Low Testosterone in Older Males: Causes, Symptoms, and Hormone Replacement Options

Introduction

Testosterone is the main male sex hormone. It is made mostly in the testicles and, in smaller amounts, in the adrenal glands. From early puberty onward it guides the body toward its adult male form. It deepens the voice, grows facial and body hair, builds muscle, and supports bone strength. It also plays a steady role in red-blood-cell production, mood control, and the drive for sexual activity. Because it acts on so many organs, any long-term drop in testosterone can affect health in many ways.

Levels of this hormone rise fast during the teen years, reach their peak in the early 20s, and then start to fall little by little after about age 30. The average drop is around 1 percent each year, but the exact rate differs from man to man. By age 60, one in every five men shows blood-test numbers below the accepted lower limit for a healthy young adult. By age 80, the share climbs to about one-half. Scientists call this state “late-onset hypogonadism” or “testosterone deficiency syndrome.”

Not every older man with low blood levels feels symptoms. The body can often adjust, and small declines may pass unnoticed. Trouble appears when hormone levels fall far enough to affect key tissues. Signs may surface in several areas at the same time. A weakening sex drive is common, as is less firm or less frequent erections. Muscle size shrinks, body fat—especially around the waist—goes up, and energy drops. Many men report dull mood, low drive, and a hard time with focus or memory. Bone loss can speed up, raising the risk for fractures. Because these changes may also come from other diseases or from normal aging, low testosterone often stays hidden until a blood test confirms it.

Several forces can speed the natural decline. Extra body weight can lower the output of the testes and change how the brain’s hormone centers send signals. Type 2 diabetes, long-standing high blood pressure, and chronic lung or kidney disease are known to suppress hormone release. Certain drugs—notably long-term opioid pain pills, high-dose steroids, and some cancer treatments—reduce testosterone production as well. Poor sleep, heavy alcohol use, and ongoing stress can add to the problem.

Low testosterone matters for more than comfort or sexual function. Studies link it to higher fat mass, loss of muscle strength, insulin resistance, and higher rates of metabolic syndrome. These changes together can push blood sugar and blood pressure upward, making heart and vessel disease more likely. The hormone also supports the marrow’s work in making red cells; severe lack may lead to mild anemia. A fall in bone density is another silent threat and may show up only after a hip or spine fracture.

Doctors have clear lab rules for deciding when the hormone is truly low. A total testosterone level below about 300 ng/dL (10.4 nmol/L) on two separate morning tests is the usual cut-off, though exact numbers vary slightly between laboratories. Free testosterone, the portion not bound to proteins in the blood, may give extra clues in borderline cases, especially when a man carries excess weight or has liver disease, both of which change binding proteins.

The steady growth in public interest in hormone health has led many older men to ask whether restoring testosterone can lift energy, sharpen thinking, or protect bones and muscles. Online searches show frequent questions about safety, best treatment forms, costs, and the right age to start therapy. Clinics now offer injections, skin gels, patches, under-skin pellets, and newer oral capsules, each with its own dosing schedule and monitoring needs.

Because treatment carries both possible gains and known risks, expert groups advise a careful approach. A full medical review should rule out other causes of the symptoms. A doctor must explain realistic goals, follow strict test schedules, and watch for side effects such as high red-blood-cell counts, prostate changes, or sleep-breathing problems. Shared decision-making, regular follow-up, and lifestyle steps—like weight loss, exercise, and good sleep—remain core parts of safe care.

The pages that follow explore these topics in depth. Readers will find clear answers to the questions most often typed into search bars: what triggers low testosterone, how it feels, when to test, what therapy looks like, and how to weigh benefits against possible harms. By mapping the science in plain English, the article aims to guide informed choices and support healthy aging for men facing late-life hormone decline.

What Is Low Testosterone and How Is It Diagnosed?

Testosterone is a hormone made mostly in the testicles. It plays a key role in male growth, development, and health. It helps with building muscle, keeping bones strong, making red blood cells, and supporting sex drive and sexual function. Testosterone also affects mood and mental clarity.

As men age, testosterone levels slowly begin to drop. This usually starts around age 30 and continues gradually over the years. While this drop is normal, some older men experience a much lower level than expected. This condition is called low testosterone or hypogonadism. When testosterone levels drop below the normal range and cause noticeable symptoms, medical treatment may be needed.

What Is Considered Low Testosterone?

Doctors use blood tests to measure testosterone levels. The normal range for total testosterone is usually between 300 and 1,000 nanograms per deciliter (ng/dL). A level below 300 ng/dL is often used as the cutoff for low testosterone. However, levels can vary between labs and from person to person.

It is important to understand that having a low number on a test does not always mean a man has hypogonadism. Many men have low levels without symptoms and may not need treatment. On the other hand, some men may have symptoms even if their levels are slightly above 300 ng/dL. That is why both lab results and symptoms are needed to make a correct diagnosis.

Types of Testosterone in the Blood

Testosterone in the blood comes in two main types:

1. Total Testosterone: This includes all the testosterone in the blood. Some of it is tightly bound to proteins like sex hormone-binding globulin (SHBG), and some is loosely bound to albumin. A small amount is not bound to any protein.

2. Free Testosterone: This is the small portion of testosterone that is not attached to proteins. It is considered the active form that can enter cells and do its job.

Most of the time, doctors check total testosterone first. If the result is borderline or unclear, they may also check free testosterone to get a better picture.

