Low Testosterone / Late Onset Hypogonadism Quiz
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Reduced libido
Erectile dysfunction
Shrinking testicles
Hot flashes
Reduced sex drive
No armpit hair
Poor concentration
Enlarged male breasts
Feeling depressed or fatigued
Low energy level
Difficulty maintaining an erection
Low motivation or ambition
Not seeing your symptoms? No worries!
What is Low Testosterone / Late Onset Hypogonadism?
Low testosterone, or late-onset hypogonadism, is a condition characterized by reduced levels of testosterone in aging males, leading to symptoms such as fatigue, reduced libido, depression, and decreased muscle mass.
Typical Symptoms of Low Testosterone / Late Onset Hypogonadism
- Difficulty achieving or maintaining an erection
- Decreased sex drive
- Recent changes in mental state
- Decreased motivation
- Mental stress and physical fatigue
- Intense mood swings
- Fatigue or low energy that varies throughout the day
- Fatigue or low energy that is worse in the morning
Diagnostic Questions for Low Testosterone / Late Onset Hypogonadism
Your doctor may ask these questions to check for this disease:
- Are you worried about your sexual performance because you can't get or keep an erection for sex?
- Have you experienced a decrease in your sex drive?
- Recently, are you more confused than before?
- Have you been experiencing decreased motivation recently?
- Are you experiencing mental stress and physical fatigue?
Treatment of Low Testosterone / Late Onset Hypogonadism
Treatment involves addressing symptoms and restoring testosterone levels, often through testosterone replacement therapy (TRT). Lifestyle modifications, managing underlying conditions, and periodic monitoring are essential to ensure efficacy and minimize risks.
Reviewed By:
Kenji Taylor, MD, MSc (Family Medicine, Primary Care)
Dr. Taylor is a Japanese-African American physician who grew up and was educated in the United States but spent a considerable amount of time in Japan as a college student, working professional and now father of three. After graduating from Brown, he worked in finance first before attending medical school at Penn. He then completed a fellowship with the Centers for Disease Control before going on to specialize in Family and Community Medicine at the University of California, San Francisco (UCSF) where he was also a chief resident. After a faculty position at Stanford, he moved with his family to Japan where he continues to see families on a military base outside of Tokyo, teach Japanese residents and serve remotely as a medical director for Roots Community Health Center. He also enjoys editing and writing podcast summaries for Hippo Education.
Yoshinori Abe, MD (Internal Medicine)
Dr. Abe graduated from The University of Tokyo School of Medicine in 2015. He completed his residency at the Tokyo Metropolitan Health and Longevity Medical Center. He co-founded Ubie, Inc. in May 2017, where he currently serves as CEO & product owner at Ubie. Since December 2019, he has been a member of the Special Committee for Activation of Research in Emergency AI of the Japanese Association for Acute Medicine. | | Dr. Abe has been elected in the 2020 Forbes 30 Under 30 Asia Healthcare & Science category.
Content updated on Apr 15, 2025
Following the Medical Content Editorial Policy
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- Premature ejaculation
- Decrease in sexual desire
- Impotence
- Confusion
- Delayed ejaculation
- Lack of motivation
- No sexual desire
- Low libido
- Feeling stressed
- No sex drive
- Change in mental status
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Symptoms Related to Low Testosterone / Late Onset Hypogonadism
Diseases Related to Low Testosterone / Late Onset Hypogonadism
FAQs
Q.
How are fatigue, depression, and anxiety interconnected, and how might low testosterone be involved?
A.
Fatigue, depression, and anxiety can be connected by overlapping changes in brain chemistry and stress responses, and low testosterone may worsen these symptoms. Low testosterone might affect the mood, energy, and stress-regulation systems in the body, which in turn can increase fatigue, depression, and anxiety.
References:
Määttänen I, Gluschkoff K, Komulainen K, Airaksinen J, Savelieva K, García-Velázquez R, Jokela M. Testosterone and specific symptoms of depression: Evidence from NHANES 2011-2016. Compr Psychoneuroendocrinol. 2021 Mar 10;6:100044. doi: 10.1016/j.cpnec.2021.100044. PMID: 35757365; PMCID: PMC9216439.
Updated 2024 May 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK541120/
https://www.ncbi.nlm.nih.gov/books/NBK541120/
Indirli R, Lanzi V, Arosio M, Mantovani G, Ferrante E. The association of hypogonadism with depression and its treatments. Front Endocrinol (Lausanne). 2023 Aug 10;14:1198437. doi: 10.3389/fendo.2023.1198437. PMID: 37635965; PMCID: PMC10449581.
Q.
When is it appropriate to seek treatment for low testosterone?
A.
Ask for help if you have symptoms like very low energy, low drive, or mood changes along with lab tests that show low testosterone. A doctor will look at your signs and test results before suggesting treatment.
References:
Updated 2024 Feb 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK532933/
https://www.ncbi.nlm.nih.gov/books/NBK532933/
Dobs AS, Campbell KJ. An Individualized Approach to Managing Testosterone Therapy in the Primary Care Setting. Int J Gen Med. 2022 Oct 7;15:7719-7733. doi: 10.2147/IJGM.S364189. PMID: 36238539; PMCID: PMC9552794.
Lunenfeld B, Mskhalaya G, Zitzmann M, Arver S, Kalinchenko S, Tishova Y, Morgentaler A. Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men. Aging Male. 2015 Mar;18(1):5-15. doi: 10.3109/13685538.2015.1004049. Epub 2015 Feb 6. PMID: 25657080; PMCID: PMC4648196.
Q.
At what age does late-onset hypogonadism typically begin to present symptoms?
A.
Late-onset hypogonadism usually shows symptoms in middle-aged and older men, often beginning around the age of 40.
References:
Updated 2024 Feb 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK532933/
https://www.ncbi.nlm.nih.gov/books/NBK532933/
Nieschlag E. Late-onset hypogonadism: a concept comes of age. Andrology. 2020 Nov;8(6):1506-1511. doi: 10.1111/andr.12719. Epub 2019 Nov 15. PMID: 31639279.
Dudek P, Kozakowski J, Zgliczyński W. Late-onset hypogonadism. Prz Menopauzalny. 2017 Jun;16(2):66-69. doi: 10.5114/pm.2017.68595. Epub 2017 Jun 30. PMID: 28721133; PMCID: PMC5509975.
Q.
At what age might men start experiencing erectile difficulties, and how is this related to testosterone levels?
A.
Many men may start noticing erectile problems around their 40s or later, and lower testosterone levels as men age can be one reason for this.
References:
Rajfer J. Relationship between testosterone and erectile dysfunction. Rev Urol. 2000 Spring;2(2):122-8. PMID: 16985751; PMCID: PMC1476110.
Gareri P, Castagna A, Francomano D, Cerminara G, De Fazio P. Erectile dysfunction in the elderly: an old widespread issue with novel treatment perspectives. Int J Endocrinol. 2014;2014:878670. doi: 10.1155/2014/878670. Epub 2014 Mar 17. PMID: 24744785; PMCID: PMC3976909.
Leslie SW, Sooriyamoorthy T. Erectile Dysfunction. [Updated 2024 Jan 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562253/
Q.
At what age might men start experiencing hot flashes due to hormonal changes?
A.
Men might start experiencing hot flashes as early as their mid-50s, and these symptoms can become more noticeable with age. Men experiencing hot flashes should be evaluated by a doctor.
References:
Spetz AC, Fredriksson MG, Hammar ML. Hot flushes in a male population aged 55, 65, and 75 years, living in the community of Linköping, Sweden. Menopause. 2003 Jan-Feb;10(1):81-7. doi: 10.1097/00042192-200310010-00013. PMID: 12544681.
Dosani M, Morris WJ, Tyldesley S, Pickles T. The Relationship between Hot Flashes and Testosterone Recovery after 12 Months of Androgen Suppression for Men with Localised Prostate Cancer in the ASCENDE-RT Trial. Clin Oncol (R Coll Radiol). 2017 Oct;29(10):696-701. doi: 10.1016/j.clon.2017.06.009. Epub 2017 Jul 13. PMID: 28712786.
Updated 2022 Dec 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK539827/
Q.
At what age might testicles start shrinking due to hormonal changes or treatments like TRT?
A.
Testicular shrinkage may occur gradually as part of the natural aging process, often starting around middle age (40s-50s), and testosterone replacement therapy (TRT) can sometimes cause shrinkage sooner because it lowers the body’s own hormone production.
References:
Cheng H, Zhang X, Li Y, Cao D, Luo C, Zhang Q, Zhang S, Jiao Y. Age-related testosterone decline: mechanisms and intervention strategies. Reprod Biol Endocrinol. 2024 Nov 14;22(1):144. doi: 10.1186/s12958-024-01316-5. PMID: 39543598; PMCID: PMC11562514.
