5 signs that your testosterone may have dropped

Testosterone deficiency is rarely noticed through a single dramatic symptom more often it is several small changes that together form a pattern. You train about the same as before but recovery feels worse. Your sex drive has decreased. Your waistline is creeping up and your mental acuity is not quite the same. Is it stress, lack of sleep and normal aging or has your testosterone actually dropped?

It's a question many men start asking after they turn 40 or 50. The problem is that almost all of the symptoms associated with low testosterone can also be caused by other things, so it's important to look for a pattern and confirm the suspicion with proper blood tests.

Testosterone declines – but age is not the whole explanation

Testosterone levels change throughout life, but in healthy men the age-related decline is often quite slow. The European Society of Urology guidelines emphasize that obesity, type 2 diabetes, chronic disease and general poor health often matter more than the date of birth itself.

It is therefore misleading to think that all men automatically develop testosterone deficiency over the years. Medical testosterone deficiency, hypogonadism, means that typical symptoms occur together with repeated, clearly low testosterone levels.

1. Sexual desire decreases and morning erections become fewer

These are often the most telling symptoms. A clear and persistent decrease in sexual desire, fewer spontaneous morning erections, or impaired erectile function may be associated with lower testosterone.

But erectile dysfunction is not the same as testosterone deficiency. Vascular disease, diabetes, stress, alcohol, lack of sleep, and several common medications can affect erections. That's why it's the change from your normal level that's interesting especially if both desire and morning erections decrease at the same time.

2. You feel unusually tired and have difficulty recovering

Low energy, decreased desire to work out, and a feeling that the body is not recovering as previously seen with testosterone deficiency. Workouts that used to give you energy may start to feel harder, and it may take longer before you feel ready again.

Fatigue is also one of the least specific symptoms. Sleep apnea, too little sleep, depression, thyroid problems, anemia, infections, medications, and prolonged stress are just a few possible explanations. Fatigue alone is therefore a poor test for testosterone.

3. You lose strength or muscle mass despite exercising

Testosterone helps maintain muscle mass, strength and normal body composition. In case of real and prolonged deficiency, muscle mass can decrease while fat mass, especially around the stomach, increases.

It's not always noticeable first in the mirror. You may notice that the weights in the gym are slowly dropping, that the same amount of training is less effective, or that your waistline is increasing without any obvious change in your diet.

But even here, the whole picture must be considered. Less exercise, insufficient protein, a long-term calorie deficit, poorer sleep and increasing age also affect muscle mass. Waist circumference can also both lower testosterone and increase as a result of low levels – the connection can therefore go both ways.

4. Drive, mood and concentration change

Some men do not primarily describe fatigue, but rather a loss of motivation. They become more easily irritated or depressed, feel less joy, and have difficulty concentrating or remembering details.

This does not mean that testosterone is the explanation for every motivational slump. Mental illness, stress, lack of sleep and life situation can give exactly the same picture. Cognitive symptoms are non-specific, and research has not shown that testosterone treatment generally improves memory in older men. However, if the change comes along with clear sexual and physical symptoms, the suspicion becomes more relevant.

5. The body begins to change in more subtle ways

In more severe or long-term testosterone deficiency, body hair may decrease, testicles may become smaller, and breasts may become tender or grow. Hot flashes and night sweats may occur when levels are very low. In the long term, bone mass may decrease and the risk of anemia may increase.

Such signs should not be ignored, but they need to be evaluated medically. They may point to testicular disease or pituitary disorders and sometimes require a broader hormonal evaluation.

How to find out if your testosterone is really low

The diagnosis cannot be made by an online symptom test or a single blood sample taken at any time of day. Guidelines recommend that total testosterone be measured in the morning, usually before 10 a.m., in a fasting state, and on at least two separate occasions.

It is best to avoid taking the test during acute illness, after very strenuous physical exertion or during a period of extreme energy deficiency. Food, stress and illness can temporarily lower the value. If the total testosterone is close to the borderline range, the doctor may also need to assess SHBG and calculated free testosterone.

A low value is the beginning of the investigation not the end. LH and FSH can help show whether the cause is primarily in the testicles or in the signaling from the pituitary gland. In some cases, prolactin, thyroid values, blood status and other tests are also checked.

Should you start testosterone treatment?

Not just because you feel tired or have had a low single test result. Treatment can be valuable for men with confirmed hypogonadism, but first the doctor needs to assess the cause, possible risks and whether something is reversible.

Weight loss in cases of obesity, better sleep, treatment of sleep apnea, sufficient energy and nutrition, and adjustment of medications can in some cases improve both symptoms and testosterone levels. Testosterone treatment also reduces the body's own sperm production and can impair fertility. Monitoring of blood counts, symptoms, and the prostate, among other things, is therefore important.

My conclusion

Testosterone levels don't always drop with a clear signal. Often it's a combination of things: decreased desire, fewer morning erections, impaired recovery, body changes, and loss of drive.

But the same symptoms can be caused by many other things. So the question shouldn’t be, “Do I have enough symptoms to start testosterone?” The better question is, “Is there a clear pattern that should be investigated properly?”

Don't guess and don't self-medicate. Take the symptoms seriously, check the values properly, and try to understand the cause before deciding what the next step should be.

All the best, Kennet Båth