How and When Testosterone Is Tested

Testosterone levels change during the day. They are highest in the early morning and drop later in the day. Because of this, blood should be drawn between 7 a.m. and 10 a.m. to get the most accurate reading. If the first test shows low levels, a second test on a different morning is needed to confirm the result.

It is also important that the person being tested is in good health during the test. Illness, lack of sleep, or high stress can cause temporary drops in testosterone levels.

Symptoms Are Key to Diagnosis

A low testosterone number is not enough to diagnose hypogonadism. There must also be symptoms linked to low testosterone. Common symptoms include:

• Low sex drive

• Erectile problems

• Fatigue or low energy

• Loss of muscle mass

• Mood changes, such as feeling sad or irritable

• Difficulty focusing or remembering

• Increase in body fat

• Weak bones or fractures

Doctors use both the blood test results and the presence of these symptoms to decide if a man has low testosterone that needs treatment. Some medical groups recommend using a symptom checklist to help guide this process.

Other Tests May Be Needed

Once low testosterone is confirmed, doctors may look for the cause of the problem. This can involve testing other hormones like luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones come from the brain and help control the testicles. High or low levels can help show if the problem is coming from the testicles or the brain.

Imaging tests like pituitary gland MRI may be needed in rare cases, especially if hormone levels suggest a brain issue.

A full health check is also important because low testosterone can be linked to chronic conditions like obesity, type 2 diabetes, or sleep apnea.

Low testosterone means the body is not making enough of this key hormone. It is diagnosed by checking hormone levels in the blood, along with reviewing a man’s symptoms. Testing must be done in the morning and repeated if the first result is low. A full medical evaluation helps ensure that the right cause is found and that treatment is only given when truly needed.

What Causes Low Testosterone in Older Men?

Low testosterone in older men can happen for several reasons. Some causes are a natural part of aging, while others are related to health problems, medications, or lifestyle habits. Understanding these causes can help doctors decide how to treat the condition safely and effectively.

Natural Aging and Testicular Changes

As men age, their bodies make less testosterone. This is a normal process. Testosterone levels usually begin to drop slowly after age 30. The testicles, which produce testosterone, may not work as well over time. This is called "primary hypogonadism." It means the problem starts in the testicles themselves. Older testicles may produce less testosterone, even if the brain sends signals to make more. This slow drop in hormone levels is one of the most common reasons for low testosterone in older men.

The amount of testosterone a man loses each year is small, about 1% to 2%. But over many years, the drop can become large enough to cause symptoms. Not every older man will feel symptoms, even with lower testosterone. But for some, the hormone level becomes low enough to affect energy, sex drive, mood, and physical strength.

Brain-Hormone Signal Problems (Secondary Hypogonadism)

Testosterone is made when the brain tells the testicles to produce it. Two parts of the brain—the hypothalamus and the pituitary gland—control this signal. If there is a problem with either of these areas, the testicles may not get the message to make testosterone. This type of problem is called "secondary hypogonadism."

In older men, the brain’s hormone signals can become weaker with age. Some men have changes in their pituitary gland that lower the signal strength. Other men may have conditions that affect brain function, such as tumors, strokes, or head injuries. In some cases, the reason is not clear, but the result is still lower testosterone due to weak hormone signals from the brain.

Chronic Diseases

Several long-term health conditions can lead to low testosterone. These diseases can affect how the body makes or uses hormones.

• Type 2 Diabetes: Men with type 2 diabetes often have low testosterone. Insulin resistance, high blood sugar, and inflammation may interfere with the hormone-making process.

• Obesity: Extra body fat can cause the body to change testosterone into estrogen. This leads to lower testosterone levels. Fat tissue also produces substances that slow down the hormone signals from the brain.

• Chronic Kidney Disease: This condition affects many body systems, including hormone balance. Men with kidney failure often have very low testosterone.

• Liver Disease: Severe liver problems, such as cirrhosis, can interfere with hormone levels.

• HIV/AIDS: This virus and the medicines used to treat it can lower testosterone.

Medications

Some medications can reduce testosterone levels as a side effect. This is often seen with:

• Opioid pain medicines, such as morphine or oxycodone, which can lower the brain’s hormone signals.

• Glucocorticoids, such as prednisone, which affect many hormone systems in the body.

• Certain antidepressants and psychiatric drugs may also play a role, although the exact link is not always clear.

• Cancer treatments, such as chemotherapy or radiation to the testicles or brain, may lower testosterone permanently or for a long time.

Doctors usually look at a man’s medication list when evaluating low testosterone to see if any drugs could be causing or worsening the problem.

Lifestyle Factors

The way someone lives can also affect testosterone levels. Common lifestyle-related causes include:

• Poor Sleep: Testosterone levels rise during deep sleep. Not getting enough sleep or having sleep disorders, such as sleep apnea, can lead to lower levels.

• Chronic Stress: High levels of the stress hormone cortisol can interfere with testosterone production.

• Excessive Alcohol Use: Drinking too much alcohol over time can harm the testicles and liver, reducing testosterone.

• Lack of Physical Activity: Sedentary lifestyles may lead to weight gain and lower testosterone. On the other hand, regular exercise—especially strength training—may help boost hormone levels.

Low testosterone in older men usually happens for more than one reason. Aging itself plays a large role, but health conditions, medications, and daily habits can also contribute. Doctors need to look at the full picture—medical history, lifestyle, and lab tests—to understand the cause and decide if treatment is needed.

What Are the Symptoms of Low Testosterone in Aging Males?

