guys would just never be asked because doctors are probably not going to wade in and ask about their erections.”

So if you struggle with any of these three problems, make sure your doctor is aware.

Symptoms of low testosterone

These are the symptoms which the NHS suggests men look out for if you’re worried you’re suffering with low testosterone:

  • Fatigue
  • Lethargy
  • Depression
  • Anxiety
  • Irritability
  • Low libido
  • Erectile dysfunction
  • Reduced exercise tolerance and strength
  • Excessive sweating or night sweats
  • Poor concentration or memory
  • Needing to shave less often

Other signs of low testosterone

The above is a broad list of symptoms. However, leading medical bodies – such as The International Society for Sexual Medicine, The British Society For Sexual Medicine, The American Urological Association, the Endocrine Society and the Society for Endocrinology – have been busy developing more detailed guidelines for medical practitioners, in an effort to provide additional clarity.

All these organisations have crafted subtly different guidelines. And the main symptoms which they highlight largely overlap with those from the NHS listed above. But some of these organisations also suggest extra symptoms for medical experts to look out for. Examples include:

  • Reduced spontaneous erections
  • Infertility
  • Low sperm count
  • Decreased frequency of sexual thoughts
  • Delayed ejaculation
  • Skeletal changes or loss of height
  • Low trauma fractures or low bone density
  • Increased obesity and BMI
  • Decreased body hair
  • Gynaecomastia (swollen breasts or ‘man boobs’)
  • Fine wrinkling of the skin, especially around the mouth

Other causes of low testosterone

Any of the symptoms listed above may be the result of low testosterone. But they may also be the result of other medical problems, unhealthy lifestyle issues, drug use or ageing. Nevertheless, they provide a useful extended symptom list for men to be aware of. If these symptoms persist, speak to your doctor so you can discover the real cause.  

But here is the big challenge with symptoms of low testosterone: although these symptoms are all (potentially) real signs of low testosterone, pretty much every man in the world might experience some of these symptoms at one stage or another. And many of these symptoms overlap with those of other health issues, such as stress, a lack of sleep or exercise, obesity, illness or heart problems. This makes it dangerously easy for healthy men to wrongly fret about low testosterone levels, based on symptoms alone. But it also makes it far too easy for doctors to miss signs of low testosterone when men turn up with other health problems, such as infertility issues or osteoporosis. That’s why blood tests are always crucial, to identify whether low testosterone is – or isn’t – the cause of the problem, before starting any further treatment such as lifestyle interventions or testosterone therapy. 

Final considerations

There is one final issue to keep in mind. Based on the latest research, many specialist organisations are now calling for doctors to screen men who have certain medical conditions for low testosterone levels. They don’t recommend every man gets tested, as it is neither necessary nor beneficial. But certain men may benefit from a check. Each organisation has its own suggestions, but some examples include:

  • Men with infertility or erectile dysfunction
  • Men with obesity, a waist circumference bigger than 102cm, or a BMI above 30
  • Men with diabetes
  • Men with unexplained anaemia or bone density loss
  • Men with chronic diseases such as HIV
  • Men on long-term opiate, antipsychotic or anticonvulsant medications

If you are in any of these groups, your doctor has never screened you for low testosterone, and you have symptoms, don’t be afraid to initiate the conversation.   

But for the majority of men, the best strategy is to watch out for those big three symptoms – loss of morning erections, decreased sexual interest and erectile dysfunction – and to keep in mind the longlist of symptoms too. But rest assured that the odds of having healthy testosterone levels are strongly in your favour.  

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