Low Testosterone: Should You See an Endocrinologist or a Urologist?

Introduction: Understanding Low Testosterone and the Importance of Specialized Care

Testosterone is a hormone that plays a key role in male health. It affects many parts of the body, including muscles, bones, mood, energy, and sexual function. When the body does not produce enough testosterone, a condition called low testosterone or hypogonadism can occur. This condition is more common in men as they get older, but it can also happen at younger ages due to certain health problems or injuries. Low testosterone can lead to fatigue, low sex drive, trouble with erections, mood swings, muscle loss, and even bone thinning.

Low testosterone can have many causes. Some people may have a problem with the testicles, which are the glands that make testosterone. This is known as primary hypogonadism. Others may have a problem with the brain areas that control hormone levels, like the pituitary gland or hypothalamus. This is called secondary hypogonadism. Because of these different causes, it is important to get the right diagnosis and treatment plan.

The first step in finding out if testosterone levels are low is usually a blood test. This test measures the total amount of testosterone in the blood, usually taken in the morning when levels are highest. If the result is lower than normal, doctors may do more blood tests to check related hormones and help find the cause. Symptoms, medical history, and physical exams are also important in making the diagnosis.

When low testosterone is confirmed, the next step is choosing the right specialist for treatment. This decision can be confusing because both endocrinologists and urologists treat this condition. However, they each have different areas of focus and may approach the problem in different ways. Knowing the difference between these two types of doctors is important for choosing the best care.

An endocrinologist is a doctor who specializes in treating hormone problems. These include conditions that affect the thyroid, adrenal glands, pancreas, and reproductive hormones like testosterone. Endocrinologists are trained to understand how hormones work together and how diseases in one area can affect the rest of the body. They often treat patients with complex or long-term hormone disorders. If low testosterone is caused by a problem with the brain or pituitary gland, an endocrinologist can run the right tests and plan the right treatment.

A urologist is a doctor who specializes in treating problems of the male reproductive system and the urinary tract. This includes the testicles, prostate, bladder, and kidneys. Urologists often treat conditions like erectile dysfunction, prostate disease, and male infertility. When low testosterone is caused by damage or disease in the testicles, a urologist may be the right specialist. Urologists can also offer treatments that help maintain sperm production, which may be important for men who want to have children.

Sometimes, men with low testosterone have health problems that fall into both areas. In those cases, both specialists may work together. For example, an endocrinologist may handle hormone testing and treatment, while a urologist may help with fertility or sexual health. The choice may also depend on other health conditions a person has. For example, a man with diabetes or thyroid disease may benefit more from seeing an endocrinologist, while a man with prostate issues may need a urologist.

Getting care for low testosterone is not just about raising hormone levels. It’s about finding the reason for the problem and choosing the safest, most effective treatment. That’s why it’s important to understand what each type of specialist can offer. The next parts of this article will explain the roles of endocrinologists and urologists, how they diagnose and treat low testosterone, and when it’s best to see one over the other. This helps people make better choices about their health and get the care they need.

What Is the Role of Testosterone in Male Health?

Testosterone is a hormone that plays a major role in male health. It is produced mainly in the testicles. A small amount is also made by the adrenal glands. Testosterone is important for many systems in the body. It affects muscles, bones, blood, sex drive, mood, and energy levels.

Muscle Mass and Strength

One of testosterone’s most well-known roles is helping the body build and maintain muscle mass. Higher levels of testosterone during puberty and early adulthood lead to an increase in muscle size and strength. Testosterone supports muscle protein production. This is why people with low testosterone may notice their muscles becoming smaller or weaker, even if they continue to exercise.

Bone Health

Testosterone helps keep bones strong. It supports the growth of bone tissue and maintains bone density. As testosterone levels drop, bones can become thinner and weaker, increasing the risk of fractures. Men with low testosterone may be more likely to develop osteoporosis, a condition where bones become brittle and break easily. This is often overlooked because osteoporosis is more common in women, but testosterone plays a major role in bone strength for men.

Sex Drive and Erectile Function

Testosterone strongly affects sex drive, or libido. Healthy testosterone levels help maintain interest in sex. When testosterone is low, men often report a lower desire for sexual activity. Testosterone also plays a role in the physical process of getting and maintaining erections. It does not directly cause an erection, but it supports the brain and body’s ability to respond to sexual signals. Low testosterone can make it harder to have or keep an erection, especially over time.

Sperm Production and Fertility

Testosterone is also important for making sperm. The hormone helps the testicles produce enough healthy sperm to support fertility. If testosterone levels are too low, sperm production can drop. This can lead to problems with having children. In some cases, men with low testosterone have a very low sperm count or no sperm at all in their semen.

Mood and Mental Health

Low testosterone can affect how a person feels emotionally. Some men with low levels report feeling more tired, sad, or anxious. Others describe a drop in motivation or difficulty concentrating. These symptoms can sometimes look like depression. While many factors affect mood, testosterone helps regulate brain chemicals that influence emotions and mental clarity. A long-term drop in testosterone may cause emotional and mental changes that impact daily life.

Energy and Fatigue

Testosterone helps the body feel energized and alert. Men with healthy levels tend to feel more physically active and mentally focused. When testosterone drops too low, a person may feel tired even after a full night’s sleep. They may also find it harder to exercise or stay active. This feeling of constant tiredness can lower quality of life and affect work and social activities.

Red Blood Cell Production

Another important role of testosterone is helping the bone marrow produce red blood cells. These cells carry oxygen from the lungs to other parts of the body. If testosterone is too low, the number of red blood cells can drop. This may lead to anemia, which causes fatigue, weakness, and shortness of breath. Low testosterone is one of several possible causes of anemia in men.