Testosterone plays a major role in the body’s physical, mental, and sexual health. When testosterone levels drop too low, older men may begin to notice several changes. These symptoms can happen slowly over time, and some may be mistaken for normal aging. However, low testosterone, also known as hypogonadism, has a specific pattern of effects that go beyond normal aging. It can affect sexual desire, physical strength, energy levels, mood, and even thinking ability.

Sexual Symptoms

One of the first and most common signs of low testosterone is a change in sexual health. Men may notice a drop in sex drive, which is also called libido. This can happen even if other parts of life are going well. Some men may lose interest in sex completely or feel less satisfied.

Erectile dysfunction (ED) is another symptom. Low testosterone does not usually cause ED by itself, but it can make the condition worse. Men with low testosterone may find it harder to get or keep an erection, especially in the morning. They may also notice fewer spontaneous erections, which usually happen during sleep.

Fertility can also be affected. Low testosterone can reduce the number of sperm the body makes. This can make it harder for men to father children, even if they had no problems before.

Physical Symptoms

Low testosterone affects the body’s muscle and fat balance. Men may start to lose muscle mass and strength. They might feel weaker than before or have trouble lifting things that used to be easy. This loss of strength is not just from less activity—it is a direct effect of lower testosterone.

At the same time, fat may build up in the body, especially around the belly. This change in body shape is not only a cosmetic issue. It can increase the risk of other health problems, like diabetes and heart disease.

Low bone density is another concern. Testosterone helps keep bones strong. When levels fall, bones can become thinner and more likely to break. This is called osteoporosis. While often seen in women, men with low testosterone are also at risk.

Other physical symptoms include feeling more tired than usual. This fatigue may not improve with rest. Some men feel like they have no energy for daily tasks. Others describe a general sense of weakness or low endurance.

Mental and Emotional Symptoms

Low testosterone does not only affect the body. It can also affect the brain. Men may feel more sad or down than usual. Some may develop symptoms of depression, such as losing interest in hobbies or feeling hopeless.

Mood swings or increased irritability can also happen. Small things that once went unnoticed may start to feel more annoying or upsetting. Men may feel more emotional, or they may find it harder to control anger.

Trouble focusing or remembering things is another possible symptom. This is often described as “mental fog.” Men may forget why they entered a room or have trouble staying on task. Some say they do not feel as sharp or quick as before.

Sleep changes are also common. Men may find it hard to fall asleep or stay asleep. Some may develop sleep apnea, a condition where breathing stops and starts during the night. Poor sleep can then make other symptoms worse, such as fatigue and mood issues.

Changes in Quality of Life

All these symptoms can reduce overall quality of life. Low testosterone can affect how a man feels about himself, his work, his relationships, and his future. These changes may happen slowly, but over time they can become harder to ignore.

Even though these signs may be part of aging, they should not be accepted without question. When several symptoms appear together, and they start to affect daily life, it may be time to check for low testosterone.

Not every man with low testosterone will have all these symptoms. Some may have only a few. But even a few signs, when unexplained or ongoing, can be a reason to look deeper. A proper diagnosis can help find the right path to feeling better.

When Should Older Men Consider Getting Tested for Low Testosterone?

Low testosterone is common in older men. However, not every man with lower levels needs treatment. Testosterone levels naturally drop with age, but only some men develop symptoms that affect health and daily life. A medical test is the only way to know if levels are truly low. But testing is only helpful when a man also has signs and symptoms that suggest low testosterone.

Doctors use clear rules to decide when testing is a good idea. These rules help avoid testing men who don’t need it and help find those who may benefit from treatment.

Symptoms That May Mean Low Testosterone

Testing for testosterone should begin when certain symptoms are present. Some of the most common include:

• Low sex drive (reduced libido)

• Trouble getting or keeping an erection

• Feeling tired all the time

• Loss of strength or muscle mass

• Weight gain, especially around the belly

• Depressed mood or feeling down

• Difficulty focusing or remembering things

• Thinning bones or fractures (osteoporosis)

• Decrease in body hair or beard growth

These symptoms may not always mean low testosterone. Many of them can happen for other reasons, like stress, poor sleep, or other health problems. But when several of these signs appear together—especially in older men—testing may help find the cause.

Conditions That May Warrant Testing

Some health problems are linked with low testosterone. Men with these conditions may be tested even if they do not have clear symptoms. These conditions include:

• Type 2 diabetes: Men with diabetes often have lower testosterone.

• Obesity: Body fat, especially around the abdomen, can lower testosterone levels.

• HIV/AIDS: This condition can affect hormone levels.

• Chronic opioid use: Long-term use of opioid pain medications can reduce testosterone production.

• Kidney failure or dialysis: These serious conditions can affect hormone balance.

• Pituitary disorders: These affect the brain’s ability to signal the testes to make testosterone.

• Unexplained anemia: When no clear reason is found for low red blood cell counts, low testosterone may be checked.

• Osteoporosis or low bone density in men: This may be the first sign of hormone imbalance.

Tools Doctors Use to Identify Symptoms

Doctors may use a symptom checklist to help decide whether testing is needed. One common tool is the ADAM questionnaire (Androgen Deficiency in Aging Males). It asks simple yes-or-no questions about energy levels, sexual function, and mood. If a man answers "yes" to several key questions, this may suggest the need for testing.

However, these questionnaires are just guides. They are not perfect, and they do not replace a full medical evaluation. A doctor will also ask about medical history, lifestyle, and other possible causes of the symptoms.