Matzkin ME, Calandra RS, Rossi SP, Bartke A, Frungieri MB. Hallmarks of Testicular Aging: The Challenge of Anti-Inflammatory and Antioxidant Therapies Using Natural and/or Pharmacological Compounds to Improve the Physiopathological Status of the Aged Male Gonad. Cells. 2021 Nov 10;10(11):3114. doi: 10.3390/cells10113114. PMID: 34831334; PMCID: PMC8619877.
Updated 2022 Feb 10]. In: Feingold KR, Ahmed SF, Anawalt B, et al., editors. Endotext [Internet]. South Dartmouth (MA): [MDText.com](http://mdtext.com/), Inc.; 2000-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK278998/
Q.
Can fatigue mimic the symptoms of depression, and how might low testosterone contribute to this?
A.
Yes, fatigue can look like depression, and low testosterone may make this worse by affecting energy and mood.
References:
Indirli R, Lanzi V, Arosio M, Mantovani G, Ferrante E. The association of hypogonadism with depression and its treatments. Front Endocrinol (Lausanne). 2023 Aug 10;14:1198437. doi: 10.3389/fendo.2023.1198437. PMID: 37635965; PMCID: PMC10449581.
Määttänen I, Gluschkoff K, Komulainen K, Airaksinen J, Savelieva K, García-Velázquez R, Jokela M. Testosterone and specific symptoms of depression: Evidence from NHANES 2011-2016. Compr Psychoneuroendocrinol. 2021 Mar 10;6:100044. doi: 10.1016/j.cpnec.2021.100044. PMID: 35757365; PMCID: PMC9216439.
Anderson DJ, Vazirnia P, Loehr C, Sternfels W, Hasoon J, Viswanath O, Kaye AD, Urits I. Testosterone Replacement Therapy in the Treatment of Depression. Health Psychol Res. 2022 Nov 26;10(4):38956. doi: 10.52965/001c.38956. PMID: 36452903; PMCID: PMC9704723.
Q.
Can feeling depressed cause tiredness, and how might low testosterone be related to these symptoms?
A.
Yes, feeling depressed can make you very tired, and low testosterone might also add to fatigue and mood changes.
References:
Määttänen I, Gluschkoff K, Komulainen K, Airaksinen J, Savelieva K, García-Velázquez R, Jokela M. Testosterone and specific symptoms of depression: Evidence from NHANES 2011-2016. Compr Psychoneuroendocrinol. 2021 Mar 10;6:100044. doi: 10.1016/j.cpnec.2021.100044. PMID: 35757365; PMCID: PMC9216439.
Kheirkhah F, Hosseini SR, Hosseini SF, Ghasemi N, Bijani A, G Cumming R. Relationship between testosterone levels and depressive symptoms in older men in Amirkola, Iran. Caspian J Intern Med. 2014 Spring;5(2):65-70. PMID: 24778779; PMCID: PMC3992230.
Zitzmann M. Testosterone, mood, behaviour and quality of life. Andrology. 2020 Nov;8(6):1598-1605. doi: 10.1111/andr.12867. Epub 2020 Jul 30. PMID: 32657051.
Q.
Can persistent tiredness lead to feelings of depression, and what role does testosterone play in this?
A.
Feeling very tired all the time may make someone feel sad or depressed, and low or changing testosterone levels can add to these feelings.
References:
Nackeeran S, Patel MS, Nallakumar DT, Ory J, Kohn T, Deibert CM, Carto C, Ramasamy R. Testosterone Therapy is Associated With Depression, Suicidality, and Intentional Self-Harm: Analysis of a National Federated Database. J Sex Med. 2022 Jun;19(6):933-939. doi: 10.1016/j.jsxm.2022.03.611. Epub 2022 Apr 16. PMID: 35437187.
de Almeida Ferreira M, Mendonça JA. Long-term testosterone replacement therapy reduces fatigue in men with hypogonadism. Drugs Context. 2022 Feb 2;11:2021-8-12. doi: 10.7573/dic.2021-8-12. PMID: 35211178; PMCID: PMC8823386.
Rodgers S, Grosse Holtforth M, Hengartner MP, Müller M, Aleksandrowicz AA, Rössler W, Ajdacic-Gross V. Serum testosterone levels and symptom-based depression subtypes in men. Front Psychiatry. 2015 May 4;6:61. doi: 10.3389/fpsyt.2015.00061. PMID: 25999864; PMCID: PMC4418274.
Q.
How can low testosterone affect motivation and performance at work?
A.
Low testosterone can lower your energy and mood, which may decrease your motivation and work performance.
References:
Hackney AC. Hypogonadism in Exercising Males: Dysfunction or Adaptive-Regulatory Adjustment? Front Endocrinol (Lausanne). 2020 Jan 31;11:11. doi: 10.3389/fendo.2020.00011. PMID: 32082255; PMCID: PMC7005256.
Rojas-Zambrano JG, Rojas-Zambrano AR, Rojas-Zambrano AF, Barahona-Cueva GE. Benefits of Testosterone Hormone in the Human Body: A Systematic Review. Cureus. 2025 Feb 9;17(2):e78785. doi: 10.7759/cureus.78785. PMID: 39926620; PMCID: PMC11807418.
Celec P, Ostatníková D, Hodosy J. On the effects of testosterone on brain behavioral functions. Front Neurosci. 2015 Feb 17;9:12. doi: 10.3389/fnins.2015.00012. PMID: 25741229; PMCID: PMC4330791.
Q.
How can low testosterone contribute to low concentration and cognitive issues?
A.
Low testosterone may lead to problems with concentration and thinking, because the hormone helps the brain work properly.
References:
Yeap BB, Flicker L. Testosterone, cognitive decline and dementia in ageing men. Rev Endocr Metab Disord. 2022 Dec;23(6):1243-1257. doi: 10.1007/s11154-022-09728-7. Epub 2022 May 28. PMID: 35633431; PMCID: PMC9789006.
Dratva MA, Banks SJ, Panizzon MS, Galasko D, Sundermann EE; Alzheimer’s Disease Neuroimaging Initiative. Low testosterone levels relate to poorer cognitive function in women in an APOE-ε4-dependant manner. Biol Sex Differ. 2024 Jun 5;15(1):45. doi: 10.1186/s13293-024-00620-4. PMID: 38835072; PMCID: PMC11151480.
Jung HJ, Shin HS. Effect of Testosterone Replacement Therapy on Cognitive Performance and Depression in Men with Testosterone Deficiency Syndrome. World J Mens Health. 2016 Dec;34(3):194-199. doi: 10.5534/wjmh.2016.34.3.194. Epub 2017 Jan 23. PMID: 28053949; PMCID: PMC5209560.
Q.
How can low testosterone levels impact concentration and motivation in adults?
A.
Low testosterone can make it hard to focus and feel motivated because it affects brain chemicals that help us think clearly and feel good. Studies have shown that when testosterone levels are low, adults may experience problems with concentration and decreased drive.
References:
Li Y, Liu M, Cui Y, Zhu Z, Chen J, Zeng F, Gao M, Li Y, Huang F, Chen H. Increased risk of testosterone deficiency is associated with the systemic immune-inflammation index: a population-based cohort study. Front Endocrinol (Lausanne). 2022 Aug 16;13:974773. doi: 10.3389/fendo.2022.974773. PMID: 36051392; PMCID: PMC9424499.
Jung HJ, Shin HS. Effect of Testosterone Replacement Therapy on Cognitive Performance and Depression in Men with Testosterone Deficiency Syndrome. World J Mens Health. 2016 Dec;34(3):194-199. doi: 10.5534/wjmh.2016.34.3.194. Epub 2017 Jan 23. PMID: 28053949; PMCID: PMC5209560.
Losecaat Vermeer AB, Krol I, Gausterer C, Wagner B, Eisenegger C, Lamm C. Exogenous testosterone increases status-seeking motivation in men with unstable low social status. Psychoneuroendocrinology. 2020 Mar;113:104552. doi: 10.1016/j.psyneuen.2019.104552. Epub 2019 Dec 19. Erratum in: Psychoneuroendocrinology. 2020 Mar;113:104586. doi: 10.1016/j.psyneuen.2020.104586. PMID: 31884320.
Q.
How can you determine if symptoms are due to fatigue, depression, or another underlying issue like low testosterone?
A.
Doctors look at a person's history, feelings, and physical signs and use lab tests to decide if fatigue is from depression, low testosterone, or another cause. They ask questions, do physical exams, and sometimes check hormone levels to find out.
References:
Maisel P, Baum E, Donner-Banzhoff N. Fatigue as the Chief Complaint–Epidemiology, Causes, Diagnosis, and Treatment. Dtsch Arztebl Int. 2021 Aug 23;118(33-34):566-576. doi: 10.3238/arztebl.m2021.0192. PMID: 34196270; PMCID: PMC8579431.
