What is low testosterone?

Low testosterone is when your total testosterone levels are below the normal range. 

Normal levels of testosterone range from 12 to 30 nmol/L in men. Testosterone below 8 nmol/L is considered low in men. In women it’s usually recommended to measure testosterone as part of something called the free androgen index and a result of less than 1.0% would be considered low. 

What are the effects of low testosterone?

The effects of low testosterone can include changes to:

• how often you want to have sex
• how easy it is for you to get or keep an erection when you’re aroused  (erectile dysfunction)
• how strong your muscles and bones are
• your weight
• the amount of hair on your head, face, and body
• your mood

Low testosterone can also make developing conditions like heart disease and diabetes more likely. 

How common is low testosterone? 

Low testosterone affects 10-40% of men worldwide and is more common with increasing age.

Can women have low testosterone? 

Yes. Testosterone also plays a part in women's health. It is important for the production of red blood cells, sex drive, and female reproductive health. 

Signs and symptoms of low testosterone

What are the symptoms of low testosterone? 

Common symptoms of low testosterone include:

• decreased libido (sex drive). Having less desire for sex
• sleep disturbance. Difficulty falling or staying asleep and poor quality of sleep
• tiredness and lack of energy that doesn’t improve with rest or sleep 
• brain fog. Difficulty focusing and concentrating on tasks. You may be more distracted and forgetful than usual
• depression. Feeling sad, losing interest in doing the things you normally enjoy, mood swings, and irritability

Low testosterone, anxiety, and depression 

Depression and anxiety are common symptoms in people with low testosterone, but it is not clear which condition causes the other. Depression becomes more common as we age, which is also when our testosterone levels naturally lower. 

Depression, anxiety, and low mood may occur as a result of other low testosterone symptoms such as low sex drive, erectile dysfunction, weight gain, and poor-quality sleep. In men who have low testosterone levels studies, however, have shown an improvement in depression and anxiety symptoms following treatment with testosterone replacement therapy.

Symptoms of low testosterone in men

In addition to the symptoms listed above, men with low testosterone may experience:

• erectile dysfunction (ED). Difficulty getting or maintaining an erection and fewer spontaneous erections (erections that occur without sexual stimulation)
• hair loss
• decreased muscle mass. Muscles become smaller and weaker
• gynecomastia. Growth of breast tissue in men or boys
• increased body fat, especially around your waist. It may also be harder to lose weight

How does low testosterone affect male fertility? 

Although low testosterone can make you want to have sex less often, and can be caused by conditions which can effect your fertility, sperm production is controlled by other hormones and the link between low testosterone and male infertility is unclear. Reduced fertility is a potential side effect of testosterone replacement therapy for as long as you are taking it, and you should be aware of this before starting treatment. If you have any questions or concerns about testosterone treatment and reduced fertility, speak to your GP. 

Symptoms of low testosterone in women

Some common symptoms in women with low testosterone are: 

• low sex drive and reduced sexual satisfaction
• depression and low mood
• tiredness, weakness, and low energy

What are the signs you may have low testosterone? 

Some visible signs of low testosterone are:

• growth of breast tissue in men (gynecomastia)
• reduced body and facial hair 
• baldness
• fat around your middle
• smaller muscles

Is it dangerous to have low testosterone? 

Low testosterone can cause your bones to become weaker and more brittle (osteoporosis) making them more likely to break. Low testosterone has also been linked to conditions like metabolic syndrome, type 2 diabetes, and heart disease.

What causes low testosterone?

There are two types of low testosterone. In primary hypogonadism, the testicles do not make enough testosterone, and in secondary hypogonadism, the problem is with the signal sent by parts of the brain that tell the testicles to make testosterone. 

Some common causes of low testosterone include: 

• normal ageing. Testosterone production naturally peaks in your teenage years to early adulthood then declines
• injury to the testicles, particularly both testes, which may result in your body not making enough testosterone
• hormonal disorders. Your body needs certain hormones to make testosterone. If there is an imbalance of these hormones or damage to the parts of the brain that produce them, your testosterone may be low
• HIV/AIDS.  Low testosterone is common in people with HIV and AIDS because of an imbalance in the hormones needed to produce testosterone
• testicular cancer can damage the testes, causing them to make less testosterone
• cancer treatment. Chemotherapy or radiotherapy can cause damage to the testicles resulting in low testosterone. This is often temporary, but in some cases can be permanent. Freezing sperm before having cancer treatment can be an option for men who want to have children
• too much iron in the blood (Haemochromatosis) can cause low testosterone either by affecting testosterone production in the testes or stopping the pituitary gland from working properly 

Some less common causes of low testosterone include:

• Some medications. If you have any questions or are worried about any medicine you are taking, talk to your GP.
• Klinefelter`s syndrome. This is a condition present at birth where there is an extra chromosome in addition to the X and Y chromosomes.  It means the testicles don’t develop as they should, resulting in low testosterone. 
• undescended testes. When babies are in the womb, the testicles develop inside the abdomen before moving down into the scrotum. Sometimes babies are born with their testes still inside the abdomen. This condition usually resolves on its own, but if it doesn’t, and is not treated, it can result in low testosterone
• mumps infection in childhood can damage the testes and result in low testosterone

Is it normal to have low testosterone in your twenties?