Best Time for Testing Testosterone Levels

Testosterone levels go up and down during the day. They are highest in the early morning and lowest in the evening. For this reason, blood tests for testosterone are done between 7:00 a.m. and 10:00 a.m., especially for younger and middle-aged men. In older men, levels may not rise as much in the morning, but morning testing is still preferred.

Doctors usually measure total testosterone first. If the level is low, they may repeat the test on a different day to confirm the result. This is important because levels can change from day to day due to stress, illness, or other factors.

If symptoms are strong and testosterone is borderline low, a doctor may also order a free testosterone test. Free testosterone is the part not attached to proteins and is more active in the body.

The Importance of Symptom and Lab Match

A low lab result alone does not mean a man needs treatment. Many older men have lower levels without symptoms. At the same time, some symptoms may be due to other causes, not hormones.

Doctors look for a match between symptoms and blood test results. When both line up, testosterone replacement therapy (TRT) may be considered. When they do not match, it is usually better to search for other causes or try lifestyle changes first.

Testing should always be part of a full medical check-up. A careful review of all health problems, medications, and lifestyle habits helps doctors give the right advice. Testing for low testosterone works best when guided by symptoms and medical knowledge, not just lab numbers alone.

What Is Testosterone Replacement Therapy (TRT) and How Does It Work?

Testosterone replacement therapy, or TRT, is a medical treatment used to help men with low testosterone levels. It works by giving the body extra testosterone to bring levels back to a normal, healthy range. This therapy is often used when a man has symptoms of low testosterone and blood tests confirm the hormone is below normal.

Testosterone is a hormone made mainly in the testicles. It plays a key role in many parts of male health. These include sex drive, bone strength, muscle mass, energy levels, and mood. As men get older, testosterone levels naturally drop. But in some cases, the drop is more than normal and causes noticeable problems. TRT is one option that can help correct this imbalance.

How Testosterone Therapy Works

TRT gives the body testosterone from an outside source. This helps raise the amount of the hormone in the blood. The goal is to bring levels back into a normal range and reduce the symptoms caused by low testosterone. When the treatment works well, many men notice improvements in energy, mood, strength, and sexual function.

TRT does not treat the root cause of why the body is making less testosterone. Instead, it acts as a supplement to make up for what the body is no longer producing. For this reason, it is usually a long-term treatment, and regular check-ups are needed to make sure the therapy is working and safe.

Types of Testosterone Replacement Therapy

There are several ways to take testosterone. Each method has pros and cons. A doctor will help decide which option is best based on a person’s health, lifestyle, and preferences.

1. Injections (Intramuscular or Subcutaneous):

Testosterone can be injected into a muscle or under the skin. Injections are usually given every 1 to 2 weeks. Some men learn to give themselves the shots at home. Injections are one of the most common and low-cost ways to take TRT. However, hormone levels can rise and fall between doses, which may cause changes in mood or energy.

2. Gels (Transdermal):

Testosterone gel is rubbed on the skin, usually on the shoulders or upper arms. It is used once a day and absorbed through the skin into the bloodstream. Gels provide steady hormone levels and are easy to use. But the hormone can be passed to others through skin contact, so care must be taken around partners and children.

3. Patches:

Testosterone patches are worn on the skin, often on the back, thigh, or upper arm. They are replaced every 24 hours. Like gels, patches give a steady supply of the hormone. Some men may develop skin irritation from the patch.

4. Pellets (Subcutaneous Implants):

Small pellets containing testosterone are placed under the skin by a doctor. They slowly release the hormone over three to six months. Pellets do not require daily or weekly dosing, which is convenient for some. However, this method involves a minor surgical procedure.

5. Oral Capsules or Buccal Tablets:

Some forms of testosterone are available as pills or tablets that dissolve between the gums and cheek. These are less common and may not be suitable for all patients. Oral forms are easier to take but may have more effects on the liver or cholesterol levels in some people.

Dosing and Frequency

Each method has different dosing schedules. Injections may be weekly or bi-weekly. Gels and patches are used daily. Pellets last for months. Doctors choose a dose based on age, symptoms, blood test results, and response to treatment. Too much testosterone can cause problems, so regular monitoring is important.

Monitoring and Follow-Up

After starting TRT, regular blood tests are needed. These tests check testosterone levels, red blood cell count (hematocrit), prostate-specific antigen (PSA), and sometimes liver function. The doctor may adjust the dose to make sure the treatment is both safe and effective.

It is important to keep all follow-up appointments. Even if symptoms improve, the therapy needs to be checked regularly to avoid side effects and make sure it is helping. The benefits of TRT are not the same for everyone, and some men may respond better than others.

Testosterone therapy can be a useful tool for men with confirmed low testosterone and bothersome symptoms. By understanding how it works and how it is given, men and their healthcare providers can choose the best treatment plan together.

What Are the Benefits of Testosterone Therapy in Older Men?

Testosterone therapy, also known as testosterone replacement therapy (TRT), can help men with low testosterone feel better. As men age, their testosterone levels often drop. When these levels fall too low, it can cause several symptoms that affect both the body and the mind. If low testosterone is confirmed by blood tests and symptoms are present, TRT may offer benefits. However, it is important that treatment is done under a doctor’s care.

Improved Sexual Function

One of the most common reasons older men seek TRT is because of sexual problems. Low testosterone can lead to reduced interest in sex, also called low libido. Some men may also have trouble getting or keeping an erection. TRT may help improve sexual desire and increase the number of satisfactory sexual experiences. In some cases, it may also improve erectile function, especially when low testosterone is the main cause. However, if there are other causes of erectile dysfunction, such as diabetes or high blood pressure, TRT alone may not be enough.