Natural Decline vs. Low Testosterone Disorder

Testosterone levels rise during puberty, peak in early adulthood, and then slowly decrease with age. This is a normal part of aging. However, some men experience a faster or more severe drop. When testosterone falls below a healthy range and causes symptoms, it may be diagnosed as low testosterone, or hypogonadism. This condition can happen for different reasons, including problems with the testicles, pituitary gland, or other health conditions.

Doctors usually measure testosterone levels with a blood test. If levels are low and symptoms are present, treatment may be considered. It is important to understand that testosterone does more than affect sex drive. It is a key hormone for total health, and changes in its levels can affect the body in many ways.

Understanding how testosterone works helps explain why low levels can cause a wide range of symptoms. This also helps guide decisions about which type of doctor might be best for diagnosis and treatment.

Who Typically Diagnoses and Treats Low Testosterone?

Low testosterone, also called hypogonadism, is a condition where the body does not make enough of the hormone testosterone. It can lead to symptoms like low energy, reduced muscle mass, mood changes, and sexual problems. When these symptoms start, many people wonder who to see for help. Several types of doctors can be involved in diagnosing and treating low testosterone. Understanding their roles can help patients get the right care.

Primary Care Providers: The First Step

Most people first talk to a primary care provider (PCP) when they notice changes in their health. A PCP may be a family doctor, general practitioner, or internist. These doctors take care of many common health problems and help guide patients through the healthcare system.

When someone reports symptoms like tiredness, low sex drive, or muscle loss, the primary care provider might suspect low testosterone. The doctor will usually order basic blood tests, such as total testosterone levels, to check for hormone imbalances. These tests are often done in the morning when testosterone is at its highest. If the results show that levels are low, the provider may repeat the test to confirm the diagnosis.

Some primary care providers are comfortable starting treatment for low testosterone, especially if the case is straightforward. They may offer testosterone replacement therapy (TRT) through gels, injections, or patches. However, if the case is more complex or if there are other health concerns, the provider may refer the patient to a specialist.

Why a Specialist May Be Needed

Low testosterone can have many causes. Some of these are simple, like aging or stress. Others are more serious, such as problems in the brain or testes. When a deeper evaluation is needed, specialists play an important role. The two main specialists who treat low testosterone are endocrinologists and urologists.

Each specialist brings a different focus. Endocrinologists are hormone experts. They deal with the glands and systems that control hormones. Urologists are experts in the male reproductive system and urinary tract. Both are trained to manage low testosterone, but they may take different approaches depending on the patient’s needs.

How Endocrinologists Help

An endocrinologist looks closely at the entire hormonal system. This includes the pituitary gland, adrenal glands, and testes. If low testosterone might be caused by a problem in one of these areas, an endocrinologist will try to find out why. For example, if a blood test shows that the brain is not sending the right signals to make testosterone, the doctor might order an MRI scan of the brain to check the pituitary gland.

Endocrinologists are especially helpful for patients who also have diabetes, thyroid problems, or metabolic disorders, which often affect hormone levels. They may also care for people whose hormone levels are affected by long-term medications or chronic illnesses.

How Urologists Help

A urologist focuses on the testes, prostate, and penis, as well as the urinary system. If a man has symptoms like erectile dysfunction, fertility issues, or testicular pain, a urologist will often be the best choice.

Urologists can run special tests to check how well the testes are working. They may perform a physical exam, ultrasound, or semen analysis. Urologists also treat problems like varicoceles (enlarged veins in the scrotum) or testicular injury that can lead to low testosterone.

Urologists also help men who want to start testosterone therapy but keep their ability to have children. Some types of TRT can lower sperm count. Urologists know how to manage therapy to keep fertility intact when that is a goal.

Making the Right Choice

Both endocrinologists and urologists are qualified to treat low testosterone. The choice often depends on the root cause of the problem and what other health issues are present. If hormone levels are out of balance in more than one system, an endocrinologist may be more helpful. If symptoms are focused on the testes, erections, or fertility, a urologist may be the better option.

Primary care providers can guide this choice. They often make the first diagnosis and then refer to a specialist if needed. Good communication between the provider, the patient, and the specialist helps make sure that the cause of low testosterone is found and treated in the best way.

What Does an Endocrinologist Do for Low Testosterone?

An endocrinologist is a medical doctor who specializes in the endocrine system. This system includes glands in the body that make hormones. Hormones control many important functions, such as growth, energy use, and reproduction. Testosterone is one of these hormones. When testosterone levels are too low, the condition is called hypogonadism. An endocrinologist helps find out why testosterone is low and offers treatment to help balance hormone levels.

Specialization in Hormonal Disorders

Endocrinologists are experts in diagnosing and treating problems with hormones and glands. These include the thyroid, adrenal glands, pancreas, and the pituitary gland. The pituitary gland, located at the base of the brain, plays a key role in sending signals to the testicles to make testosterone. If the pituitary gland is not working properly, the body may not produce enough testosterone. This kind of issue is called secondary hypogonadism. An endocrinologist is trained to find problems like this that can cause low testosterone.

They also treat patients who have conditions like diabetes, obesity, thyroid disease, and osteoporosis. These health problems are often connected with low testosterone. For example, men with type 2 diabetes often have lower levels of testosterone. Treating the hormone imbalance may improve overall health, energy levels, and mood.

How an Endocrinologist Checks for Low Testosterone

The endocrinologist will begin with a full medical history and physical exam. Important questions include when symptoms started and whether there are problems like low sex drive, tiredness, or mood changes. The doctor may also ask about sleep, stress, past injuries, and family history.