It is a lot less common for men in their twenties and thirties to have low testosterone than older men as testosterone declines with age. 

What causes low testosterone in women? 

In women, testosterone is produced in small amounts by the ovaries, adrenal glands (hormone-producing glands on top of the kidneys), and fat tissue. Before and after menopause, some women experience a drop in the levels of hormones produced by the ovaries, including testosterone. 

Low testosterone in women can also be caused by:

• the adrenal glands not working properly (adrenal insufficiency)
• removal of the ovaries (oophorectomy)
• menopause
• the pituitary gland not working properly (hypopituitarism)

How do you know if you have low testosterone?

How is low testosterone diagnosed?

Low testosterone should be diagnosed by a Doctor. At your appointment, your doctor will ask you some questions about your symptoms, medical history, and any medications you are taking. They will check your blood pressure, weight, take measurements around your waist, and examine you physically. They may order a blood test to check your testosterone level. 

Testosterone tests

The main test to diagnose low testosterone is a blood test. This test should be done in the morning when testosterone levels are at their highest. If the result is low or borderline, it is recommended that you repeat the test in 4 weeks. If you are unwell it is best to wait until you are better as the result may not be accurate. 

You can get a fast & easy to use total testosterone level test from Superdrug Online Doctor. This is a simple at home test you can take in your own time whenever and wherever you're comfortable. It comes with full instructions and can be done with a small drop of blood from your finger. If you think you need to start testosterone replacement therapy, you will need to make an appointment to see your GP.

What level of testosterone is considered to be low? 

In men, a testosterone level below 8 nmol/L  is considered to be low and a level of between 8-12 nmol/L is borderline.

At what level should low testosterone be treated? 

Treatment is normally recommended when you have had two tests and both results show testosterone levels below 8 nmol/L. If you have a level between 8 and 12 nmol/L treatment might be recommended if you have symptoms of testosterone deficiency. 

How to treat low testosterone

Low testosterone is easily treated with testosterone replacement therapy. If you think you need testosterone replacement therapy you should contact your GP as it’s important to check this is suitable for you and there are some side effects you should know about before you start treatment. 

How do you fix low testosterone? 

Low testosterone is normally treated with testosterone replacement therapy (TRT). Making some changes to your lifestyle such as losing weight if you are overweight can also help increase your testosterone. TRT is not suitable for men who have certain health conditions such as prostate or breast cancer.

Low testosterone treatment

Testosterone replacement therapy must be prescribed by a doctor. It is available in various forms. 

Tostran gel and Testogel  

Tostran gel 2% and Testogel 50mg/5g are two types of testosterone replacement therapy gel that you apply to your skin. Make sure you apply the gel exactly as your doctor tells you. Once you have been prescribed Tostran or Testogel by your doctor and have regular reviews, you can reorder it from Superdrug online doctor for home delivery or collect it in-store. 

Other treatments

TRT is also available as a patch that you apply to your skin, or as tablets or injections. Talk to your GP about which one is right for you.

What are the side effects of low testosterone treatment? 

TRT is generally safe, but it can cause side effects meaning you will need to have regular check-ups before you start and while you are taking TRT. 

Serious side effects include:

• increased risk of prostate problems
• thickening of the blood leading to an increased risk of blood clots, heart attack, and stroke.

Other possible side effects are:

• oily skin and acne
• weight gain
• nausea
• high blood pressure
• swelling of the legs or arms
• increased breast size
• depression

Can women get this treatment? 

TRT is not currently licensed for use in women but may be prescribed in certain situations when low sex drive has not improved with other treatments. 

Can vitamins or supplements help? 

Studies haven’t found any convincing evidence that taking additional zinc of vitamin D beyond the amount that is recommended daily has a significant effect on testosterone levels. 

What lifestyle changes can increase testosterone levels? 

A healthy lifestyle can naturally boost testosterone, so it is important to look after yourself and adopt some healthy habits. Some things you can do are:

• lose weight, if you are overweight
• make sure you get enough sleep 
• avoid stress 
• exercise regularly if you are able to do so 
• don’t smoke
• don’t drink too much alcohol
• eat a healthy diet

Sources

Impact of exogenous testosterone on mood: a systematic review and meta-analysis of randomized placebo-controlled trials (2014) Accessed 13th December 2021

NHS: Hormone replacement therapy (2019) Accessed 20th November 2021 

NCBI: Hypogonadism in the HIV infected man (2017) Accessed 20th November 2021 

Testosterone replacement in menopause (2019) Accessed 13th December 2021

Testosterone deficiency in adults and corresponding treatment patterns across the globe (2017) Accessed 13th December 2021