Signs of Low Testosterone

Testosterone is essential to mood, muscle mass, cardiac function and more.

Erica Dermer

Medically reviewed by

Andre C. King, MD

and

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Highlights

  • Testosterone is a major hormone responsible for sexual development and function, but it can also impact cardiac health, bone density, muscle mass, mood and more.
  • Production of testosterone naturally wanes with age, and lower levels are common in men 45 and over. High testosterone is less common.
  • Balanced testosterone levels may contribute to better health and quality of life.

You probably already know that low testosterone can affect a man's fertility, energy and sex drive, but did you know that testosterone impacts everything from facial hair to bone and muscle mass to mood, cardiac health and blood cell counts?

That's why it's important to get checked if you think you might have a testosterone deficiency. Luckily there are easy warning signs to look for and treatment options available.

How is testosterone produced?

Testosterone is a major sex hormone found in people of all genders. In those born with a penis, testosterone is produced by the testes; in those born with a vagina, testosterone is produced by the ovaries. The adrenal glands of all people also contribute to testosterone production.

What does testosterone do?

Most people's testosterone blood levels are relatively stable through infancy, toddlerhood and childhood. At puberty, as the body matures and the pituitary gland sends hormonal signals to the rest of the body, testosterone levels will rise — especially in boys. At this time, the following events start:

  • Growth of facial and body hair
  • Enlargement of genitals
  • Deepening of the voice
  • Experience of erections and ejaculation
  • Increase in height and weight

In adolescence and adulthood, testosterone also affects sexual health and fertility, skeletal and muscle development, cardiac function and more.

What are the symptoms of low testosterone?

Men with low testosterone may first notice a dip in their libido, or sex drive, and/or symptoms of erectile dysfunction,¹
but there can be other subtle signs. 

These symptoms may include:²³

  • Hair loss, aka pattern baldness
  • Fatigue
  • Irritability, depression and other mood changes 
  • Memory and concentration issues
  • Loss of muscle strength
  • Increased body fat

Low testosterone affects almost 40% of men aged 45 and older, but age-related decline is not the only cause of this hormonal imbalance. Other factors include:⁵⁶

  • Medications, including opioid narcotics, drugs used to treat prostate cancer, steroids and more
  • Medical conditions, including liver cirrhosis, kidney failure, HIV and severe hypothyroidism
  • Injury or infection of the testes
  • Alcohol abuse
  • Obstructive sleep apnea
  • Obesity, sedentary lifestyle and depression
  • High levels of estrogen or prolactin

What are the long-term effects of low testosterone?

If low testosterone is left untreated, it can have a number of negative long-term impacts on men. Some of these negative effects can include:

Cardiac complications

There is a direct link between testosterone and heart health. Blood vessels and heart cells both have receptor sites for testosterone; the hormone is thought to help widen blood vessels. There is also evidence that low testosterone may contribute to cholesterol blockages.

Loss of bone density

Osteoporosis can occur in men with low testosterone. The hormone loss accelerates bone turnover, making bones brittle and more prone to fracture. With proper diagnosis and treatment, which may include testosterone replacement therapy, the effects of osteoporosis can be slowed.

Loss of muscle mass

Muscle mass naturally declines with age, but more severe muscle atrophy is typically caused by an injury or a condition such as a hormonal imbalance.¹⁰ ¹¹

What are the symptoms of high testosterone?

Clinically high testosterone in men is uncommon. When it does occur, it usually has a known cause, such as excessive use of anabolic steroids or testosterone supplements. 

Symptoms can include:¹²

  • Acne
  • Mood swings, including potentially aggressive or risky behavior
  • Prostate enlargement and difficulty peeing
  • Shrunken testicles
  • Swollen hands and feet
  • Weight gain
  • High blood pressure
  • Headaches
  • Insomnia

What are the long-term effects of high testosterone?

There's a complicated relationship between this essential hormone and prostate cancer¹³—in careful doses, it can be used as therapy, but according to research published by Johns Hopkins Medicine, most researchers view it as “fuel for prostate cancer.”¹⁴ Too much testosterone is also associated with liver disease, cardiac damage and low sperm count.¹⁵

How are testosterone levels tested?

Your testosterone levels can be tested with a blood draw at your doctor's office, a lab or with an at-home testing kit.  Whether you leave the house or not, total blood testosterone is the most common test, and is considered normal when level falls between 240 and 950 nanograms per deciliter (ng/dL).

How are testosterone imbalances treated?

If your test results indicate abnormal levels, don't panic — there are treatments available: 

Testosterone replacement therapy (TRT)

This is the most common option for low testosterone and typically involves supplementing with testosterone injections, skin patches, oral medications or topical gels. 

TRT increases the risk of blood clots, stroke and heart attack and can include side effects such as acne and sleep apnea¹⁶ — your healthcare professional can help assess if this testosterone treatment is right for you.

Medications to suppress testosterone levels

This treatment is designed to bring your hormone levels to a normal range and will vary depending on the cause of the abnormal test results. 

Your healthcare professional may also tweak other medications you're taking or recommend lifestyle changes. A medical professional can help to determine the best course of action depending on your particular hormonal imbalance and risk factors.

Summary

Testosterone is a hormone present in people of all genders and is particularly important to men's sexual health and development. Too much or too little testosterone can cause health issues. Testosterone levels naturally wane with age, with implications for sexual health, cardiac wellness, bone density, mood and muscle mass. Testosterone imbalances are easy to test and simple to treat. Talk to your healthcare professional if you have symptoms.

Updated on
May 31, 2022
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REFERENCES

  1. Cleveland Clinic. Low Testosterone. Accessed November 15, 2021.
  2. JAMA Network. Testosterone Deficiency. Accessed November 30, 2021.
  3. Cleveland Clinic. Low Testosterone. Accessed November 15, 2021.
  4. Cleveland Clinic. UW Health. What You Need to Know About Low Testosterone. Accessed November 30, 2021.
  5. Cleveland Clinic. Low Testosterone. Accessed November 15, 2021.
  6. JAMA Network. Testosterone Deficiency. Accessed November 30, 2021.
  7. Harvard Health Publishing. Testosterone and the heart. Accessed November 30, 2021.
  8. Clinical Interventions in Aging. A concise review of testosterone and bone health. Accessed November 30, 2021. 
  9. Harvard Health Publishing. Testosterone — What It Does And Doesn’t Do. Accessed November 30, 2021.
  10. Advances in Experimental Medicine and Biology. Hormones and Muscle Atrophy
  11. The World Journal of Men’s Health. Testosterone and Sarcopenia. Accessed November 30. 2021. 
  12. Harvard Health Publishing. Testosterone — What It Does And Doesn’t Do. Accessed November 30, 2021.
  13.  The World Journal of Men’s Health.Testosterone Replacement Therapy and Prostate Cancer Incidence. Accessed December 1, 2021.
  14. Johns Hopkins Medicine, Promise and Progress 2018. Testosterone as a Drug. Accessed December 1, 2021.
  15.  Harvard Health Publishing. Testosterone — What It Does And Doesn’t Do. Accessed November 30, 2021.
  16. University of Michigan Health. Testosterone injection. Accessed December 15, 2021.

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