A blood test is the main way to check testosterone levels. The test is usually done in the morning, when testosterone is at its highest. If the levels are low, more tests may be ordered. These may include:

• Free testosterone: Measures the testosterone that is not bound to proteins in the blood

• Luteinizing hormone (LH) and follicle-stimulating hormone (FSH): These show how the pituitary gland is working

• Prolactin: High levels can affect testosterone production

• Thyroid function tests: Thyroid problems can affect energy and mood

• Pituitary imaging (usually MRI): If the tests show low pituitary function, an imaging scan may be needed to check for a tumor or damage

Finding the Cause of Hormone Problems

One of the main goals for an endocrinologist is to find the root cause of low testosterone. Not all cases are the same. Some men may have low testosterone because of aging, but others may have a more serious issue such as a tumor in the pituitary gland. The endocrinologist uses test results to understand where the problem starts: in the testicles (primary hypogonadism) or in the brain (secondary hypogonadism).

For example, if LH and FSH levels are high and testosterone is low, this points to a problem in the testicles. If LH and FSH are also low, the problem may come from the brain or pituitary gland.

Treatment Options Offered by Endocrinologists

Once the cause is known, the endocrinologist will create a treatment plan. Not every patient with low testosterone needs treatment right away. In some cases, other health problems like obesity or sleep apnea need to be treated first. Losing weight or improving sleep can sometimes raise testosterone naturally.

If hormone treatment is needed, the endocrinologist may suggest testosterone replacement therapy (TRT). This therapy helps restore hormone levels to a normal range. TRT can be given in several ways:

• Injections (every 1 to 4 weeks)

• Gels or creams applied to the skin

• Patches worn daily

• Pellets placed under the skin that release testosterone slowly

The endocrinologist will choose the method based on the patient’s age, health, and personal preference. Regular follow-ups are important to check hormone levels, blood counts, and side effects.

Some men may not be good candidates for TRT. For example, those with prostate cancer or high red blood cell counts may need other treatments. In these cases, the endocrinologist may work closely with other doctors to manage the condition safely.

Monitoring Hormone Levels and Overall Health

After treatment begins, the endocrinologist will continue to monitor hormone levels to make sure the therapy is working. Blood tests may be done every few months. The doctor will also watch for side effects such as acne, mood swings, or changes in blood pressure. Monitoring helps keep testosterone at a safe and effective level.

Endocrinologists often treat patients with more than one hormone issue. If low testosterone is linked with diabetes or thyroid disease, all conditions will be treated together. This approach helps improve overall health, not just hormone levels.

Endocrinologists use a careful and detailed method to find the cause of low testosterone. They focus on balancing hormones and managing related health problems. Their training allows them to treat both common and rare causes of hormone imbalance, making them an important part of care for men with low testosterone.

What Does a Urologist Do for Low Testosterone?

A urologist is a doctor who specializes in the urinary system and male reproductive system. This includes the kidneys, bladder, ureters, urethra, penis, testicles, and prostate gland. Urologists are trained to treat a wide range of problems such as urination issues, kidney stones, prostate disorders, and male fertility problems. When it comes to low testosterone (Low T), urologists play a key role—especially when the issue may involve the testicles or male reproductive function.

Expertise in Male Reproductive and Urinary Systems

Urologists often treat men with testicular problems, erectile dysfunction, or concerns about fertility. These conditions are sometimes linked to low testosterone levels. Since urologists are trained in surgery and procedures involving the male genitals and urinary tract, they can evaluate if the cause of low testosterone is related to testicular damage, infection, trauma, or surgery.

In cases where testosterone levels are low due to a problem in the testicles themselves, a urologist can help diagnose primary hypogonadism. This is a condition where the testicles cannot produce enough testosterone even if the brain signals them correctly.

Evaluation Tools and Diagnosis

Urologists use several tools to diagnose low testosterone and its underlying cause. The first step is usually a physical exam. During this, the urologist may check the size and feel of the testicles, look for any signs of injury or abnormalities, and ask about symptoms such as low sex drive, tiredness, muscle weakness, or mood changes.

A scrotal ultrasound might be ordered. This test uses sound waves to create images of the testicles and surrounding tissues. It helps find conditions like varicoceles (enlarged veins in the scrotum), testicular tumors, or signs of injury that might be causing testosterone production to drop.

If the patient is worried about fertility, the urologist may order a semen analysis to check sperm count, shape, and movement. This is important because some treatments for low testosterone can lower sperm production, so it's helpful to know the baseline fertility status before starting therapy.

Testosterone Replacement Therapy (TRT) Options

Urologists often prescribe testosterone replacement therapy (TRT) to increase testosterone levels. There are several forms of TRT, and the urologist helps choose the one that fits the patient's needs and lifestyle.

Some of the most common TRT options include:

• Injections: Testosterone can be injected into the muscle every 1 to 2 weeks. This is often a cost-effective choice but may cause levels to rise and fall between doses.

• Gels or Creams: These are applied to the skin daily and allow a steady release of testosterone into the bloodstream. The downside is the risk of spreading the hormone to others through skin contact.

• Pellets: Small pellets are placed under the skin during a minor surgical procedure. They release testosterone slowly over several months.

• Patches: Applied to the skin like a bandage, these provide steady hormone delivery but may cause skin irritation.

A urologist will also explain the possible side effects of TRT, such as acne, mood swings, increased red blood cells, or prostate growth. Regular follow-up appointments are needed to make sure the treatment is working and not causing problems.

Preserving Fertility During TRT

One of the main reasons men with low testosterone may choose to see a urologist is if they want to preserve fertility. Many forms of TRT, especially testosterone injections and gels, can lower sperm production or even stop it altogether. This is because added testosterone tells the brain to stop sending signals to the testicles to make sperm.

A urologist has special training to manage this problem. In some cases, rather than giving testosterone directly, the urologist may prescribe medicines like clomiphene citrate or hCG (human chorionic gonadotropin). These medications stimulate the body’s own testosterone and sperm production, offering a better choice for men who want to stay fertile.