Increased Muscle Mass and Strength

Testosterone plays a key role in building and keeping muscle. When levels are low, men may lose muscle size and feel physically weaker. TRT can help increase lean muscle mass and improve strength. This can make it easier to perform everyday tasks like climbing stairs, lifting items, or walking longer distances. While it is not a substitute for exercise, TRT combined with strength training often leads to better results. Some men also report feeling more energy and less fatigue after starting treatment.

Improved Mood and Mental Function

Low testosterone is linked to changes in mood, such as feeling sad, tired, or irritable. Some men even experience symptoms of depression. TRT may help improve mood, reduce feelings of depression, and increase a sense of well-being. Some men feel more motivated, confident, and mentally sharp. They may find it easier to focus and remember things. These effects can vary from person to person, and improvements in mood may take several weeks or months to appear.

Better Bone Health

Testosterone helps maintain bone density, which is the strength of bones. As men age and testosterone levels fall, bones can become thinner and weaker, leading to a condition called osteoporosis. This increases the risk of fractures, especially in the hips and spine. TRT can help slow down or even reverse bone loss in men with low testosterone. Bone density tests may be done before and during treatment to track progress. Stronger bones mean fewer falls and injuries, which is very important as men get older.

Changes in Body Fat

Testosterone also affects how the body stores fat. Low levels can lead to increased body fat, especially around the belly. TRT may help reduce fat mass and improve body shape, although changes are usually modest. These effects are more noticeable when treatment is combined with healthy eating and regular exercise. Some men also notice less bloating or swelling as their hormone levels return to normal.

Improved Quality of Life

For many men, the biggest benefit of TRT is an overall improvement in quality of life. They may feel more like themselves—more active, more social, and more interested in hobbies and relationships. While TRT is not a cure-all, it may restore energy and help older men stay independent and engaged with life. These benefits tend to build over time with consistent treatment and medical follow-up.

Important Points to Remember

Not every man will experience all these benefits. The response to testosterone therapy depends on many factors, including age, health status, and how low testosterone levels were to begin with. Some men notice changes quickly, while for others, improvements may be slow and gradual. It is also possible that some symptoms may not improve at all.

Doctors often recommend a trial period of TRT to see if symptoms improve. Regular follow-up is important to check testosterone levels and watch for side effects. If there is no clear benefit after several months, doctors may suggest stopping treatment.

Testosterone therapy can offer real benefits for older men with proven low testosterone and symptoms that affect daily life. However, it should only be used when needed and under the care of a healthcare provider.

What Are the Risks and Side Effects of Testosterone Therapy?

Testosterone replacement therapy (TRT) can help improve symptoms of low testosterone, such as low energy, reduced sex drive, and loss of muscle strength. However, it can also cause side effects and raise health concerns. Understanding these risks is important before starting treatment.

Common Side Effects

Some side effects of TRT are mild and can be managed with monitoring or adjusting the treatment.

• Acne and oily skin: Testosterone can increase oil production in the skin. This may lead to acne, especially on the back or chest. In most cases, this is mild and can be treated with over-the-counter skin care products.

• Fluid retention: Some people may notice swelling in the ankles or feet. This happens when the body holds on to extra fluid. In rare cases, fluid retention can make conditions like high blood pressure or heart failure worse.

• Sleep apnea: TRT may make sleep apnea worse in people who already have it. Sleep apnea is a condition where breathing stops and starts during sleep. Signs include loud snoring, gasping during sleep, and feeling very tired during the day.

• Breast tenderness or enlargement: Hormone changes from TRT can cause the breast tissue in men to become swollen or tender. This side effect is called gynecomastia. It usually does not cause serious harm but can be uncomfortable or cause concern.

• Mood changes: Some men report changes in mood while on TRT. This may include feeling more irritable, anxious, or emotional. These changes are not common and often go away over time or with dose adjustments.

Erythrocytosis (High Red Blood Cell Count)

One of the more serious side effects of TRT is an increase in red blood cells. This condition is called erythrocytosis. Testosterone tells the bone marrow to make more red blood cells. A small increase is normal, but if red blood cell levels go too high, the blood can become thick. This raises the risk of blood clots, strokes, and heart attacks. Doctors check blood tests to measure hematocrit, which is the percentage of red blood cells in the blood. If hematocrit goes above 54%, treatment may need to be stopped or changed.

Prostate Health Concerns

Testosterone does not cause prostate cancer, but it may make existing prostate conditions worse.

• Benign prostatic hyperplasia (BPH): This is a common condition where the prostate gland becomes larger with age. TRT may increase the size of the prostate further, which can make it harder to urinate. Symptoms of BPH include a weak urine stream, feeling the need to urinate often, and waking up at night to urinate.

• Prostate cancer: Testosterone therapy does not start prostate cancer, but it can cause undiagnosed prostate cancer to grow faster. That is why doctors often check prostate-specific antigen (PSA) levels before and during TRT. A rising PSA level during treatment may lead to further testing, such as a prostate biopsy.

Cardiovascular Risk

There has been concern about whether testosterone therapy increases the risk of heart problems, such as heart attacks and strokes. Some studies have shown possible links between TRT and heart problems, while others have not. The risk may be higher in older men, especially those with a history of heart disease.

To reduce risk, doctors often avoid giving TRT to men who have had a recent heart attack or stroke. Regular monitoring of blood pressure, cholesterol, and heart health is important during treatment.

