The current influx of online and television ads about “Low T” might convince you that American men are facing a widespread epidemic of low testosterone.
But is it really that common?
Medically known as male hypogonadism, this condition occurs when the testes do not produce enough testosterone, an essential hormone that determines a wide range of male bodily functions and traits, from libido, muscle development and strength to blood cell production, bone density and even memory.
While it’s true that testosterone levels naturally decline by about 1% per year after age 30, true hypogonadism is actually quite rare, affecting less than 1% of men.
Yet public interest is soaring.
According to a Men’s Health survey, 40% of men say their testosterone levels matter more to them today than just a year ago.
A major byproduct of this boom is that testosterone replacement therapy (TRT) – the prescription medical treatment for low testosterone – is increasingly being marketed as a lifestyle supplement for performance and optimization. This growing visibility has sparked trends such as “testmaxxing” where men without medical impairments take TRT without a doctor’s advice to accelerate their progress in the gym.
Unnecessary TRT carries serious health risks, ranging from thickened blood to impaired cardiovascular health, and can also lead to physical dependence and infertility.
Here’s what men should know about low testosterone, including what’s normal, what’s not, and when treatment is actually necessary.
Myth: Low testosterone only affects your libido
Although a drop in libido is the most widely recognized sign of low testosterone, mood changes are actually the most important and often overlooked effects.
Depressed mood is a common symptom when testosterone levels drop significantly, although most people incorrectly attribute it to external causes.
Testosterone deficiency can also trigger physical changes, such as loss of muscle mass, which often leads to fat gain and can ultimately contribute to obesity.
Additionally, testosterone plays a vital role in signaling the bone marrow to produce red blood cells. When these hormone levels decrease, red blood cell production also decreases.
Myth: Low testosterone is an inevitable and normal part of aging
The cause of low testosterone generally falls into three main categories:
Primary hypogonadism (testicular damage): Since testosterone is produced in the testicles, any direct damage – whether from chemotherapy, physical trauma, surgery, or developmental issues – prevents them from functioning properly.
Secondary hypogonadism (pituitary dysfunction): The pituitary gland, a small gland located outside the brain, acts as the body’s main regulator, signaling organs like the testicles to produce hormones. If the pituitary gland is impaired, the testicles do not receive the instructions they need and stop production.
Stress-induced suppression: A temporary drop in levels may be triggered by psychosocial stress, grief, lack of sleep, exhaustion, infection or financial stress. It can also occur regularly after childbirth. To conserve energy, the brain suppresses testosterone and plans to restore it later.
Myth: Taking TRT without a doctor’s approval is low risk
When you introduce external testosterone, your brain signals the pituitary gland to stop natural production. This can cause secondary hypogonadism and testicular shrinkage, ultimately leading to infertility.
Excess testosterone also stimulates the production of red blood cells, thickening the blood and increasing the risk of blood clots, embolisms or strokes. Additionally, it can negatively impact your cholesterol levels, increasing your long-term risks of cardiovascular disease.
Because many tissues respond to testosterone, improper dosage can cause an enlarged prostate, making urination difficult, or thickening of throat tissues, which can trigger or worsen sleep apnea.
Because of these complexities, a doctor must manage TRT, monitoring your red blood cell, cholesterol, sleep, and PSA levels.
Myth: Healthy testosterone never fluctuates or drops
Testosterone levels naturally fluctuate throughout the day, typically peaking in the early morning between 7:00 and 10:00 a.m. before decreasing by up to 50% towards the evening.
Because medical reference ranges are standardized to early morning values, clinicians recommend drawing blood in the morning to ensure an accurate baseline.
Tests taken later in the day may give artificially low results that do not reflect true hormonal health.
Seasonal changes can also cause minor variations in overall levels.
Myth: TRT is the only way to increase low testosterone levels
TRT is designed and FDA approved to restore testosterone to normal levels in cases of true clinical deficiency.
In men, testosterone levels are closely linked to estrogen, much of which is produced in fatty tissues. When a man gains a lot of weight or is obese, the increase in fatty tissue can cause more testosterone to be converted to estrogen, thereby naturally lowering testosterone levels.
Therefore, losing that extra weight can help reverse this process and increase testosterone naturally.
Fundamental lifestyle habits, such as getting enough sleep, maintaining a healthy diet, and avoiding extreme physical overwork, play a vital role in supporting the production of natural hormones.
Myth: Stopping TRT on your own is safe
For most men, natural testosterone production will eventually return after stopping TRT, especially if they haven’t taken it for a long time.
However, the exact timeline is very unpredictable.
While some people see their levels rebound in about six weeks, for others it may take nine months or even longer. Recovery tends to be much slower for those who have used high doses over an extended period of time.
During this transition, it is common to experience symptoms of clinically low testosterone, such as fatigue and depressed mood, as the body works to restore its baseline.
Dr. Marcus D. Goncalves is Director of the Holman Division of Endocrinology, Diabetes and Metabolism at NYU Langone Health. An endocrinologist and biomedical researcher, he specializes in metabolic disorders, including diabetes, high cholesterol, cachexia and muscle wasting. His research focuses on the role of insulin resistance and dietary sugars in metabolic diseases, obesity and cancer progression.
Gn Health