Addressing Sexual Dysfunction

Low testosterone can cause erectile dysfunction (ED) or worsen existing ED. Urologists regularly treat ED and can offer several options. These include oral medications like sildenafil (Viagra), penile injections, vacuum erection devices, or even penile implants for severe cases. Because they are trained in male sexual health, urologists can look at all aspects of sexual function—not just hormone levels—and create a full treatment plan.

Urologists are specially trained to treat men with low testosterone when the problem may involve the testicles, fertility, or sexual function. They perform thorough physical exams, order targeted imaging, and offer a wide range of treatments—including hormone therapy, fertility-preserving drugs, and procedures for sexual dysfunction. For men who want to maintain fertility while treating low testosterone or who have symptoms involving the testicles or sexual health, a urologist is often the right specialist to see.

What Are the Differences Between an Endocrinologist and a Urologist in Managing Low Testosterone?

Low testosterone, also called hypogonadism, can affect energy levels, mood, muscle mass, sexual health, and overall well-being. Both endocrinologists and urologists treat low testosterone, but they approach it from different medical backgrounds and perspectives. Understanding the key differences between these two types of doctors can help guide people toward the right care.

Training and Background

Endocrinologists are specialists in hormone-related problems. They complete medical school, a residency in internal medicine, and additional training (a fellowship) in endocrinology. Their focus is on the endocrine system, which includes glands such as the thyroid, pituitary, adrenal glands, and testes. These glands make hormones that control important body functions like growth, metabolism, and reproduction.

Urologists, on the other hand, are surgical specialists trained in the urinary tract and male reproductive organs. After medical school, they complete a residency in urology. Urologists treat issues like prostate problems, kidney stones, erectile dysfunction, and male infertility. Their training includes surgical procedures, and they are experts in the physical structures of the urinary and reproductive systems.

Because of their different training, endocrinologists and urologists look at low testosterone in different ways.

Focus of Evaluation

An endocrinologist will focus on how hormones are made, controlled, and how they affect other glands. When a person has low testosterone, an endocrinologist looks for problems with the pituitary gland or hypothalamus, which send signals to the testes to produce testosterone. They may also investigate other hormonal conditions, such as diabetes, thyroid disease, or adrenal issues, which can affect testosterone levels.

A urologist, in contrast, focuses more directly on the testicles, prostate, and other parts of the male reproductive system. If low testosterone is caused by testicular damage, surgery, infection, or a genetic condition, the urologist will often take the lead. Urologists are also more likely to treat related symptoms like erectile dysfunction or low sperm count.

Types of Tests Used

Both types of specialists often start with blood tests to measure total testosterone, free testosterone, and other hormones such as LH (luteinizing hormone) and FSH (follicle-stimulating hormone). These levels help show whether the problem starts in the brain or in the testes.

Endocrinologists may order more advanced hormone tests, including those for thyroid function, prolactin, cortisol, or growth hormone. If the pituitary gland is suspected to be involved, imaging tests such as an MRI of the brain may be used.

Urologists may use ultrasound to examine the testicles or prostate. If fertility is a concern, semen analysis may be ordered. Urologists also examine for structural problems or injury that could affect hormone levels.

Treatment Options and Goals

Both specialists can prescribe testosterone replacement therapy (TRT). This can come in the form of injections, skin gels, patches, or pellets placed under the skin.

Endocrinologists often treat patients who need careful hormone balance, such as men with pituitary tumors, multiple hormone problems, or other chronic conditions. Their goal is to restore hormone levels in a safe and steady way. They often focus on managing long-term health, including bone density, blood sugar levels, and other hormone-related risks.

Urologists may also offer TRT, especially when low testosterone affects sexual function or fertility. However, if a man still wants to father children, urologists may offer treatments that preserve sperm production. This may include medications like clomiphene citrate or hCG (human chorionic gonadotropin), which stimulate the body to produce more testosterone naturally. Urologists can also perform surgeries if needed, such as varicocele repair, vasectomy reversal, or testicular implants.

Approach to Testosterone Therapy

Endocrinologists may be more cautious with starting TRT. They often look for the cause of low testosterone before deciding on treatment. They also monitor for possible side effects like high red blood cell count, sleep apnea, or worsening of prostate problems.

Urologists may take a more direct approach, especially if the main complaint is sexual dysfunction or infertility. They are trained to manage prostate health during TRT and to check for risks such as prostate enlargement or cancer. Urologists are also more likely to offer sperm banking or fertility protection before starting TRT, especially for younger men.

Which Specialist Is Better?

Neither specialist is “better” in general—it depends on the cause of low testosterone and the person’s needs. An endocrinologist may be more helpful when hormone issues are complex or involve more than one gland. A urologist may be the right choice when there are fertility concerns, sexual problems, or testicular pain.

Both specialists can play an important role. In some cases, they may even work together to provide complete care. For example, a man with a pituitary tumor and fertility issues might need help from both an endocrinologist and a urologist.

When Should You See an Endocrinologist for Low Testosterone?

Low testosterone, also called low T, can happen for many reasons. Sometimes, it starts in the testicles. Other times, it is caused by problems in the brain, especially in a small area called the pituitary gland. When the problem may involve hormones made by the brain or when other health problems affect hormone levels, an endocrinologist is the right type of doctor to help.

An endocrinologist is a doctor who specializes in hormone-related diseases. Hormones are chemical messengers in the body that control how organs work. Testosterone is one of these hormones. Endocrinologists are trained to understand how testosterone fits into the full picture of hormone balance. They also know how to find and treat other hormone issues that might be linked to low T.

Signs That an Endocrinologist May Be the Right Specialist

There are some signs and health clues that suggest an endocrinologist should be involved in care. These include:

• Low testosterone with no clear cause
  If testosterone levels are low and there is no clear reason—such as aging or testicular injury—then further tests may be needed. An endocrinologist can look for causes that are harder to find, like problems in the brain’s hormone center.