Indirli R, Lanzi V, Arosio M, Mantovani G, Ferrante E. The association of hypogonadism with depression and its treatments. Front Endocrinol (Lausanne). 2023 Aug 10;14:1198437. doi: 10.3389/fendo.2023.1198437. PMID: 37635965; PMCID: PMC10449581.
Määttänen I, Gluschkoff K, Komulainen K, Airaksinen J, Savelieva K, García-Velázquez R, Jokela M. Testosterone and specific symptoms of depression: Evidence from NHANES 2011-2016. Compr Psychoneuroendocrinol. 2021 Mar 10;6:100044. doi: 10.1016/j.cpnec.2021.100044. PMID: 35757365; PMCID: PMC9216439.
Q.
How can you differentiate between fatigue and depression, and what role does testosterone play?
A.
Fatigue is a tired feeling that can occur with many conditions, while depression is a mood disorder that not only brings tiredness but also sadness and loss of interest. Testosterone, a hormone found in higher levels in men, can affect mood, and low levels are sometimes linked with signs of depression rather than just simple fatigue.
References:
Määttänen I, Gluschkoff K, Komulainen K, Airaksinen J, Savelieva K, García-Velázquez R, Jokela M. Testosterone and specific symptoms of depression: Evidence from NHANES 2011-2016. Compr Psychoneuroendocrinol. 2021 Mar 10;6:100044. doi: 10.1016/j.cpnec.2021.100044. PMID: 35757365; PMCID: PMC9216439.
Spitzer M, Basaria S, Travison TG, Davda MN, DeRogatis L, Bhasin S. The effect of testosterone on mood and well-being in men with erectile dysfunction in a randomized, placebo-controlled trial. Andrology. 2013 May;1(3):475-82. doi: 10.1111/j.2047-2927.2013.00075.x. Epub 2013 Mar 15. PMID: 23494931; PMCID: PMC3630276.
Kheirkhah F, Hosseini SR, Hosseini SF, Ghasemi N, Bijani A, G Cumming R. Relationship between testosterone levels and depressive symptoms in older men in Amirkola, Iran. Caspian J Intern Med. 2014 Spring;5(2):65-70. PMID: 24778779; PMCID: PMC3992230.
Q.
How common are hot flashes in men with low testosterone?
A.
Hot flashes can occur in men with low testosterone, and while not every man experiences them, a noticeable portion may notice these symptoms, especially if the testosterone deficiency is significant or altered by treatments.
References:
Jones JM, Kohli M, Loprinzi CL. Androgen deprivation therapy-associated vasomotor symptoms. Asian J Androl. 2012 Mar;14(2):193-7. doi: 10.1038/aja.2011.101. Epub 2012 Jan 30. PMID: 22286861; PMCID: PMC3338189.
Taylor AP, Lee H, Webb ML, Joffe H, Finkelstein JS. Effects of Testosterone and Estradiol Deficiency on Vasomotor Symptoms in Hypogonadal Men. J Clin Endocrinol Metab. 2016 Sep;101(9):3479-86. doi: 10.1210/jc.2016-1612. Epub 2016 Jun 14. PMID: 27300575; PMCID: PMC5010571.
Hackett G, Kirby M, Sinclair AJ. Testosterone deficiency, cardiac health, and older men. Int J Endocrinol. 2014;2014:143763. doi: 10.1155/2014/143763. Epub 2014 Apr 10. PMID: 24812558; PMCID: PMC4000629.
Q.
How does low testosterone affect motivation and energy levels in men?
A.
Low testosterone can make men feel less motivated and lower their energy because this hormone helps keep our bodies active and our moods bright.
References:
Straftis AA, Gray PB. Sex, Energy, Well-Being and Low Testosterone: An Exploratory Survey of U.S. Men's Experiences on Prescription Testosterone. Int J Environ Res Public Health. 2019 Sep 5;16(18):3261. doi: 10.3390/ijerph16183261. PMID: 31491933; PMCID: PMC6765788.
Cohen J, Nassau DE, Patel P, Ramasamy R. Low Testosterone in Adolescents & Young Adults. Front Endocrinol (Lausanne). 2020 Jan 10;10:916. doi: 10.3389/fendo.2019.00916. Erratum in: Front Endocrinol (Lausanne). 2020 Jul 14;11:449. doi: 10.3389/fendo.2020.00449. PMID: 32063884; PMCID: PMC6966696.
Zitzmann M. Testosterone, mood, behaviour and quality of life. Andrology. 2020 Nov;8(6):1598-1605. doi: 10.1111/andr.12867. Epub 2020 Jul 30. PMID: 32657051.
Q.
How does low testosterone contribute to a lack of concentration and increased anxiety?
A.
Low testosterone can affect the brain areas that help us stay focused and manage stress, which may lead to trouble concentrating and feeling more anxious.
References:
Celec P, Ostatníková D, Hodosy J. On the effects of testosterone on brain behavioral functions. Front Neurosci. 2015 Feb 17;9:12. doi: 10.3389/fnins.2015.00012. PMID: 25741229; PMCID: PMC4330791.
Domonkos E, Hodosy J, Ostatníková D, Celec P. On the Role of Testosterone in Anxiety-Like Behavior Across Life in Experimental Rodents. Front Endocrinol (Lausanne). 2018 Aug 6;9:441. doi: 10.3389/fendo.2018.00441. PMID: 30127767; PMCID: PMC6088149.
Mónica Flores-Ramos, Lucía Martínez-Mota, Roberto Silvestri-Tommasoni, Griselda Jiménez Domínguez, Denisse Linares Silva, Free testosterone is associated with perceived stress in women, Personalized Medicine in Psychiatry,45–46,2024,
Q.
How does low testosterone contribute to erectile dysfunction?
A.
Low testosterone can lead to erectile dysfunction by reducing libido and decreasing the signals that help the penis become and stay erect.
References:
Rajfer J. Relationship between testosterone and erectile dysfunction. Rev Urol. 2000 Spring;2(2):122-8. PMID: 16985751; PMCID: PMC1476110.
Tsujimura A. The Relationship between Testosterone Deficiency and Men's Health. World J Mens Health. 2013 Aug;31(2):126-35. doi: 10.5534/wjmh.2013.31.2.126. Epub 2013 Aug 31. PMID: 24044107; PMCID: PMC3770847.
Mikhail N. Does testosterone have a role in erectile function? Am J Med. 2006 May;119(5):373-82. doi: 10.1016/j.amjmed.2005.07.042. PMID: 16651047.
Q.
How does low testosterone impact concentration and focus in men?
A.
Low testosterone can make it harder for men to concentrate and focus because this hormone helps keep the brain sharp and active.
References:
Beauchet O. Testosterone and cognitive function: current clinical evidence of a relationship. Eur J Endocrinol. 2006 Dec;155(6):773-81. doi: 10.1530/eje.1.02306. PMID: 17132744.
Jung HJ, Shin HS. Effect of Testosterone Replacement Therapy on Cognitive Performance and Depression in Men with Testosterone Deficiency Syndrome. World J Mens Health. 2016 Dec;34(3):194-199. doi: 10.5534/wjmh.2016.34.3.194. Epub 2017 Jan 23. PMID: 28053949; PMCID: PMC5209560.
Hua JT, Hildreth KL, Pelak VS. Effects of Testosterone Therapy on Cognitive Function in Aging: A Systematic Review. Cogn Behav Neurol. 2016 Sep;29(3):122-38. doi: 10.1097/WNN.0000000000000104. PMID: 27662450; PMCID: PMC5079177.
Q.
How has the understanding of late-onset hypogonadism evolved over time?
A.
Doctors used to think late-onset hypogonadism was just a natural drop in testosterone as men age, but now we understand it is more complex with many factors involved.
References:
Nieschlag E. Late-onset hypogonadism: a concept comes of age. Andrology. 2020 Nov;8(6):1506-1511. doi: 10.1111/andr.12719. Epub 2019 Nov 15. PMID: 31639279.
Jaschke N, Wang A, Hofbauer LC, Rauner M, Rachner TD. Late-onset hypogonadism: Clinical evidence, biological aspects and evolutionary considerations. Ageing Res Rev. 2021 May;67:101301. doi: 10.1016/j.arr.2021.101301. Epub 2021 Feb 18. PMID: 33610812; PMCID: PMC8043243.
Huhtaniemi I. Late-onset hypogonadism: current concepts and controversies of pathogenesis, diagnosis and treatment. Asian J Androl. 2014 Mar-Apr;16(2):192-202. doi: 10.4103/1008-682X.122336. PMID: 24407185; PMCID: PMC3955328.
Q.