Misuse and Overuse

TRT is sometimes misused by people trying to build muscle or improve athletic performance. Using testosterone in high doses without medical need increases the risk of serious side effects. These may include liver damage, infertility, and mood swings. TRT should only be used under a doctor’s care for diagnosed low testosterone.

Monitoring and Risk Reduction

Most of the risks linked to TRT can be managed through regular monitoring. Doctors check testosterone levels, red blood cell counts (hematocrit), PSA levels, and watch for symptoms of sleep apnea or mood changes. Adjusting the dose or changing how testosterone is given (for example, switching from gel to injection) can help reduce side effects.

The goal of TRT is to bring testosterone levels back to normal without causing harm. A good treatment plan includes regular checkups and a careful review of benefits and risks. Not every man with low testosterone needs therapy. The decision to start TRT should be based on symptoms, lab results, and overall health.

Who Should Not Take Testosterone Therapy?

Testosterone replacement therapy (TRT) is not right for everyone. Before starting TRT, it is very important to look at the person’s full medical history. Some men may have health conditions that make TRT risky or unsafe. Doctors must check for these conditions before treatment begins. These are called contraindications. There are two types: absolute contraindications, where TRT should never be used, and relative contraindications, where the risks may outweigh the benefits.

Prostate or Breast Cancer

Men who have prostate cancer or male breast cancer should not take testosterone therapy. Testosterone can make some cancers grow faster, especially those that depend on male hormones. If a man has a history of prostate cancer, even if treated, TRT may still be unsafe. Doctors must check prostate health carefully before starting treatment. This usually includes a prostate-specific antigen (PSA) blood test and sometimes a digital rectal exam. If cancer is found or suspected, TRT should not be started.

High Hematocrit (Thick Blood)

Testosterone can cause the body to make more red blood cells. This can raise hematocrit, which is the percentage of red blood cells in the blood. If hematocrit gets too high (above 54%), the blood becomes thick. Thick blood flows more slowly and may form clots, which can lead to serious problems like heart attacks or strokes. If a man already has a high hematocrit level, TRT should not be used unless the problem is corrected. Regular blood tests are needed to check hematocrit during treatment.

Severe Sleep Apnea

Sleep apnea is a condition where a person stops breathing for short periods during sleep. Testosterone can make sleep apnea worse. In men with severe, untreated sleep apnea, TRT can increase the risk of breathing problems during the night. It can also raise the chances of high blood pressure and heart disease. Men with sleep apnea should be treated first—often with a CPAP machine—before TRT is considered.

Uncontrolled Heart Failure

Heart failure is when the heart does not pump blood as well as it should. Testosterone may cause the body to keep too much fluid, which can make heart failure worse. In men with uncontrolled or severe heart failure, TRT can increase the risk of swelling, breathing problems, and hospitalization. These men should not use TRT until their heart condition is stable and managed properly by a doctor.

Men Trying to Have Children

Testosterone therapy can lower sperm count. It does this by telling the brain to stop making hormones that help the testes produce sperm. This can lead to infertility. For men who are trying to have children, TRT is not a good choice. There are other treatments that can help raise testosterone levels without harming fertility. One example is clomiphene citrate, which helps the body make its own testosterone and preserve sperm production. Men should speak with a specialist if they want to boost testosterone while still having children.

Other Conditions That Need Special Care

Some men have medical issues that don’t fully block TRT, but they make the risks higher. These are called relative contraindications. TRT might still be used in these cases, but with caution and close monitoring. Examples include:

• High risk of blood clots (like a history of deep vein thrombosis or pulmonary embolism)

• Enlarged prostate (benign prostatic hyperplasia) with symptoms like trouble urinating

• Liver or kidney disease that affects how the body processes medications

• History of hormone-sensitive conditions, such as some types of brain tumors

Each of these situations needs a careful decision made by the doctor and patient together. Risks and benefits must be weighed.

Importance of Medical Screening

Before starting TRT, a full health check is needed. This includes blood tests, a medical exam, and a review of family history. Doctors will look for any signs of conditions that could make TRT unsafe. If any of the risks listed above are present, other options should be considered.

Testosterone therapy can help some men feel better and improve their quality of life. But for others, it may do more harm than good. Knowing who should not take testosterone helps keep treatment safe and effective.

How Is Testosterone Therapy Monitored Over Time?

Testosterone replacement therapy (TRT) needs careful and regular monitoring to make sure it is working well and remains safe. Once therapy begins, follow-up tests and checkups help doctors see how the body is reacting. This helps catch problems early and ensures the treatment is adjusted to give the best results with the lowest risk.

Regular Blood Tests Are Important

After starting testosterone therapy, blood tests are usually done at regular times. These tests check how much testosterone is in the blood, and whether levels are too low, too high, or within the desired range. Most doctors recommend testing total testosterone about 3 to 6 months after starting treatment. If levels are stable and the person is doing well, testing may then happen every 6 to 12 months.

The blood test should be done in the morning, when testosterone is highest, especially in younger men. Even though older men may not have as much change between morning and evening, testing early in the day is still the standard. If testosterone levels are too high, the dose may need to be lowered. If levels are too low, the dose might be increased.

Hematocrit Levels Must Be Watched

Testosterone therapy can increase the number of red blood cells. This can raise the hematocrit, which is the percentage of red blood cells in the blood. If hematocrit gets too high, it can make the blood thicker. Thicker blood may increase the risk of blood clots, stroke, or heart attack.