• Abnormal levels of other hormones
  Blood tests may show that other hormones like luteinizing hormone (LH), follicle-stimulating hormone (FSH), or prolactin are not normal. These hormones help control testosterone levels. Changes in these levels can be signs of a problem in the pituitary gland. Endocrinologists are trained to read these tests and understand what they mean.

• Symptoms that point to pituitary or adrenal problems
  The pituitary gland makes several hormones that control the thyroid, adrenal glands, and reproductive system. If someone has symptoms like extreme fatigue, vision problems, unexplained weight changes, or frequent headaches along with low testosterone, a problem in the pituitary or adrenal gland may be the cause. These are areas that endocrinologists regularly treat.

Conditions Often Treated by Endocrinologists

Low testosterone is sometimes just one part of a bigger hormone disorder. Some conditions that an endocrinologist may diagnose or treat include:

• Secondary hypogonadism
  This is when the testicles are healthy but don’t get the right signals from the brain to make testosterone. Causes may include tumors in the pituitary gland, genetic conditions, or past use of certain medications or steroids.

• Hyperprolactinemia
  This happens when the pituitary makes too much prolactin. High prolactin levels can block the production of testosterone. It may also come from a benign tumor in the brain, called a prolactinoma. Endocrinologists can treat this with medication.

• Kallmann syndrome or other genetic conditions
  Some rare genetic conditions affect how the body makes or responds to hormones. These can start in childhood or show up later. Endocrinologists know how to test for and manage these disorders.

• Metabolic and endocrine disorders
  Diabetes, thyroid problems, obesity, and sleep apnea are all linked to hormone imbalances and can affect testosterone levels. An endocrinologist can manage these conditions while also addressing low testosterone.

Testing and Diagnosis by an Endocrinologist

Endocrinologists often order detailed hormone panels. These may include:

• Total testosterone

• Free testosterone

• LH and FSH

• Prolactin

• Cortisol

• Thyroid hormones

• IGF-1 (linked to growth hormone)

If hormone levels are abnormal, further testing such as a pituitary MRI may be done. This helps look for growths or other changes in the brain that could be affecting hormone production.

Why Choose an Endocrinologist?

An endocrinologist is often the best choice when low testosterone is not a simple case. This is especially true if there are signs of a deeper hormone problem, if other hormone levels are off, or if a rare condition is suspected. Endocrinologists focus on long-term hormone health and balance. They also know how different glands and systems affect each other, which helps them treat the full picture—not just the low testosterone.

In more complex cases, the care of an endocrinologist can lead to earlier diagnosis of serious conditions and more effective treatment. This can prevent problems in the future, such as weak bones, heart risks, or reproductive issues.

When Should You See a Urologist for Low Testosterone?

A urologist is a doctor who treats problems related to the male reproductive system and urinary tract. For men with low testosterone, a urologist can be the right specialist in many situations. This is especially true when the cause of low testosterone involves the testicles or when there are symptoms like infertility or sexual dysfunction.

Focus on Testicular Health

Urologists are trained to look closely at how the testicles are working. The testicles produce most of the testosterone in the male body. If they are not working properly, testosterone levels may fall. This is called primary hypogonadism. It means that the problem starts in the testicles themselves.

There are several reasons the testicles might not make enough testosterone. These include:

• Injury or trauma to the testicles

• Infections, such as mumps, that affect the testicles

• Radiation or chemotherapy used to treat cancer

• Congenital conditions, like Klinefelter syndrome

A urologist can perform a physical exam to check for size, firmness, and any signs of damage or disease in the testicles. If needed, an ultrasound of the scrotum may be ordered to look more closely at the testicles and surrounding structures.

Help With Fertility Concerns

Low testosterone can cause problems with sperm production, which may lead to male infertility. Men who want to have children in the future need to be careful about starting testosterone therapy, because testosterone treatment can actually lower sperm production. This is one of the most important reasons to see a urologist.

Urologists can help men with low testosterone find alternatives to testosterone therapy that do not harm fertility. These may include:

• Clomiphene citrate: A pill that helps the body produce more natural testosterone

• hCG injections: A hormone that tells the testicles to make more testosterone and sperm

• Aromatase inhibitors: Medications that lower estrogen and raise testosterone

Urologists can also order semen analysis to check the number and quality of sperm. If needed, they can guide treatment to improve fertility while managing testosterone levels at the same time.

Treatment for Sexual Health Problems

Low testosterone often causes low sex drive and erectile dysfunction (ED). Urologists treat both of these problems regularly. In some cases, low testosterone is the main cause. In others, there may be more than one cause, such as poor blood flow or nerve problems.

A urologist can check for:

• Signs of erectile dysfunction that do not improve with testosterone therapy

• Prostate health, especially in older men

• Other causes of sexual problems, such as diabetes, high blood pressure, or pelvic surgery

Treatment may include testosterone therapy, medications for ED, or lifestyle changes. Urologists also offer penile implants or injections if other treatments do not work.

Managing Testosterone Therapy

Many urologists provide testosterone replacement therapy in their clinics. They can prescribe:

• Injections (given in the muscle or under the skin)

• Gels or creams (applied to the skin daily)

• Pellets (inserted under the skin every few months)

Urologists monitor for side effects of testosterone therapy, such as:

• Thickening of the blood (high hematocrit)

• Prostate problems

• Acne or oily skin

• Breast enlargement

Regular follow-up visits help make sure the therapy is working and safe.

When to Consider a Urologist

It is a good idea to see a urologist if:

• There is concern about infertility or future family planning

• There are symptoms like testicular pain, shrinkage, or changes in size

• There is difficulty with erections or low sex drive

• Testosterone levels are low and the cause appears to be testicular

• Previous testosterone treatment has not worked well

A urologist can often provide both a diagnosis and a treatment plan. When fertility, sexual function, or testicular health are major concerns, they are often the most appropriate specialist to see.