How might low testosterone contribute to a lack of ambition or drive in adults?
A.
Low testosterone can make a person feel tired and less interested in doing things. This might lead to a lack of ambition and drive because the hormone helps regulate energy, mood, and motivation.
References:
Straftis AA, Gray PB. Sex, Energy, Well-Being and Low Testosterone: An Exploratory Survey of U.S. Men's Experiences on Prescription Testosterone. Int J Environ Res Public Health. 2019 Sep 5;16(18):3261. doi: 10.3390/ijerph16183261. PMID: 31491933; PMCID: PMC6765788.
Corona G, Maggi M. The role of testosterone in male sexual function. Rev Endocr Metab Disord. 2022 Dec;23(6):1159-1172. doi: 10.1007/s11154-022-09748-3. Epub 2022 Aug 23. PMID: 35999483; PMCID: PMC9789013.
Grossmann M, Matsumoto AM. A Perspective on Middle-Aged and Older Men With Functional Hypogonadism: Focus on Holistic Management. J Clin Endocrinol Metab. 2017 Mar 1;102(3):1067-1075. doi: 10.1210/jc.2016-3580. PMID: 28359097; PMCID: PMC5477803.
Q.
How much can testicles shrink as a side effect of testosterone replacement therapy (TRT)?
A.
Studies show that testicles may shrink by about 10% to 30% when using testosterone replacement therapy.
References:
Palacios A, McClure RD, Campfield A, Swerdloff RS. Effect of testosterone enanthate on testis size. J Urol. 1981 Jul;126(1):46-8. doi: 10.1016/s0022-5347(17)54372-4. PMID: 6788960.
Osterberg EC, Bernie AM, Ramasamy R. Risks of testosterone replacement therapy in men. Indian J Urol. 2014 Jan;30(1):2-7. doi: 10.4103/0970-1591.124197. PMID: 24497673; PMCID: PMC3897047.
Bassil N, Alkaade S, Morley JE. The benefits and risks of testosterone replacement therapy: a review. Ther Clin Risk Manag. 2009 Jun;5(3):427-48. doi: 10.2147/tcrm.s3025. Epub 2009 Jun 22. PMID: 19707253; PMCID: PMC2701485.
Q.
Is it normal for testicles to shrink after ejaculation, and how does testosterone affect this?
A.
It is normal for the testicles to feel a little smaller right after ejaculation, and this temporary change is different from the long-term effects of testosterone on testicular size and function.
References:
Aggarwal D, Parmar K, Sharma AP, Tyagi S, Kumar S, Singh SK, Gupta S. Long-term impact of testicular torsion and its salvage on semen parameters and gonadal function. Indian J Urol. 2022 Apr-Jun;38(2):135-139. doi: 10.4103/iju.iju_328_21. Epub 2022 Apr 1. PMID: 35400863; PMCID: PMC8992720.
Sizar O, Leslie SW, Schwartz J. Male Hypogonadism. [Updated 2024 Feb 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532933/
Sharma A, Minhas S, Dhillo WS, Jayasena CN. Male infertility due to testicular disorders. J Clin Endocrinol Metab. 2021 Jan 23;106(2):e442-e459. doi: 10.1210/clinem/dgaa781. PMID: 33295608; PMCID: PMC7823320.
Q.
Is it possible to achieve an erection if you have erectile dysfunction, and how does testosterone therapy help?
A.
Many men with erectile dysfunction can still have erections, and testosterone therapy may help those with low testosterone by improving sexual desire and the physical mechanisms needed for an erection.
References:
Rizk PJ, Kohn TP, Pastuszak AW, Khera M. Testosterone therapy improves erectile function and libido in hypogonadal men. Curr Opin Urol. 2017 Nov;27(6):511-515. doi: 10.1097/MOU.0000000000000442. PMID: 28816715; PMCID: PMC5649360.
Cunningham GR, Hirshkowitz M, Korenman SG, Karacan I. Testosterone replacement therapy and sleep-related erections in hypogonadal men. J Clin Endocrinol Metab. 1990 Mar;70(3):792-7. doi: 10.1210/jcem-70-3-792. PMID: 2307732.
Yafi FA, Jenkins L, Albersen M, Corona G, Isidori AM, Goldfarb S, Maggi M, Nelson CJ, Parish S, Salonia A, Tan R, Mulhall JP, Hellstrom WJ. Erectile dysfunction. Nat Rev Dis Primers. 2016 Feb 4;2:16003. doi: 10.1038/nrdp.2016.3. PMID: 27188339; PMCID: PMC5027992.
Q.
What are some common reasons for low energy levels, and how might they relate to testosterone?
A.
Low energy levels can be caused by several factors like poor sleep, stress, and medical conditions, and low testosterone can be one of the factors that contribute to feeling tired.
References:
Updated 2023 Jan 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK526128/
https://www.ncbi.nlm.nih.gov/books/NBK526128/
Straftis AA, Gray PB. Sex, Energy, Well-Being and Low Testosterone: An Exploratory Survey of U.S. Men's Experiences on Prescription Testosterone. Int J Environ Res Public Health. 2019 Sep 5;16(18):3261. doi: 10.3390/ijerph16183261. PMID: 31491933; PMCID: PMC6765788.
Kenangil G, Orken DN, Ur E, Forta H, Celik M. The relation of testosterone levels with fatigue and apathy in Parkinson's disease. Clin Neurol Neurosurg. 2009 Jun;111(5):412-4. doi: 10.1016/j.clineuro.2008.11.019. Epub 2009 Jan 8. PMID: 19131155.
Q.
What are some effective ways to stop hot flashes quickly in men?
A.
To stop a hot flash quickly, men can cool down their body with immediate measures like a cold shower or cool compress, and in some cases, medications such as megestrol acetate may be used under a doctor's supervision.
References:
Loprinzi CL, Michalak JC, Quella SK, O'Fallon JR, Hatfield AK, Nelimark RA, Dose AM, Fischer T, Johnson C, Klatt NE, et al. Megestrol acetate for the prevention of hot flashes. N Engl J Med. 1994 Aug 11;331(6):347-52. doi: 10.1056/NEJM199408113310602. PMID: 8028614.
Mohile SG, Mustian K, Bylow K, Hall W, Dale W. Management of complications of androgen deprivation therapy in the older man. Crit Rev Oncol Hematol. 2009 Jun;70(3):235-55. doi: 10.1016/j.critrevonc.2008.09.004. Epub 2008 Oct 25. PMID: 18952456; PMCID: PMC3074615.
Witkowski S, Evard R, Rickson JJ, White Q, Sievert LL. Physical activity and exercise for hot flashes: trigger or treatment? Menopause. 2023 Feb 1;30(2):218-224. doi: 10.1097/GME.0000000000002107. Epub 2022 Nov 7. PMID: 36696647; PMCID: PMC9886316.
Q.
What are some strategies to improve concentration that might be affected by low testosterone?
A.
Improving concentration can involve lifestyle changes like better sleep, exercise, and nutrition, and if low testosterone is a factor, addressing it with a doctor’s help may also be useful.
References:
Updated 2024 Feb 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK532933/
https://www.ncbi.nlm.nih.gov/books/NBK532933/
Cohen J, Nassau DE, Patel P, Ramasamy R. Low Testosterone in Adolescents & Young Adults. Front Endocrinol (Lausanne). 2020 Jan 10;10:916. doi: 10.3389/fendo.2019.00916. Erratum in: Front Endocrinol (Lausanne). 2020 Jul 14;11:449. doi: 10.3389/fendo.2020.00449. PMID: 32063884; PMCID: PMC6966696.
Rivas AM, Mulkey Z, Lado-Abeal J, Yarbrough S. Diagnosing and managing low serum testosterone. Proc (Bayl Univ Med Cent). 2014 Oct;27(4):321-4. doi: 10.1080/08998280.2014.11929145. PMID: 25484498; PMCID: PMC4255853.
Q.
What are the common causes of erectile dysfunction in older men?
A.
Older men often experience erectile dysfunction due to changes in blood vessels, nerves, and hormone levels, as well as health issues like heart disease and diabetes.
References:
Gökçe Mİ, Yaman Ö. Erectile dysfunction in the elderly male. Turk J Urol. 2017 Sep;43(3):247-251. doi: 10.5152/tud.2017.70482. Epub 2017 Aug 3. PMID: 28861293; PMCID: PMC5562240.
Gareri P, Castagna A, Francomano D, Cerminara G, De Fazio P. Erectile dysfunction in the elderly: an old widespread issue with novel treatment perspectives. Int J Endocrinol. 2014;2014:878670. doi: 10.1155/2014/878670. Epub 2014 Mar 17. PMID: 24744785; PMCID: PMC3976909.