Doctors usually check hematocrit at baseline (before starting treatment), again at 3 to 6 months, and then every year. If the hematocrit goes above 54%, therapy may need to be stopped or changed. In some cases, the dose is lowered or the treatment is paused until the hematocrit returns to a safer level.

Prostate Health Needs Ongoing Monitoring

Testosterone therapy may affect the prostate gland. Some men notice more frequent urination, especially at night. Others may have an increase in prostate-specific antigen (PSA), a marker that may show prostate changes. PSA does not always mean cancer is present, but a large jump in PSA levels needs more testing.

Doctors often check PSA levels before starting TRT and again at 3 to 6 months, and then every 6 to 12 months. If PSA rises more than expected, or if there are other signs like difficulty urinating, more tests may be done. These could include a digital rectal exam (DRE) or referral to a urologist.

Monitoring Symptom Improvement

One major goal of testosterone therapy is to relieve symptoms of low testosterone. These include low energy, reduced sex drive, depression, and decreased muscle strength. After starting TRT, doctors will ask whether symptoms are getting better. Not everyone feels better right away. It may take a few months before changes are clear.

Some men may feel much better, while others may notice little or no improvement. In cases where symptoms do not improve, doctors will look at testosterone levels and check for other causes. Sometimes, a different delivery method (like changing from a gel to an injection) may help. If symptoms still do not get better and risks are high, stopping therapy may be considered.

Changing the Dose or Type of Testosterone

Testosterone therapy is not the same for everyone. Some people respond better to one form than another. For example, one person may do well with injections, while another may prefer a daily gel. Blood levels can also vary depending on the method used.

If the current method is not working or causes side effects, the doctor may switch to a different type or adjust the dose. Changing the treatment plan may improve symptoms or lower risks. This is why regular follow-up is important.

Knowing When to Stop Treatment

Testosterone therapy is not always a lifelong treatment. If risks become too high—like very high hematocrit, rising PSA, or serious side effects—doctors may stop the treatment. In other cases, if symptoms do not improve after a proper trial period and testosterone levels are normal, the therapy might not be continued.

Stopping testosterone suddenly can cause symptoms to return. In some cases, doctors taper the dose slowly to reduce side effects from stopping. Follow-up is needed after stopping therapy to watch for changes in mood, energy, and overall health.

Long-Term Follow-Up

Even when therapy is working well, long-term checkups are needed. Hormone levels, blood counts, and PSA should be checked every year. This helps keep the therapy safe and effective. Other health issues, such as heart problems, should also be reviewed during follow-up visits.

Good communication between doctors and patients helps keep the treatment plan up to date. Adjustments over time are normal. Careful monitoring helps make sure that testosterone therapy continues to offer benefits while keeping risks as low as possible.

What Other Treatments or Lifestyle Changes Support Hormonal Health?

Low testosterone in older males is not always treated with medication alone. In many cases, changes in daily habits can help improve testosterone levels or reduce symptoms. These changes can support overall health, improve quality of life, and may even make hormone therapy more effective when used. Below are key lifestyle treatments that play an important role in supporting hormonal health.

Exercise and Physical Activity

Regular exercise, especially strength training, helps increase testosterone levels. Lifting weights or using resistance bands builds muscle and reduces body fat. Both of these effects are linked to higher testosterone. Studies have shown that older men who do strength training two to three times a week may see improvements in hormone levels and energy. Cardio exercise, like walking, biking, or swimming, also helps the heart and lowers stress levels, which can help balance hormones. Staying active also improves sleep and mood, two important parts of hormonal health.

For best results, a mix of resistance training and aerobic exercise is ideal. Even light activity, such as stretching or yoga, can help reduce stress and improve circulation. It's important for older adults to find an exercise routine that is safe, enjoyable, and done regularly.

Diet and Nutrition

A healthy diet supports hormone production and overall well-being. Testosterone is made from cholesterol, so the body needs healthy fats in the diet. Foods like avocados, nuts, olive oil, and fatty fish such as salmon are good sources of these fats. Protein is also important. Lean meats, eggs, beans, and dairy help the body build and repair muscle, which helps support testosterone levels.

Vitamins and minerals play a key role in hormone health. Zinc and vitamin D are two of the most important for testosterone production. Zinc is found in foods like beef, pumpkin seeds, and lentils. Vitamin D comes from sunlight and foods like egg yolks, mushrooms, and fortified milk. Many older adults have low vitamin D, so a supplement may be needed if levels are too low. A doctor can check vitamin D levels with a simple blood test.

Cutting back on processed foods, sugar, and alcohol can also help. These foods may lead to weight gain, high blood sugar, and inflammation, which can lower testosterone. Eating more fruits, vegetables, whole grains, and healthy fats helps the body stay in balance.

Weight Management

Extra body fat, especially around the belly, is linked to lower testosterone levels. Fat tissue can turn testosterone into estrogen, which is not helpful for men. Losing weight can help reverse this process. Even a small amount of weight loss can lead to better hormone balance. For men who are overweight or obese, weight loss through healthy eating and exercise is often the first step before starting hormone therapy.

Doctors may also screen for conditions linked to weight, such as insulin resistance or type 2 diabetes. Treating these conditions can also help improve hormone levels.

Sleep and Rest

Sleep is when the body makes and balances many hormones, including testosterone. Poor sleep or not getting enough hours of rest can lower testosterone. Older men often have trouble sleeping due to stress, pain, or sleep disorders like sleep apnea. Fixing sleep problems may help improve hormone levels naturally.