In some cases, a urologist may work together with other doctors, such as endocrinologists, to give the best care. But for many men with testicular or sexual health problems, a urologist is the first choice for managing low testosterone.

What Tests Will Each Specialist Order for Low Testosterone?

Testing is an important part of understanding low testosterone. Both endocrinologists and urologists order specific tests to find out what is causing the problem. These tests help doctors make the right diagnosis and choose the best treatment. While there is some overlap in the tests used by both specialists, each type of doctor may focus on different areas depending on their training.

Common Blood Tests

The first step in diagnosing low testosterone is usually a blood test. This test checks the level of testosterone in the blood. The two most common types of testosterone tests are total testosterone and free testosterone.

• Total testosterone measures all the testosterone in the blood, including the part attached to proteins.

• Free testosterone measures the testosterone not attached to proteins and is available for the body to use.

Most doctors check testosterone levels in the morning, usually between 7 a.m. and 10 a.m., because this is when levels are highest. Two separate blood tests on different days are often needed to confirm that testosterone is truly low.

Other blood tests may include:

• Luteinizing hormone (LH): This hormone is made by the pituitary gland and helps control the testicles. If LH is high, it may mean the testicles are not working well. If LH is low or normal, the problem may be in the brain or pituitary gland.

• Follicle-stimulating hormone (FSH): This hormone is also made by the pituitary gland. It plays a role in sperm production and is often checked in men with fertility problems.

• Prolactin: This hormone is made by the pituitary gland. High levels of prolactin may suggest a tumor or other issue with the pituitary.

• Sex hormone-binding globulin (SHBG): This protein binds to testosterone in the blood. If SHBG is high or low, it can affect the amount of free testosterone.

• Estradiol: This is a form of estrogen. In some men with low testosterone, especially those who are overweight or have symptoms like breast tenderness, doctors may check estrogen levels.

• Thyroid function tests: Sometimes thyroid problems can cause symptoms similar to low testosterone.

• Blood sugar and cholesterol tests: These are often included to check for diabetes and heart disease, which are linked to low testosterone.

Imaging Studies and Other Tests

Sometimes blood tests are not enough. Doctors may order images or other tests to look at different parts of the body.

Endocrinologists may order:

• MRI of the brain or pituitary gland: This is done if the doctor thinks there might be a tumor or problem in the pituitary. An MRI gives a detailed picture and helps spot growths or damage that could affect hormone production.

• Bone density scan (DEXA scan): Low testosterone can lead to weak bones. A bone scan may be ordered to check for signs of osteoporosis.

Urologists may order:

• Scrotal ultrasound: This test uses sound waves to make pictures of the testicles. It can show if there is any damage, swelling, or masses that could explain low testosterone.

• Semen analysis: For men who want to have children, a semen test can show how many sperm are present and how well they move. This helps the urologist know if fertility is a problem.

• Prostate-specific antigen (PSA) test: This blood test checks for signs of prostate problems. It is often done before starting testosterone therapy to make sure the prostate is healthy.

Hormone Stimulation and Suppression Testing

Endocrinologists may also use special tests to see how well the body makes hormones. These are called stimulation or suppression tests. For example:

• A GnRH stimulation test checks how the pituitary gland responds when given a hormone that should increase LH and FSH levels.

• An ACTH stimulation test might be used if there is concern about adrenal gland function, which can also affect testosterone levels.

These tests are usually done if the cause of low testosterone is not clear after basic blood work.

Both endocrinologists and urologists use many of the same blood tests. However, endocrinologists often focus on the brain, pituitary gland, and overall hormone balance. They may use advanced hormone panels and brain imaging. Urologists focus more on the testicles, prostate, and reproductive health. They are more likely to use physical exams, scrotal ultrasound, and semen analysis.

Getting the right tests is a key step in treating low testosterone. Choosing the right specialist helps make sure nothing is missed. Each test gives important information that guides safe and effective care.

Can Both Specialists Work Together in Low Testosterone Management?

Low testosterone can sometimes be more complex than it first seems. A person may have symptoms that involve more than one part of the body. Sometimes, both an endocrinologist and a urologist are needed to manage low testosterone. These two types of doctors can work together to give complete care. Each doctor brings different knowledge and skills, and working as a team can help find the best treatment plan.

An endocrinologist understands how hormones work in the body. This doctor can check the pituitary gland, thyroid gland, and adrenal glands. These glands help control how much testosterone is made. If the problem is in the brain or pituitary gland, an endocrinologist may find it and treat it. The endocrinologist also knows how to manage other hormone problems that may be linked to low testosterone, like diabetes or thyroid disease.

A urologist is trained to treat the male reproductive system. This includes the testicles, prostate, and penis. A urologist is helpful if the cause of low testosterone is in the testicles. Urologists are also skilled in treating sexual problems such as erectile dysfunction or low sperm count. For patients who want to have children, a urologist can help preserve fertility while still treating low testosterone.

In some cases, a patient may first see a urologist who finds signs of a hormone problem in the pituitary gland. The urologist may then refer the patient to an endocrinologist. Other times, the endocrinologist may notice testicular damage or low sperm count and refer the patient to a urologist. This kind of teamwork makes it easier to find the main cause of the problem and treat it the right way.

Fertility is one reason both doctors may work together. Some men with low testosterone want to have children. Testosterone therapy can lower sperm production. A urologist may help by using medicines like clomiphene citrate or hCG instead of testosterone. These options can raise testosterone levels while keeping sperm production normal. The endocrinologist may check hormone levels during treatment, and the urologist may monitor sperm health. Together, they can protect both hormone balance and fertility.

Another reason for team care is when low testosterone is part of a larger health issue. Some patients have several hormone problems, such as low testosterone along with low thyroid hormone. The endocrinologist can treat all the hormone issues, while the urologist can manage any problems with sexual function or the urinary system. This way, all symptoms are treated, not just one part of the problem.

