Testosterone declines gradually in men, roughly one percent per year after age 30. For some, the change is barely noticeable. For others, it adds up to a real shift in energy, mood, strength, and drive.
This transition is sometimes called andropause, and it is far more common than most men realize.
Common Symptoms of Low Testosterone
- Persistent fatigue. Low energy that does not improve with rest or caffeine.
- Low libido and erectile dysfunction. Often the symptom that finally prompts a visit.
- Loss of muscle and strength. Harder to build, easier to lose, even with consistent training.
- Increased belly fat. Along with worsening insulin resistance and cholesterol numbers.
- Brain fog. Poor concentration, memory slips, and reduced mental sharpness.
- Mood changes. Irritability, low motivation, or a flat, depressed mood.
- Poor sleep. Both a symptom and a cause, since sleep loss further suppresses testosterone.
Most men do not arrive with all of these. The common story is several small changes over a few years that get written off as normal aging.
The Belly Fat Loop
Low testosterone and belly fat feed each other. Fat tissue contains an enzyme that converts testosterone into estrogen, so more belly fat means lower testosterone, which makes it easier to store more belly fat.
Breaking that loop usually takes addressing both at once rather than waiting for one to fix the other.
Getting Tested the Right Way
Testing is where most men get poor answers.
Testosterone follows a daily rhythm and peaks in the morning, so the sample should be drawn before about 10 a.m. An afternoon draw can look low when your morning level is fine.
Total testosterone is not enough on its own. Most of it is bound to a protein called SHBG and unavailable to your tissues. Free testosterone is what your body can actually use, and a man can have a normal total with a low free level.
A proper workup includes total and free testosterone, SHBG, estradiol, LH and FSH, plus thyroid, a metabolic panel, vitamin D, and a complete blood count. LH and FSH tell us whether the problem is in the testes or in the brain's signaling, and that changes treatment.
Because levels vary, we confirm a low result with a second morning draw before treating.
The "Normal" Problem
Reference ranges are built from men of all ages, including men in their eighties. A 45-year-old sitting at the bottom of that range is told he is normal.
He may be normal for a population. He is not necessarily at a level where he feels well. We read your numbers against your symptoms and your age, not against a range built from everyone.
What We Look For First
Before starting testosterone, we look for reversible causes. Sleep apnea is a frequent one and suppresses testosterone significantly. So do excess weight, heavy alcohol use, chronic stress, certain medications including opioids, and untreated thyroid disease.
Sometimes treating the cause raises testosterone enough that replacement is unnecessary. That is a better outcome, and it is worth a few months to find out.
Treatment Options
When replacement is appropriate, options include injections, creams and gels, and other delivery methods. Injections are common, effective, and inexpensive. Creams avoid needles but require care to avoid transferring to family members.
For men who want to preserve fertility, testosterone replacement is usually not the right first step, since it suppresses the body's own production. Other medications can raise your natural testosterone instead. Tell us early if fertility matters to you.
Monitoring Matters
We recheck at six to eight weeks, then periodically. We watch testosterone and free testosterone, estradiol, red blood cell count, and PSA.
Red blood cell count matters because testosterone can thicken the blood. This is manageable when someone is watching and a genuine risk when nobody is. Any clinic that prescribes testosterone without regular labs is not managing your care.
What Testosterone Will Not Fix
Expectations matter. Testosterone reliably helps energy, libido, mood, and the ability to build muscle when your level is genuinely low.
It will not build muscle without training, replace sleep, or resolve a marriage problem or job stress. If low testosterone was one of three things dragging you down, correcting it fixes one of three.
How Long Before You Feel It
Libido and mood often shift within three to six weeks. Energy follows. Changes in muscle and body composition take three to six months and require that you are training and eating enough protein.
If nothing has changed by week eight, that usually means the dose needs adjusting or something else is going on. It is a reason to look further, not a reason to quit.
Dr. Milani is board-certified in advanced hormone therapy through ABHRT. We treat low testosterone by telehealth for men across Washington and Idaho, from our clinic in Spokane. Book a free 15-minute call.