Experts recommend 7 to 9 hours of sleep per night. Good habits include going to bed at the same time each night, avoiding screens before sleep, and keeping the room dark and quiet. Men who snore loudly or feel tired during the day may need to be tested for sleep apnea. Treating sleep apnea with a CPAP machine or other method can lead to better rest and better hormone health.

Managing Stress

Stress leads to high levels of a hormone called cortisol. When cortisol is high for a long time, it can block testosterone. Stress also causes problems with sleep and weight, which further affect hormone balance. Managing stress with healthy habits can help the body return to normal hormone levels.

Helpful methods include deep breathing, meditation, time outdoors, listening to music, or talking to a counselor. Some people find that spending time with loved ones, doing hobbies, or joining support groups also lowers stress.

Treating Medical Conditions That Affect Hormones

Certain health conditions can lead to low testosterone. These include type 2 diabetes, obesity, high blood pressure, and sleep apnea. Managing these conditions with medicine, lifestyle changes, or both can help improve testosterone levels. For example, improving blood sugar in diabetes often leads to better hormone levels.

Doctors may also check thyroid function, kidney health, and other hormone levels to make sure there are no hidden problems. If these conditions are treated early, testosterone levels may improve without the need for hormone therapy.

Non-Testosterone Medications That May Help

Some medications can help the body make more testosterone naturally. These are usually used in younger men, but doctors may use them in select older patients. For example, clomiphene citrate helps the brain signal the testicles to make more testosterone. Aromatase inhibitors reduce the conversion of testosterone to estrogen. These options are only used under medical care and are not right for everyone. A doctor decides based on blood tests and symptoms.

Improving testosterone levels is not just about taking medication. Exercise, healthy eating, good sleep, stress control, and managing chronic diseases all support better hormonal health. These changes not only help balance hormones but also improve overall health, energy, and quality of life. Many men benefit from starting these habits even before beginning hormone replacement therapy. When used together, lifestyle changes and medical treatments give the best long-term results.

Conclusion

Low testosterone is a condition that becomes more common as men get older. It can affect many parts of the body, including sexual function, energy levels, mood, and physical strength. This condition, often called late-onset hypogonadism, happens when the body does not make enough testosterone. Some men may not notice any symptoms, but for others, the changes can be difficult and affect daily life. Understanding the causes, symptoms, and treatment options is important for making informed health choices.

Testosterone levels naturally drop as men age, usually starting around the age of 30 and continuing slowly over time. This drop is normal, but in some men, levels fall below what is healthy. This can be caused by aging itself, but other problems may also play a role. Medical conditions like diabetes, obesity, and kidney disease can lower testosterone. Some medicines, such as opioids and steroids, may also affect hormone levels. Poor sleep, stress, and unhealthy habits like smoking or drinking too much alcohol can make the problem worse.

Symptoms of low testosterone are not always easy to spot. They may include low sex drive, trouble getting or keeping an erection, tiredness, loss of muscle, or gaining fat. Some men may feel sad, moody, or have trouble focusing. Bone strength may also go down, which raises the risk of fractures. Because these signs can also be caused by other conditions, doctors often look at both symptoms and blood test results before making a diagnosis.

Blood tests are used to check testosterone levels. Doctors usually order tests in the early morning when testosterone is highest. If levels are low, the test is often repeated to confirm the result. A diagnosis is not based on the number alone—clear symptoms must also be present. Guidelines from medical groups help doctors decide when to test and how to interpret the results.

When low testosterone causes problems and is confirmed with testing, treatment may be an option. Testosterone replacement therapy, or TRT, helps raise hormone levels to a normal range. The goal is to reduce symptoms and improve quality of life. TRT can be given in several forms, including injections, skin gels, patches, oral capsules, and small pellets placed under the skin. The choice depends on the patient’s needs, preferences, and any health risks.

TRT has been shown to improve sex drive and erectile function in many men. It may also help build muscle, reduce fat, and improve mood. Some men report feeling more focused and less tired. Bone strength may also improve, which helps protect against fractures as men age. However, not all men see the same benefits, and some may notice only small changes. Each person responds to treatment differently.

Like any treatment, testosterone therapy comes with risks. Some men develop side effects like oily skin, acne, or swelling in the feet. TRT can raise red blood cell counts, which may increase the risk of blood clots. There are concerns that TRT could affect the prostate, so doctors monitor prostate-specific antigen (PSA) levels during treatment. The link between testosterone therapy and heart problems is still being studied, and results are mixed. Because of these risks, TRT should be started only after a full medical review.

Some men are not good candidates for testosterone therapy. This includes those with prostate or breast cancer, untreated sleep apnea, very high red blood cell counts, or severe heart problems. Men who want to have children should also avoid TRT, since it can lower sperm production. Doctors take all of this into account before recommending treatment.

Once a man starts TRT, regular follow-up is important. Blood tests help check hormone levels, red blood cell counts, and PSA levels. Doctors also ask about symptoms to see if the treatment is working. If problems appear or symptoms do not improve, the dose or method of treatment may be changed. In some cases, the treatment may be stopped.

Besides hormone therapy, lifestyle changes can help support testosterone levels. Losing weight, exercising often, sleeping well, and managing medical problems can all make a difference. These changes may also improve the results of TRT or even reduce the need for it.

In summary, low testosterone is a common issue in older men and can affect many areas of health. Treatment with testosterone may help when symptoms are clear and blood tests confirm low levels. It is important to weigh the benefits and risks with a healthcare provider and to stay under regular medical care during treatment. With the right plan, many men can manage their symptoms and improve their well-being.