Sometimes, a patient may need surgery, such as when a pituitary tumor is found. The endocrinologist may diagnose the tumor and explain its effect on testosterone levels. A surgeon may be needed to remove the tumor, and the endocrinologist will help manage hormone levels before and after surgery. If there are testicular problems, a urologist may perform procedures or recommend surgery to improve testicle function. The team can plan the right treatment together.

Communication between both doctors is very important. They may send medical reports back and forth or talk directly about the patient’s progress. A clear treatment plan helps avoid confusion and makes sure that care is safe and complete. It also helps avoid doing the same tests twice or giving treatments that cancel each other out.

In many medical centers, there are clinics where urologists and endocrinologists work side by side. This makes it easier for patients to get care from both experts without going to many different places. Even when they work in separate offices, these specialists often refer patients to one another and work as a team.

When both specialists manage low testosterone together, the patient often receives more complete care. This combined approach helps treat not just the low testosterone levels but also the cause and any other related problems. Working together, an endocrinologist and a urologist can give patients the best chance for safe and effective treatment.

How Is Treatment Monitored Over Time?

Managing low testosterone does not end once treatment starts. Monitoring is a key part of ongoing care. It helps ensure that the treatment is working, the dose is correct, and there are no harmful side effects. Whether a person sees a urologist or an endocrinologist, regular follow-up is very important for safe and effective treatment.

Tracking Testosterone Levels

After starting testosterone therapy, blood tests are needed to measure how the body responds. Most doctors check total testosterone levels in the blood to see if they are in the normal range. These tests are usually done in the morning when testosterone is highest. For people using injections, blood is taken at a certain time after the shot. For those using gels or patches, levels may be checked after a few weeks of use.

The goal is to keep testosterone levels within a safe and normal range, usually between 300 and 1,000 ng/dL. If levels are too low, the dose might be increased. If levels are too high, the dose may be lowered to avoid side effects.

Checking Symptoms and Daily Function

Lab results are important, but symptoms also matter. Doctors ask about energy, mood, sex drive, erections, muscle strength, and focus. These symptoms often improve in the first few months of treatment. If they don’t, the doctor may adjust the dose or check for other health problems.

Some people may feel better quickly. Others may take longer. Monitoring how symptoms change over time helps doctors decide if the treatment is working. If there are no improvements, further testing or changes in therapy may be needed.

Adjusting the Dose or Delivery Method

Testosterone can be given in different ways, such as shots, skin gels, patches, or pellets placed under the skin. If one method is not working well, another may be tried. For example, some people may not absorb gels properly through the skin. Others may not like the ups and downs of hormone levels that happen with injections.

Doctors may also adjust how often treatment is given. For example, injections can be weekly or every two weeks, depending on how the body responds. Patches and gels are usually used daily. Each person’s body reacts differently, so treatment is often adjusted over time.

Watching for Side Effects

Testosterone therapy can cause side effects. Some are mild and go away with time. Others need medical attention. One possible side effect is high red blood cell count, also called high hematocrit. This can make the blood thicker and raise the risk of clots. Blood tests can find this early. If levels are too high, the doctor may lower the dose or stop treatment for a while.

Testosterone can also affect the prostate. Doctors may check prostate-specific antigen (PSA) levels in the blood. A fast rise in PSA may lead to more tests. An exam of the prostate may also be done, especially in men over age 50.

Other side effects to watch for include acne, swelling, trouble sleeping, and mood changes. Some men may grow breast tissue, called gynecomastia. Fertility can also be affected. Testosterone therapy can lower sperm count, so men who want children should talk to a doctor about this before starting treatment.

Follow-Up Schedules

Doctors usually check testosterone levels 3 to 6 months after starting therapy. After that, tests are often done once or twice a year. The schedule may be more frequent if there are side effects or other health concerns.

Endocrinologists may also check other hormones, like luteinizing hormone (LH), follicle-stimulating hormone (FSH), or estradiol. This helps to see how the body’s hormone system is working as a whole.

Urologists may focus more on testicular health, semen quality, and sexual function. They may also perform imaging or fertility testing if needed.

Different Monitoring Styles

While both endocrinologists and urologists monitor testosterone therapy, their focus can differ. Endocrinologists often look at hormone levels in detail and manage related conditions like diabetes or thyroid disease. Urologists may pay more attention to sexual health, fertility, and urinary symptoms.

Some patients may see both specialists, especially if they have complex needs. Clear communication between all doctors involved helps provide complete and safe care.

Regular monitoring is essential for anyone taking testosterone therapy. It helps track improvement, avoid risks, and make sure the treatment stays on the right path. This careful follow-up helps support long-term health and well-being.

Are There Any Risks in Choosing the Wrong Specialist?

Choosing the right doctor to treat low testosterone is an important decision. When the wrong specialist is chosen, there can be delays in diagnosis, missed health problems, or the wrong treatment plan. Each type of doctor—endocrinologist or urologist—has different training and focuses on different parts of the body. Picking the one who does not match the cause of the problem may lead to poor health results.

Delays in Diagnosis

One of the biggest risks of seeing the wrong specialist is a delay in finding out what is truly causing the low testosterone. Testosterone levels can be low for many different reasons. Sometimes the problem is in the brain, such as with the pituitary gland or hypothalamus. These areas control how much testosterone the body makes. If a man has a tumor or damage in these parts of the brain, only an endocrinologist will usually know what to look for. A urologist may not test or examine these areas right away. As a result, treatment may begin without first finding the real cause.

Other times, the problem is in the testicles. This could be due to injury, infection, or genetic conditions. A urologist is trained to check for these problems. If a man with low testosterone only sees an endocrinologist and the issue is actually in the testicles, the cause might be missed. A scrotal ultrasound or semen test, which a urologist may order, might never be done.

