- Diagnostic threshold (AUA)
- Total testosterone below 300 ng/dL
- Confirmation
- Two morning tests on separate days
- Most specific symptoms
- Low desire, fewer morning erections, erectile problems
- Key fertility fact
- Testosterone therapy suppresses sperm production
What testosterone deficiency actually is
Testosterone deficiency, also called male hypogonadism, means the body makes too little testosterone and that shortfall causes symptoms. Both parts are required. A low number without symptoms is not a diagnosis, and symptoms with a normal number point somewhere else.
The American Urological Association treats a total testosterone below 300 ng/dL as a reasonable cutoff, confirmed on two separate morning blood draws. The Endocrine Society likewise advises diagnosing only when symptoms are present and levels are unequivocally and consistently low.
Does testosterone simply fall with age?
Testosterone does drift down slowly with age, but most men stay within the normal range. In the European Male Ageing Study, true late-onset hypogonadism defined by symptoms plus low levels affected only about 2% of older men and was often tied to obesity and poor general health.
Symptoms that point toward low testosterone
Sexual symptoms are the most closely linked. In the European Male Ageing Study of more than 3,300 men aged 40 to 79, fewer morning erections, lower sex drive and erectile problems were the symptoms most tied to low testosterone. Tiredness, poor concentration and low mood were only weakly related.
Other signs that can fit include loss of body hair, reduced muscle, enlarged breast tissue, thinning bones or unexplained anemia. These are less common but more meaningful when they appear.
- Strongly linked: reduced desire, fewer spontaneous or morning erections, erectile dysfunction
- Possibly linked: lower energy, less strength, more body fat, low mood
- Weakly or not linked on their own: poor sleep, anxiety, trouble concentrating
Conditions that produce the same picture
Many problems in midlife cause fatigue, low drive and weight gain. Some of them also lower testosterone, which can make a low reading a consequence rather than the root cause. Before testosterone therapy, it's worth checking for:
- Obstructive sleep apnea, which fragments sleep and is closely tied to excess weight
- Thyroid disease, either underactive or overactive
- Excess weight and insulin resistance, which lower testosterone and binding proteins
- Regular alcohol use
- Depression
- Medications, especially long-term opioids and corticosteroids, and past anabolic steroid use
How a careful workup is done
Testosterone peaks in the morning, so tests should be drawn early, roughly between 7 and 10 a.m. A single low result is repeated before any decision. If levels are low, luteinizing hormone (LH) helps show whether the problem starts in the testes or in the brain's signaling, and prolactin is checked when LH is low or low-normal.
Before treatment, guidelines call for a hematocrit and, in men over 40, a PSA test. Men who may want children in the future need a different plan, because outside testosterone shuts down sperm production.
Treatment options and their trade-offs
When deficiency is confirmed and symptoms fit, testosterone therapy can improve sexual function and other symptoms for many men. It requires monitoring: testosterone levels, hematocrit (red blood cell concentration), PSA and blood pressure. In 2025 the FDA updated testosterone labeling to add results from the TRAVERSE trial, which did not find increased cardiovascular risk in men treated for hypogonadism, and to add warnings about raised blood pressure.
For men who want to protect fertility or whose problem is in pituitary signaling, a clinician may discuss alternatives such as enclomiphene. Lifestyle changes, including weight loss, treating sleep apnea and cutting alcohol, are part of every plan. At HealifyMD, testosterone replacement therapy is $249 for the first month, then $149/month, confirmed at your eligibility review; the first month includes the lab panel.
Steps that help regardless of your number
Losing excess weight, treating sleep apnea, cutting back on alcohol and regular strength training can raise testosterone modestly in some men and improve energy and sexual function on their own. They also make any therapy safer and more effective.
When to see a doctor in person
Get prompt in-person care if you notice a new breast lump, testicular swelling or pain, severe headaches with vision changes, or very low testosterone together with loss of other hormone functions. These can point to pituitary or testicular conditions that need examination and imaging.