Ferrini MG, Gonzalez-Cadavid NF, Rajfer J. Aging related erectile dysfunction-potential mechanism to halt or delay its onset. Transl Androl Urol. 2017 Feb;6(1):20-27. doi: 10.21037/tau.2016.11.18. PMID: 28217447; PMCID: PMC5313305.
Q.
What are the current guidelines for diagnosing and treating late-onset hypogonadism?
A.
Current guidelines recommend diagnosing late-onset hypogonadism based on both consistent clinical symptoms and confirmed low testosterone levels measured in the morning, and treatment generally involves careful testosterone therapy with regular monitoring.
References:
Huhtaniemi I. Late-onset hypogonadism: current concepts and controversies of pathogenesis, diagnosis and treatment. Asian J Androl. 2014 Mar-Apr;16(2):192-202. doi: 10.4103/1008-682X.122336. PMID: 24407185; PMCID: PMC3955328.
Amano T. Late-onset hypogonadism: current methods of clinical diagnosis and treatment in Japan. Asian J Androl. 2025 Jan 28. doi: 10.4103/aja2024111. Epub ahead of print. PMID: 39887188.
Kalra S, Jacob J, Unnikrishnan AG, Bantwal G, Sahoo A, Sahay R, Jindal S, Agrawal MS, Kapoor N, Saboo B, Tiwaskar M, Kochhar K. Expert Opinion on the Diagnosis and Management of Male Hypogonadism in India. Int J Endocrinol. 2023 Feb 22;2023:4408697. doi: 10.1155/2023/4408697. PMID: 36876281; PMCID: PMC9977550.
Q.
What are the effective treatments for low libido related to hormonal imbalances?
A.
Fixing low libido from hormone imbalances can be done by using hormone replacement therapy and healthy lifestyle changes, and sometimes adding counseling or other treatments to help balance hormones and improve desire.
References:
Krakowsky Y, Grober ED. A practical guide to female sexual dysfunction: An evidence-based review for physicians in Canada. Can Urol Assoc J. 2018 Jun;12(6):211-216. doi: 10.5489/cuaj.4907. Epub 2018 Feb 23. PMID: 29485038; PMCID: PMC5994984.
Some people also find that talking to a counselor or joining a support group helps if stress or relationship issues are a part of the problem. It is important to work with a doctor to check your hormone levels and decide what treatment is best. By using a mix of therapy to balance your hormones and taking care of your general health, many people see improvements in their libido.
AlAwlaqi A, Amor H, Hammadeh ME. Role of hormones in hypoactive sexual desire disorder and current treatment. J Turk Ger Gynecol Assoc. 2017 Dec 15;18(4):210-218. doi: 10.4274/jtgga.2017.0071. PMID: 29278235; PMCID: PMC5776161.
Q.
What are the potential causes of low energy levels in males, and how might testosterone play a role?
A.
Low energy in males can be caused by many factors, including low testosterone levels. Testosterone is a hormone that helps keep energy up, and when levels drop, it may lead to feeling tired, weak, or unmotivated.
References:
Updated 2024 Feb 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK532933/
https://www.ncbi.nlm.nih.gov/books/NBK532933/
Updated 2023 Jan 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK526128/
https://www.ncbi.nlm.nih.gov/books/NBK526128/
Rajfer J. Relationship between testosterone and erectile dysfunction. Rev Urol. 2000 Spring;2(2):122-8. PMID: 16985751; PMCID: PMC1476110.
Q.
What are the signs of low energy levels linked to low testosterone?
A.
Low testosterone can make you feel very tired and less motivated. Signs include chronic fatigue, difficulty concentrating, lower physical stamina, and sometimes mood changes.
References:
Anaissie J, DeLay KJ, Wang W, Hatzichristodoulou G, Hellstrom WJ. Testosterone deficiency in adults and corresponding treatment patterns across the globe. Transl Androl Urol. 2017 Apr;6(2):183-191. doi: 10.21037/tau.2016.11.16. PMID: 28540225; PMCID: PMC5422691.
Updated 2024 Feb 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK532933/
https://www.ncbi.nlm.nih.gov/books/NBK532933/
Ramasamy R, Wilken N, Scovell JM, Kovac JR, Lipshultz LI. Hypogonadal symptoms are associated with different serum testosterone thresholds in middle-aged and elderly men. Urology. 2014 Dec;84(6):1378-82. doi: 10.1016/j.urology.2014.07.049. Epub 2014 Oct 5. PMID: 25288577; PMCID: PMC4247997.
Q.
What can cause enlarged male nipples, and is this related to hormonal changes such as low testosterone?
A.
Enlarged male nipples, often called gynecomastia, can happen when there is an imbalance in hormones. This can be related to low testosterone, but there are also other causes like medications and certain health conditions which a doctor should evaluate promptly.
References:
Raheem AA, Zaghloul AS, Sadek AMG, Rayes B, Abdel-Raheem TM. The Impact and Management of Gynaecomastia in Klinefelter Syndrome. Front Reprod Health. 2021 Feb 12;3:629673. doi: 10.3389/frph.2021.629673. PMID: 36303983; PMCID: PMC9580767.
Metwalley KA, Farghaly HS. Gynecomastia in adolescent males: current understanding of its etiology, pathophysiology, diagnosis, and treatment. Ann Pediatr Endocrinol Metab. 2024 Apr;29(2):75-81. doi: 10.6065/apem.2346142.071. Epub 2024 Apr 30. PMID: 38712491; PMCID: PMC11076233.
Nuttall FQ, Warrier RS, Gannon MC. Gynecomastia and drugs: a critical evaluation of the literature. Eur J Clin Pharmacol. 2015 May;71(5):569-78. doi: 10.1007/s00228-015-1835-x. Epub 2015 Apr 2. PMID: 25827472; PMCID: PMC4412434.
Q.
What causes enlarged male breasts, and how might hormonal imbalances like low testosterone be involved?
A.
Gynecomastia, or enlarged male breasts, often happens when the balance between estrogen and testosterone is upset. When there is low testosterone or high estrogen for any reason, it can lead to extra breast tissue growth.
References:
Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK430812/
https://www.ncbi.nlm.nih.gov/books/NBK430812/
Shi Z, Xin M. Endocrine Hormones and Their Impact on Pubertal Gynecomastia. J Clin Med. 2024 Dec 30;14(1):158. doi: 10.3390/jcm14010158. PMID: 39797240; PMCID: PMC11721017.
Sansone A, Romanelli F, Sansone M, Lenzi A, Di Luigi L. Gynecomastia and hormones. Endocrine. 2017 Jan;55(1):37-44. doi: 10.1007/s12020-016-0975-9. Epub 2016 May 4. PMID: 27145756.
Q.
What causes pain in enlarged male breasts, and how might hormonal imbalances be involved?
A.
Enlarged male breasts, known as gynecomastia, can hurt because the extra tissue stretches and sometimes becomes inflamed. Hormonal imbalances, especially shifts that increase estrogen or lower testosterone, often play a key role in this process.
References:
Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK430812/
https://www.ncbi.nlm.nih.gov/books/NBK430812/
Sansone A, Romanelli F, Sansone M, Lenzi A, Di Luigi L. Gynecomastia and hormones. Endocrine. 2017 Jan;55(1):37-44. doi: 10.1007/s12020-016-0975-9. Epub 2016 May 4. PMID: 27145756.
Robeva R, Elenkova A, Zacharieva S. Causes and Metabolic Consequences of Gynecomastia in Adult Patients. Int J Endocrinol. 2019 Oct 3;2019:6718761. doi: 10.1155/2019/6718761. PMID: 31687020; PMCID: PMC6794958.
Q.
What constitutes a weak erection, and could low testosterone be a contributing factor?
A.
A weak erection is one that isn’t firm enough for satisfying sexual activity, and low testosterone can sometimes play a role in this issue by affecting a man’s sexual desire and function.
References:
Updated 2024 Jan 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK562253/
https://www.ncbi.nlm.nih.gov/books/NBK562253/
Tsujimura A. The Relationship between Testosterone Deficiency and Men's Health. World J Mens Health. 2013 Aug;31(2):126-35. doi: 10.5534/wjmh.2013.31.2.126. Epub 2013 Aug 31. PMID: 24044107; PMCID: PMC3770847.
Corona G, Maggi M. The role of testosterone in male sexual function. Rev Endocr Metab Disord. 2022 Dec;23(6):1159-1172. doi: 10.1007/s11154-022-09748-3. Epub 2022 Aug 23. PMID: 35999483; PMCID: PMC9789013.
Q.
What could be the reasons for losing an erection quickly, and is low testosterone a factor?
A.
Losing an erection quickly can happen for many reasons, such as blood flow problems, nerve issues, or stress, and while low testosterone can play a role, it is often not the only factor.