Getting the correct diagnosis is the first step to the right treatment. Seeing the wrong type of doctor can delay this process and make symptoms worse over time.

Suboptimal Treatment and Missed Health Goals

Doctors from different specialties also treat low testosterone in different ways. If the wrong doctor is chosen, the treatment may not match the patient's needs. For example, some men want to raise testosterone levels but also want to have children in the future. Standard testosterone therapy (TRT) can lower sperm production. Urologists are more likely to suggest treatments that raise testosterone but protect fertility, such as clomiphene citrate or hCG injections. An endocrinologist may focus more on balancing hormone levels without focusing on future fertility.

Some men have other hormone problems, such as high prolactin or thyroid disorders. An endocrinologist is trained to spot and treat these issues. A urologist might not test for them. If these conditions are missed, the low testosterone may not improve. This means the treatment will not help and the symptoms may continue.

When the treatment does not match the true cause, the body can suffer. Fatigue, low mood, poor sexual function, and muscle loss may continue even if testosterone numbers go up. That is why it is not enough to simply increase testosterone. The root cause must be treated, too.

Long-Term Health Risks

Low testosterone affects more than just energy and sex drive. It can also lead to low bone density, higher risk of fractures, heart problems, and changes in mood. If these problems are not managed properly, they can become serious over time. An endocrinologist will often monitor bone health with tests like a DEXA scan. A urologist might focus more on sexual symptoms and not check bone strength.

The type of testosterone therapy used also brings different risks. Some forms of TRT can increase red blood cell count or affect the prostate. A urologist will usually track prostate health more closely. An endocrinologist may look at cardiovascular health or hormone levels from a wider view. If only one side of the problem is monitored, other health risks might go unnoticed.

Also, stopping testosterone therapy suddenly can bring back symptoms quickly. Some doctors help patients "cycle off" therapy safely, while others may not have a long-term plan. This can cause mood swings, fatigue, or loss of muscle. Good follow-up care and a clear plan for ongoing treatment are needed to avoid these issues.

The Value of the Right Specialist

Picking the right specialist means better care, faster diagnosis, and a treatment plan that fits the full picture. If the focus is on fertility, sexual health, or the testicles, a urologist is often the better choice. If the concern is hormone balance, pituitary function, or multiple health conditions, an endocrinologist may be best.

When there is doubt, starting with a primary care doctor can help. That doctor can refer the patient to the most appropriate specialist based on lab results and symptoms. In some cases, both a urologist and an endocrinologist may need to work together.

Choosing the right expert early can prevent complications, reduce long-term risks, and lead to better results. It is not just about getting treatment—it is about getting the right kind of treatment for the specific cause of low testosterone.

Conclusion: Choosing the Right Specialist for Low Testosterone

Low testosterone is a medical condition that can affect physical, mental, and emotional health. It may lead to fatigue, low sex drive, weight gain, depression, and loss of muscle mass. Because testosterone is a hormone, problems with it may come from different parts of the body. This makes it important to choose the right type of doctor for diagnosis and treatment. In most cases, low testosterone is not dangerous, but it should still be evaluated by a trained medical professional. Finding the right specialist helps ensure the proper tests are done and the best treatment plan is followed.

There are two types of specialists who often treat low testosterone: endocrinologists and urologists. Both are highly trained, but they focus on different parts of the body. Endocrinologists are hormone experts. They treat conditions related to glands like the thyroid, adrenal glands, and the pituitary gland. These glands control how much testosterone the body makes. Endocrinologists usually treat people who have secondary hypogonadism. This type of low testosterone starts in the brain or pituitary gland, which stops sending the right signals to the testicles. Endocrinologists also care for people who have other hormone problems at the same time, such as diabetes or thyroid disease.

Urologists are doctors who treat the urinary tract and male reproductive system. They are often involved when low testosterone is caused by problems in the testicles or if there are fertility concerns. Urologists also treat men with erectile dysfunction, prostate conditions, or scrotal pain. If low testosterone is linked to primary hypogonadism, which begins in the testicles, a urologist may be the best choice. Urologists often help men who want to preserve their fertility while receiving testosterone therapy. They are trained to balance hormone levels while protecting sperm production.

Each doctor approaches testing and treatment in a different way. An endocrinologist may order blood tests for several hormones like luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin. These tests help find out if the cause of low testosterone is in the brain or pituitary gland. If the results are unusual, imaging tests like an MRI may be done to look at the pituitary gland. On the other hand, a urologist may focus more on testicular function. They might perform a physical exam, check for lumps or swelling, or order an ultrasound of the scrotum. A semen analysis may be used if fertility is a concern.

Sometimes both specialists are involved. If the cause of low testosterone is not clear, or if there are several health issues at once, doctors may work together to give the best care. For example, a patient might see a urologist for fertility preservation and also be referred to an endocrinologist to manage hormone levels safely. Shared care can also be useful for men who start testosterone therapy and later need additional monitoring or adjustments. In these cases, communication between doctors helps avoid missed diagnoses and makes sure treatments are safe.

Choosing the wrong specialist can lead to problems. If a man with pituitary gland issues only sees a urologist, he may not receive the correct hormone testing. On the other hand, if a man with testicular injury only sees an endocrinologist, fertility options may not be discussed. Treatment without proper diagnosis can result in poor symptom control or side effects. For this reason, the best starting point is often the primary care provider. This doctor can evaluate symptoms, check testosterone levels, and then decide which type of specialist is best.

There is no one-size-fits-all answer when it comes to treating low testosterone. The choice between an endocrinologist and a urologist depends on many factors. These include the cause of the low testosterone, whether fertility is important, the person’s age, and any other health problems. What matters most is that the treatment is guided by a specialist with the right experience. With the correct care, men with low testosterone can feel better, regain energy, and improve their quality of life.