What is low testosterone?

As you get older, you will likely experience typical aging-related physical and mental changes. You may gain weight and belly fat, lose muscle, and start noticing a gradual loss of vigour and sex drive, and get the feeling that you have passed your peak. But what if this isn’t just because of aging?

Commonly, testosterone levels progressively decline in men as they get older,6 low testosterone can also occur in young men, especially if they have developed a belly or have an excess amount of total body fat.7 Other causes of low testosterone in younger men is life/work stress8,9 and use of medications, such as opioids,10 selective serotonin reuptake inhibitors (SSRIs)11 and statins.12 Therefore, low testosterone is not just an “old man’s problem”. 

Less common causes of low testosterone in young men include testicular trauma, concussion and congenital (present at birth) disease caused by chromosomal abnormalities or gene mutations.

So why is testosterone important? Testosterone not only gives you sexual desire (libido) and enables you to have an erection,13 it also provides a wide range of health benefits, such as improvement in wellbeing/quality of life, blood sugar control, cholesterol profile, body composition (reduced body fat and increased muscle mass) and bone density, that might be expected to reduce long-term sickness and prevent premature death.14,15 In fact, it is well documented that men with low testosterone have increased risk of the metabolic syndrome, diabetes, heart disease and death.14-16

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What are the signs & symptoms of low testosterone?

Signs & symptoms

Men who have signs and symptoms of low testosterone – summarized in the illustration and listing below - commonly ignore them, thinking “I’m just getting older” and believing that nothing can be done to get rid of these bothersome symptoms.

Common symptoms and signs of hypogonadism (low testosterone) in men..2,4,5,17,18

Metabolic Symptoms


  • Obesity (BMI 30 or higher)
  • Abdominal (belly) obesity (waist circumference 102cm or higher)
  • Metabolic syndrome
  • Insulin resistance, prediabetes or type 2 diabetes

Sexual symptoms


  • Decreased sexual desire and activity
  • Decreased frequency of sexual thoughts
  • Erectile dysfunction
  • Delayed ejaculation
  • Decreased volume of ejaculate
  • Decreased frequency or absent morning or night-time erections
  • Small testes
  • Infertility


Marek on his own

Psychological symptoms


  • Depressed mood
  • Loss of energy
  • Reduced motivation
  • Poor concentration
  • Decreased well-being and/or poor self-rated health
  • Irritability
  • Sadness
  • Impaired memory
  • Decreased cognitive function (including impaired concentration, verbal memory, and spatial performance)


Physical symptoms


  • Decreased muscle mass and strength
  • Reduced physical performance
  • Hot flushes or sweats
  • Sleep disturbances
  • Fatigue
  • Reduced bone mineral density, osteoporosis,
    low trauma fractures
  • Decreased body hair
  • Gynecomastia (female breasts)

Is ageing the only reason for low testosterone?

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Many people think that the main cause of low testosterone is ageing. This is wrong. The most common and strongest risk factor for low testosterone is actually obesity.6,22,23

This means that by living a healthy lifestyle with regular exercise and healthy food habits, you can maintain your testosterone level in the healthy range even as you get older. In other words, low testosterone – while common - is not inevitable in men as they get older, as menopause is in women.

Other common causes of low testosterone are the metabolic syndrome24-26 and type 2 diabetes.27-30 Chronic diseases, such as high blood pressure, heart disease, liver disease, kidney disease, arthritis, stroke, emphysema, rheumatoid arthritis and depression may also be risk factors for low testosterone.1,28,31

Which men are most at risk of TD?

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Men with...


Up to 80% of men with obesity have low testosterone.32,33 Medical guidelines state that all men who have an increased waist circumference - 94 cm (37 inches) or higher - or who have obesity (BMI 30 or higher) should be checked for low testosterone by having testosterone levels measured.34

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Men with...
Erectile dysfunction


Among men with erectile dysfunction, over one third (36%) have low testosterone levels.9 Low testosterone can cause erectile dysfunction and/or non-responsiveness to treatment with PDE5i (phosphodiesterase 5 inhibitors) such as Sidenafil. Therefore, according to medical guidelines is it mandatory that men with erectile dysfunction have testosterone levels measured.38,39


This is particularly important if your erectile dysfunction treatment doesn’t appear to be working well.

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Men who...
Take medications


Certain medications, especially opioids,10 selective serotonin reuptake inhibitors (SSRIs)11 and statins,12 can reduce your testosterone level.

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Men with...
Type 2 diabetes


Half of men with type 2 diabetes have low testosterone.35 Obesity is common among men with type 2 diabetes,36 but even non-obese men with type 2 diabetes commonly have low testosterone.35 The frequent occurrence of low testosterone in men with type 2 diabetes prompted medical guidelines to recommend that testosterone levels are measured in men with type 2 diabetes who have symptoms of testosterone deficiency.37

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Men with...
Heart disease


Nearly one in four men (24%) with heart disease have low testosterone.40 Men with heart disease who also have low testosterone have a higher risk of death compared to men with heart disease who have healthy testosterone levels.40

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Men with...
High level of work stress


Over 40% of men who report having a higher degree of work related stress have low testosterone.9

Have you done a self assessment on testosterone deficiency before?

Find out how testosterone deficiency is diagnosed by healthcare professionals.

Check your symptoms now


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  • Bhasin S, Brito JP, Cunningham GR, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5): 1715-1744. Return to content
  • Hackett G, Kirby M, Edwards D, et al. British Society for Sexual Medicine Guidelines on Adult Testosterone Deficiency, With Statements for UK Practice. The journal of sexual medicine. 2017;14(12):1504-1523. Return to content
  • Dohle GR, Arver S, Bettocchi C, Jones TH, Kliesch S. 2018 European Association of Urology (EAU) Guidelines on Male Hypogonadism. Available at https://uroweb.org/guideline/malehypogonadism. Return to content
  • Travison TG, Araujo AB, Kupelian V, O’Donnell AB, McKinlay JB. The relative contributions of aging, health, and lifestyle factors to serum testosterone decline in men. J Clin Endocrinol Metab. 2007;92(2):549-555. Return to content
  • Gapstur SM, Gann PH, Kopp P, Colangelo L, Longcope C, Liu K. Serum androgen concentrations in young men: a longitudinal analysis of associations with age, obesity, and race. The CARDIA male hormone study. Cancer Epidemiol Biomarkers Prev. 2002;11(10 Pt 1):1041-1047. Return to content
  • Kreuz LE, Rose RM, Jennings JR. Suppression of plasma testosterone levels and psychological stress. A longitudinal study of young men in Officer Candidate School. Arch Gen Psychiatry. 1972;26(5):479-482 Return to content
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  • Bawor M, Bami H, Dennis BB, et al. Testosterone suppression in opioid users: a systematic review and meta-analysis. Drug Alcohol Depend. 2015;149:1-9. Return to content
  • Corona G, Ricca V, Bandini E, et al. Selective serotonin reuptake inhibitor-induced sexual dysfunction. The journal of sexual medicine. 2009;6(5):1259-1269. Return to content
  • Corona G, Boddi V, Balercia G, et al. The effect of statin therapy on testosterone levels in subjects consulting for erectile dysfunction. The journal of sexual medicine. 2010;7(4 Pt 1):1547-1556 Return to content
  • Corona G, Rastrelli G, Morgentaler A, Sforza A, Mannucci E, Maggi M. Meta-analysis of Results of Testosterone Therapy on Sexual Function Based on International Index of Erectile Function Scores. Eur Urol. 2017;72(6):1000-1011. Return to content
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