References:
Rajfer J. Relationship between testosterone and erectile dysfunction. Rev Urol. 2000 Spring;2(2):122-8. PMID: 16985751; PMCID: PMC1476110.
Tsujimura A. The Relationship between Testosterone Deficiency and Men's Health. World J Mens Health. 2013 Aug;31(2):126-35. doi: 10.5534/wjmh.2013.31.2.126. Epub 2013 Aug 31. PMID: 24044107; PMCID: PMC3770847.
Corona G, Maggi M. The role of testosterone in male sexual function. Rev Endocr Metab Disord. 2022 Dec;23(6):1159-1172. doi: 10.1007/s11154-022-09748-3. Epub 2022 Aug 23. PMID: 35999483; PMCID: PMC9789013.
Q.
What could cause a loss of erection when standing, and is it related to low testosterone?
A.
Losing an erection when standing may happen from changes in blood flow or nerve signals, and while low testosterone can affect erections, it is not usually the main cause of this specific issue.
References:
Barkin J. Erectile dysfunction and hypogonadism (low testosterone). Can J Urol. 2011 Apr;18 Suppl:2-7. PMID: 21501544.
Rajfer J. Relationship between testosterone and erectile dysfunction. Rev Urol. 2000 Spring;2(2):122-8. PMID: 16985751; PMCID: PMC1476110.
Thomas C, Konstantinidis C. Neurogenic Erectile Dysfunction. Where Do We Stand? Medicines (Basel). 2021 Jan 7;8(1):3. doi: 10.3390/medicines8010003. PMID: 33430218; PMCID: PMC7825654.
Q.
What could cause problems maintaining an erection with a new partner, and is low testosterone a factor?
A.
Erection problems with a new partner may be caused by stress or anxiety and sometimes low testosterone can play a role, but many factors can work together.
References:
Updated 2024 Jan 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK562253/
https://www.ncbi.nlm.nih.gov/books/NBK562253/
Lowy M, Ramanathan V. Erectile dysfunction: causes, assessment and management options. Aust Prescr. 2022 Oct;45(5):159-161. doi: 10.18773/austprescr.2022.051. Epub 2022 Oct 4. PMID: 36382171; PMCID: PMC9584785.
Anderson D, Laforge J, Ross MM, Vanlangendonck R, Hasoon J, Viswanath O, Kaye AD, Urits I. Male Sexual Dysfunction. Health Psychol Res. 2022 Aug 20;10(3):37533. doi: 10.52965/001c.37533. PMID: 35999971; PMCID: PMC9392840.
Q.
What could cause simultaneous feelings of depression and fatigue, and is low testosterone a contributing factor?
A.
Both depression and fatigue can be caused by many things like stress, poor sleep, or hormonal changes. Research shows that low testosterone may play a role in these symptoms, but it is only one factor among many.
References:
Määttänen I, Gluschkoff K, Komulainen K, Airaksinen J, Savelieva K, García-Velázquez R, Jokela M. Testosterone and specific symptoms of depression: Evidence from NHANES 2011-2016. Compr Psychoneuroendocrinol. 2021 Mar 10;6:100044. doi: 10.1016/j.cpnec.2021.100044. PMID: 35757365; PMCID: PMC9216439.
Indirli R, Lanzi V, Arosio M, Mantovani G, Ferrante E. The association of hypogonadism with depression and its treatments. Front Endocrinol (Lausanne). 2023 Aug 10;14:1198437. doi: 10.3389/fendo.2023.1198437. PMID: 37635965; PMCID: PMC10449581.
Kheirkhah F, Hosseini SR, Hosseini SF, Ghasemi N, Bijani A, G Cumming R. Relationship between testosterone levels and depressive symptoms in older men in Amirkola, Iran. Caspian J Intern Med. 2014 Spring;5(2):65-70. PMID: 24778779; PMCID: PMC3992230.
Q.
What could cause the absence of armpit hair despite having pubic hair, and is it related to testosterone levels?
A.
Not having armpit hair but having pubic hair can happen because different hair follicles respond differently to hormones like testosterone rather than always meaning low testosterone.
References:
Grymowicz M, Rudnicka E, Podfigurna A, et al. Hormonal Effects on Hair Follicles. International Journal of Molecular Sciences. 2020 Jul;21(15):E5342. DOI: 10.3390/ijms21155342. PMID: 32731328; PMCID: PMC7432488.
Miranda BH, Charlesworth MR, Tobin DJ, Sharpe DT, Randall VA. Androgens trigger different growth responses in genetically identical human hair follicles in organ culture that reflect their epigenetic diversity in life. FASEB J. 2018 Feb;32(2):795-806. doi: 10.1096/fj.201700260RR. Epub 2018 Jan 4. PMID: 29046359; PMCID: PMC5928870.
Kumar P, Kumar N, Thakur DS, Patidar A. Male hypogonadism: Symptoms and treatment. J Adv Pharm Technol Res. 2010 Jul;1(3):297-301. doi: 10.4103/0110-5558.72420. PMID: 22247861; PMCID: PMC3255409.
Q.
What factors contribute to weaker erections with age, and is testosterone a factor?
A.
As men age, weaker erections can be due to several factors like reduced blood flow, nerve changes, and lower testosterone levels, with low testosterone being one part of a bigger picture.
References:
Gareri P, Castagna A, Francomano D, Cerminara G, De Fazio P. Erectile dysfunction in the elderly: an old widespread issue with novel treatment perspectives. Int J Endocrinol. 2014;2014:878670. doi: 10.1155/2014/878670. Epub 2014 Mar 17. PMID: 24744785; PMCID: PMC3976909.
Rajfer J. Relationship between testosterone and erectile dysfunction. Rev Urol. 2000 Spring;2(2):122-8. PMID: 16985751; PMCID: PMC1476110.
Corona G, Maggi M. The role of testosterone in male sexual function. Rev Endocr Metab Disord. 2022 Dec;23(6):1159-1172. doi: 10.1007/s11154-022-09748-3. Epub 2022 Aug 23. PMID: 35999483; PMCID: PMC9789013.
Q.
What might cause low libido in males in their 30s, and how is it linked to testosterone levels?
A.
Low libido in men in their 30s can result from a mix of factors, including stress, lifestyle habits, and sometimes lower testosterone. While testosterone plays a role in sex drive, many other things can also influence a man’s desire for sex.
References:
Tsujimura A. The Relationship between Testosterone Deficiency and Men's Health. World J Mens Health. 2013 Aug;31(2):126-35. doi: 10.5534/wjmh.2013.31.2.126. Epub 2013 Aug 31. PMID: 24044107; PMCID: PMC3770847.
Rizk PJ, Kohn TP, Pastuszak AW, Khera M. Testosterone therapy improves erectile function and libido in hypogonadal men. Curr Opin Urol. 2017 Nov;27(6):511-515. doi: 10.1097/MOU.0000000000000442. PMID: 28816715; PMCID: PMC5649360.
Singh P. Andropause: Current concepts. Indian J Endocrinol Metab. 2013 Dec;17(Suppl 3):S621-9. doi: 10.4103/2230-8210.123552. PMID: 24910824; PMCID: PMC4046605.
Q.
What might cause trouble maintaining an erection when using a condom, and is it linked to low testosterone?
A.
Condom use can sometimes cause anxiety, distraction, or decreased sensation that may interfere with keeping an erection, and this is usually not directly linked to low testosterone.
References:
Hill BJ, Sanders SA, Crosby RA, Ingelhart KN, Janssen E. Condom-associated erection problems: behavioural responses and attributions in young, heterosexual men. Sex Health. 2015 Oct;12(5):397-404. doi: 10.1071/SH14051. PMID: 26166025; PMCID: PMC4712123.
Yafi FA, Jenkins L, Albersen M, Corona G, Isidori AM, Goldfarb S, Maggi M, Nelson CJ, Parish S, Salonia A, Tan R, Mulhall JP, Hellstrom WJ. Erectile dysfunction. Nat Rev Dis Primers. 2016 Feb 4;2:16003. doi: 10.1038/nrdp.2016.3. PMID: 27188339; PMCID: PMC5027992.
Graham CA, Crosby R, Sanders S, Milhausen R, Yarber WL. Condom-Associated Erection Problems: A Study of High-Risk Young Black Males Residing in the Southern United States. Am J Mens Health. 2016 Mar;10(2):141-5. doi: 10.1177/1557988314561311. Epub 2014 Dec 4. PMID: 25475105.
Q.
What physiological changes cause hot flashes in men?
A.
Hot flashes in men are caused by changes in hormone levels, especially a drop in testosterone, which disrupts the body’s normal way of keeping cool. This symptom should promot evaluation by a doctor.
