Low Testosterone: Symptoms, Testing, and Treatment Options
By Dr. Christopher Vendryes, MD · Board-Certified Urologist · · 5 min read
Quick answer: Low testosterone (hypogonadism) is diagnosed when a man has symptoms and a total testosterone level below 300 ng/dL on two separate early-morning blood tests, according to the American Urological Association. Symptoms include low sex drive, erectile dysfunction, fatigue, low mood, and loss of muscle. Treatment options include testosterone gels, injections, and pellets. Testosterone therapy suppresses sperm production, so men who want children need a different approach, such as medications that raise the body's own testosterone.
What are the symptoms of low testosterone?
- Low sex drive
- Erectile dysfunction
- Fatigue and low energy
- Depressed mood or irritability
- Reduced muscle mass and strength
- Increased body fat
- Decreased bone density
Many of these symptoms overlap with sleep problems, depression, thyroid disease, and other conditions, which is why proper testing matters.
How is low testosterone diagnosed?
- Two early-morning blood tests, because testosterone is highest in the morning and varies day to day
- Total testosterone below 300 ng/dL plus symptoms, per AUA guidance
- Additional tests such as LH, prolactin, and blood count to find the cause and establish a baseline
A single afternoon test or an at-home kit isn't enough to start treatment.
What are the treatment options?
| Option | How it's used | Good to know |
|---|---|---|
| Gels | Applied to skin daily | Can transfer to partners or children through skin contact |
| Injections | Weekly to every few weeks | Levels can rise and fall between doses |
| Pellets | Placed under the skin every few months | Steady levels; requires a minor procedure |
| Clomiphene, hCG | Stimulate natural production | Used off-label, often for men who want to preserve fertility |
What are the risks of TRT?
- Infertility: sperm counts can drop to zero
- Thickened blood: monitoring hematocrit is required
- Acne, breast tenderness, and fluid retention
- Effects on PSA: prostate monitoring is part of treatment
What about heart risk? The TRAVERSE trial, published in 2023, found that testosterone therapy didn't increase major cardiovascular events compared with placebo in men with hypogonadism and heart risk factors. Your urologist will still review your individual risks.
What can I do naturally?
Weight loss, regular exercise (especially strength training), good sleep, treating sleep apnea, and limiting alcohol can raise testosterone in some men.
Why see a urologist for low T?
A urologist can confirm the diagnosis, find the cause, protect your fertility if you want children, and monitor treatment safely. Read Male Infertility Testing.
Frequently Asked Questions
Talk to a Board-Certified Urologist
Dr. Vendryes sees patients in Plantation and across Broward and Palm Beach Counties for men's health, fertility, kidney stones, urologic cancers, and bladder problems.
References
- American Urological Association. Evaluation and Management of Testosterone Deficiency Guideline. 2018, amended 2024.
- Lincoff AM, et al. Cardiovascular Safety of Testosterone-Replacement Therapy (TRAVERSE). N Engl J Med. 2023.
- Urology Care Foundation. Low Testosterone.