References:
Updated 2022 Dec 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK539827/
https://www.ncbi.nlm.nih.gov/books/NBK539827/
Spetz AC, Zetterlund EL, Varenhorst E, Hammar M. Incidence and management of hot flashes in prostate cancer. J Support Oncol. 2003 Nov-Dec;1(4):263-6, 269-70, 272-3; discussion 267-8, 271-2. PMID: 15334868.
Mohile SG, Mustian K, Bylow K, Hall W, Dale W. Management of complications of androgen deprivation therapy in the older man. Crit Rev Oncol Hematol. 2009 Jun;70(3):235-55. doi: 10.1016/j.critrevonc.2008.09.004. Epub 2008 Oct 25. PMID: 18952456; PMCID: PMC3074615.
Q.
What self-care strategies can help manage erectile dysfunction?
A.
Self-care strategies to help manage erectile dysfunction include lifestyle changes like regular exercise, healthy eating, stress reduction, and avoiding smoking and excessive alcohol. These practices may improve blood flow and overall health, which can support better erectile function.
References:
Maiorino MI, Bellastella G, Esposito K. Lifestyle modifications and erectile dysfunction: what can be expected? Asian J Androl. 2015 Jan-Feb;17(1):5-10. doi: 10.4103/1008-682X.137687. PMID: 25248655; PMCID: PMC4291878.
Gerbild H, Larsen CM, Graugaard C, Areskoug Josefsson K. Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies. Sex Med. 2018 Jun;6(2):75-89. doi: 10.1016/j.esxm.2018.02.001. Epub 2018 Apr 13. PMID: 29661646; PMCID: PMC5960035.
Lowy M, Ramanathan V. Erectile dysfunction: causes, assessment and management options. Aust Prescr. 2022 Oct;45(5):159-161. doi: 10.18773/austprescr.2022.051. Epub 2022 Oct 4. PMID: 36382171; PMCID: PMC9584785.
Q.
What strategies or treatments can help improve low motivation potentially linked to low testosterone?
A.
Making healthy lifestyle choices and, when needed, testosterone replacement therapy are strategies that may help improve low motivation when it is linked to low testosterone.
References:
Huo S, Scialli AR, McGarvey S, Hill E, Tügertimur B, Hogenmiller A, Hirsch AI, Fugh-Berman A. Treatment of Men for "Low Testosterone": A Systematic Review. PLoS One. 2016 Sep 21;11(9):e0162480. doi: 10.1371/journal.pone.0162480. PMID: 27655114; PMCID: PMC5031462.
Cohen J, Nassau DE, Patel P, Ramasamy R. Low Testosterone in Adolescents & Young Adults. Front Endocrinol (Lausanne). 2020 Jan 10;10:916. doi: 10.3389/fendo.2019.00916. Erratum in: Front Endocrinol (Lausanne). 2020 Jul 14;11:449. doi: 10.3389/fendo.2020.00449. PMID: 32063884; PMCID: PMC6966696.
Straftis AA, Gray PB. Sex, Energy, Well-Being and Low Testosterone: An Exploratory Survey of U.S. Men's Experiences on Prescription Testosterone. Int J Environ Res Public Health. 2019 Sep 5;16(18):3261. doi: 10.3390/ijerph16183261. PMID: 31491933; PMCID: PMC6765788.
Q.
Which medications are known to cause enlarged breasts in men, and how does testosterone play a role?
A.
Some medications, including anti-androgens, certain cardiovascular and psychiatric drugs, and even rare cases with medications like methylphenidate, can lead to enlarged breasts in men by disrupting the balance between testosterone and estrogen. Lower levels or blocked effects of testosterone can allow estrogen to stimulate breast tissue growth.
References:
Updated 2023 Jan 6]. In: Feingold KR, Ahmed SF, Anawalt B, et al., editors. Endotext [Internet]. South Dartmouth (MA): [MDText.com](http://mdtext.com/), Inc.; 2000-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK279105/
https://www.ncbi.nlm.nih.gov/books/NBK279105/
Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK430812/
https://www.ncbi.nlm.nih.gov/books/NBK430812/
Narula HS, Carlson HE. Gynaecomastia--pathophysiology, diagnosis and treatment. Nat Rev Endocrinol. 2014 Nov;10(11):684-98. doi: 10.1038/nrendo.2014.139. Epub 2014 Aug 12. PMID: 25112235.
Q.
Why do hot flashes often occur at night, and how can they be managed?
A.
Hot flashes often happen at night because our body’s temperature control becomes more sensitive during sleep, and they can be managed with lifestyle adjustments and sometimes medications.
References:
Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK65717/
https://www.ncbi.nlm.nih.gov/books/NBK65717/
Morrow PK, Mattair DN, Hortobagyi GN. Hot flashes: a review of pathophysiology and treatment modalities. Oncologist. 2011;16(11):1658-64. doi: 10.1634/theoncologist.2011-0174. Epub 2011 Oct 31. PMID: 22042786; PMCID: PMC3233302.
Thurston RC, Chang Y, Buysse DJ, Hall MH, Matthews KA. Hot flashes and awakenings among midlife women. Sleep. 2019 Sep 6;42(9):zsz131. doi: 10.1093/sleep/zsz131. PMID: 31152182; PMCID: PMC7368339.
Q.
Why might testicles shrink with age or due to hormonal treatments like TRT?
A.
Testicles can shrink naturally with age and may also get smaller with hormonal treatments like TRT because the body reduces its own testosterone production.
References:
Varela-Cives R, Mendez-Gallart R, Estevez-Martinez E, Rodriguez-Barca P, Bautista-Casasnovas A, Pombo-Arias M, Tojo-Sierra R. A cross-sectional study of cryptorchidism in children: testicular volume and hormonal function at 18 years of age. Int Braz J Urol. 2015 Jan-Feb;41(1):57-66. doi: 10.1590/S1677-5538.IBJU.2015.01.09. PMID: 25928530; PMCID: PMC4752057.
Cheng H, Zhang X, Li Y, Cao D, Luo C, Zhang Q, Zhang S, Jiao Y. Age-related testosterone decline: mechanisms and intervention strategies. Reprod Biol Endocrinol. 2024 Nov 14;22(1):144. doi: 10.1186/s12958-024-01316-5. PMID: 39543598; PMCID: PMC11562514.
Tenover JS. Declining testicular function in aging men. Int J Impot Res. 2003 Aug;15 Suppl 4:S3-8. doi: 10.1038/sj.ijir.3901029. PMID: 12934044.
Q.
Why might TRT cause testicles to shrink, and how can this side effect be managed?
A.
When a man uses testosterone replacement therapy (TRT), the extra testosterone sends a signal to the brain that reduces the natural hormone signals, so the testicles shrink because they produce less testosterone. This side effect can be managed by adjusting the therapy or adding treatments like hCG to help keep the testicles active.
References:
Wang C, Swerdloff RS. Testosterone Replacement Therapy in Hypogonadal Men. Endocrinol Metab Clin North Am. 2022 Mar;51(1):77-98. doi: 10.1016/j.ecl.2021.11.005. Epub 2022 Feb 8. PMID: 35216722; PMCID: PMC8994707.
Bassil N, Alkaade S, Morley JE. The benefits and risks of testosterone replacement therapy: a review. Ther Clin Risk Manag. 2009 Jun;5(3):427-48. doi: 10.2147/tcrm.s3025. Epub 2009 Jun 22. PMID: 19707253; PMCID: PMC2701485.
Grech A, Breck J, Heidelbaugh J. Adverse effects of testosterone replacement therapy: an update on the evidence and controversy. Ther Adv Drug Saf. 2014 Oct;5(5):190-200. doi: 10.1177/2042098614548680. PMID: 25360240; PMCID: PMC4212439.
Q.
Can low testosterone cause depression ?
A.
Low testosterone has been linked to depression, as research shows that men with low levels may experience a lower mood and symptoms of depression, though depression can also be influenced by many other factors.
References:
Zitzmann M. Testosterone, mood, behaviour and quality of life. Andrology. 2020 Nov;8(6):1598-1605. doi: 10.1111/andr.12867. Epub 2020 Jul 30. PMID: 32657051.
Hauger RL, Saelzler UG, Pagadala MS, Panizzon MS. The role of testosterone, the androgen receptor, and hypothalamic-pituitary-gonadal axis in depression in ageing Men. Rev Endocr Metab Disord. 2022 Dec;23(6):1259-1273. doi: 10.1007/s11154-022-09767-0. Epub 2022 Nov 22. PMID: 36418656; PMCID: PMC9789012.
Q.
Can low testosterone cause high blood pressure?
A.
Low testosterone might be linked to changes in blood pressure, but it is not clear if it directly causes high blood pressure.
References:
Li N, Ma R, Wang S, Zhao Y, Wang P, Yang Z, Jin L, Zhang P, Ding H, Bai F, Yu J. The potential role of testosterone in hypertension and target organ damage in hypertensive postmenopausal women. Clin Interv Aging. 2019 Apr 29;14:743-752. doi: 10.2147/CIA.S195498. PMID: 31118595; PMCID: PMC6501555.
Qu M, Feng C, Wang X, et al. Association of serum testosterone and luteinizing hormone with blood pressure and risk of cardiovascular disease in middle‐aged and elderly men. _J Am Heart Assoc_. 2021;10(7):e019559. doi:10.1161/JAHA.120.019559. Available at:
https://doi.org/10.1161/JAHA.120.019559
Hackett G, Mann A, Haider A, Haider KS, Desnerck P, König CS, Strange RC, Ramachandran S. Testosterone Replacement Therapy: Effects on Blood Pressure in Hypogonadal Men. World J Mens Health. 2024 Oct;42(4):749-761. doi: 10.5534/wjmh.230239. Epub 2024 Feb 14. PMID: 38449452; PMCID: PMC11439806.
Q.
Can you tell low testosterone by looking at their face?
A.
You can't tell for sure if someone has low testosterone just by looking at their face, even though certain facial features might hint at changes.
References:
Nukana RP, Rusyati LMM, Praharsini GAA, Winaya KK, Suryawati N, Karna NLPRV. Association of testosterone level with melasma in men: a case-control study in Indonesia. Pan Afr Med J. 2022 Dec 16;43:194. doi: 10.11604/pamj.2022.43.194.37435. PMID: 36942149; PMCID: PMC10024555.
Bhasin S, Brito JP, Cunningham GR, Hayes FJ, Hodis HN, Matsumoto AM, Snyder PJ, Swerdloff RS, Wu FC, Yialamas MA. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018 May 1;103(5):1715-1744. doi: 10.1210/jc.2018-00229. PMID: 29562364.
Q.
Does low testosterone cause erectile dysfunction (ED)?
A.
Low testosterone can be one reason for erectile dysfunction, especially in men with very low levels, but ED is usually caused by a mix of factors.
References:
Rizk PJ, Kohn TP, Pastuszak AW, Khera M. Testosterone therapy improves erectile function and libido in hypogonadal men. Curr Opin Urol. 2017 Nov;27(6):511-515. doi: 10.1097/MOU.0000000000000442. PMID: 28816715; PMCID: PMC5649360.
Onyeji IC, Clavijo RI. Testosterone replacement therapy and erectile dysfunction. Int J Impot Res. 2022 Nov;34(7):698-703. doi: 10.1038/s41443-021-00512-w. Epub 2022 Jan 8. PMID: 34997198.
Wang Y, Jiang R. Androgens and erectile dysfunction: from androgen deficiency to treatment. Sex Med Rev. 2024 Jun 26;12(3):458-468. doi: 10.1093/sxmrev/qeae030. PMID: 38719619.
Q.
Does low testosterone cause hair loss?
A.
Low testosterone is not usually the main cause of hair loss in men, but in some cases of hormonal imbalance—especially in women—adjusting testosterone levels might improve hair growth.
References:
Glaser RL, Dimitrakakis C, Messenger AG. Improvement in scalp hair growth in androgen-deficient women treated with testosterone: a questionnaire study. Br J Dermatol. 2012 Feb;166(2):274-8. doi: 10.1111/j.1365-2133.2011.10655.x. Epub 2012 Jan 9. PMID: 21967243; PMCID: PMC3380548.
Kische H, Arnold A, Gross S, Wallaschofski H, Völzke H, Nauck M, Haring R. Sex Hormones and Hair Loss in Men From the General Population of Northeastern Germany. JAMA Dermatol. 2017 Sep 1;153(9):935-937. doi: 10.1001/jamadermatol.2017.0297. PMID: 28403384; PMCID: PMC5817427.
Asfour L, Cranwell W, Sinclair R. Male Androgenetic Alopecia. [Updated 2023 Jan 25]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet].
Q.
Does low testosterone cause weight gain?
A.
Low testosterone is linked with weight gain because it can reduce muscle mass and slow metabolism, but many factors also affect body weight.
References:
Kelly DM, Jones TH. Testosterone and obesity. Obes Rev. 2015 Jul;16(7):581-606. doi: 10.1111/obr.12282. Epub 2015 May 15. PMID: 25982085.
Fernández-García JC, Barrios-Rodríguez R, Asenjo-Plaza M, et al. Metformin, testosterone, or both in men with obesity and low testosterone: A double-blind, parallel-group, randomized controlled trial. Metabolism journal. 2022;136(155290):1-10. doi:10.1002/oby.23695.
Q.
Does low testosterone make you tired?
A.
Yes, low testosterone can make you feel very tired because this hormone helps keep your body energized.
References:
Mani SB, Clavijo RI. Medical Treatment of Hypogonadism in Men. Urol Clin North Am. 2022 May;49(2):197-207. doi: 10.1016/j.ucl.2021.12.008. PMID: 35428426.
de Almeida Ferreira M, Mendonça JA. Long-term testosterone replacement therapy reduces fatigue in men with hypogonadism. Drugs Context. 2022 Feb 2;11:2021-8-12. doi: 10.7573/dic.2021-8-12. PMID: 35211178; PMCID: PMC8823386.
Q.
Is low testosterone genetic?
A.
Yes, genetics can play a role in low testosterone. Some men inherit genes or genetic conditions, like Klinefelter syndrome, that make them more likely to have low testosterone levels.
References:
Fantus RJ, Na R, Wei J, Shi Z, Resurreccion WK, Halpern JA, Franco O, Hayward SW, Isaacs WB, Zheng SL, Xu J, Helfand BT. Genetic Susceptibility for Low Testosterone in Men and Its Implications in Biology and Screening: Data from the UK Biobank. Eur Urol Open Sci. 2021 May 25;29:36-46. doi: 10.1016/j.euros.2021.04.010. PMID: 34337532; PMCID: PMC8317803.
Millar AC, Faghfoury H, Bieniek JM. Genetics of hypogonadotropic hypogonadism. Transl Androl Urol. 2021 Mar;10(3):1401-1409. doi: 10.21037/tau.2020.03.33. PMID: 33850776; PMCID: PMC8039576.
Los E, Leslie SW, Ford GA. Klinefelter Syndrome. [Updated 2023 Nov 12]. In: StatPearls [Internet]
Q.
What is a dangerously low testosterone level?
A.
There is no clearly defined ‘dangerously low testosterone level’. Low testosterone is generally considered to be well below the normal range for a range defined by biological sex (male vs. female), not gender identity. Often under about 200 ng/dL on repeated morning tests is considered low, especially when combined with significant symptoms.
References:
S. Mitchell Harman, E. Jeffrey Metter, Jordan D. Tobin, Jay Pearson, Marc R. Blackman, Longitudinal Effects of Aging on Serum Total and Free Testosterone Levels in Healthy Men, _The Journal of Clinical Endocrinology & Metabolism_, Volume 86, Issue 2, 1 February 2001, Pages 724–731,
https://doi.org/10.1210/jcem.86.2.7219
Shalender Bhasin, Juan P Brito, Glenn R Cunningham, Frances J Hayes, Howard N Hodis, Alvin M Matsumoto, Peter J Snyder, Ronald S Swerdloff, Frederick C Wu, Maria A Yialamas, Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline, _The Journal of Clinical Endocrinology & Metabolism_, Volume 103, Issue 5, May 2018, Pages 1715–1744,
Q.
What kind of test is required to confirm low testosterone?
A.
A blood test that measures your serum testosterone levels—usually taken in the morning—is the main test used to confirm low testosterone.
References:
Rivas AM, Mulkey Z, Lado-Abeal J, Yarbrough S. Diagnosing and managing low serum testosterone. Proc (Bayl Univ Med Cent). 2014 Oct;27(4):321-4. doi: 10.1080/08998280.2014.11929145. PMID: 25484498; PMCID: PMC4255853.
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Dudek P, Kozakowski J, Zgliczyński W. Late-onset hypogonadism. Prz Menopauzalny. 2017 Jun;16(2):66-69. doi: 10.5114/pm.2017.68595. Epub 2017 Jun 30. PMID: 28721133; PMCID: PMC5509975.
https://pmc.ncbi.nlm.nih.gov/articles/PMC5509975/Griebling, T.L. Late Onset Hypogonadism, Testosterone Replacement Therapy, and Sexual Health in Elderly Men. Curr Transl Geriatr and Exp Gerontol Rep 2, 76–83 (2013). https://doi.org/10.1007/s13670-013-0042-9
https://link.springer.com/article/10.1007/s13670-013-0042-9Giagulli VA, Castellana M, Lisco G, Triggiani V. Critical evaluation of different available guidelines for late-onset hypogonadism. Andrology. 2020; 8: 1628–1641.
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