Endocrinology · Praxis Dr. Romanos
Low Testosterone in Men: Test Properly, Treat Precisely
Testosterone has become a lifestyle topic — with online tests, clinics and promises of more energy and muscle. True testosterone deficiency is a medical diagnosis and treats well. But it is less common than the advertising suggests, and it is not diagnosed from a single blood test.
Typical symptoms
Sexual symptoms are the most telling: lower libido, fewer morning erections, erectile problems. Others include fatigue, low mood, loss of muscle mass and strength, more belly fat and, with longer-standing deficiency, falling bone density.
Almost all of these symptoms also have other causes: lack of sleep, stress, depression, thyroid problems, iron deficiency, diabetes. That is why the whole workup matters, not just the testosterone value.
How to measure it correctly
Testosterone varies over the day and is highest in the morning. It is therefore measured in the morning, roughly between 7 and 11 a.m., ideally fasting. A single low value is not enough for a diagnosis; it is confirmed on a second morning.
If total testosterone is borderline, we also measure SHBG and calculate free testosterone. Once deficiency is confirmed, LH and FSH show whether the cause lies in the testes or the pituitary gland. Depending on the findings, prolactin, ferritin and further tests follow.
As a guide: values below about 8 nmol/l clearly point to deficiency. Between 8 and 12 nmol/l is a grey zone in which symptoms and free testosterone decide.
Common causes to treat first
Low testosterone is often a consequence, not the cause. Excess weight and insulin resistance lower testosterone, as do type 2 diabetes, untreated sleep apnoea, heavy drinking, chronic stress, acute illness, opioids and cortisone. Previous anabolic steroid use can also suppress your own production for a long time.
In these cases the best treatment is to treat the cause. Weight loss, better sleep and treating sleep apnoea often raise testosterone measurably — without hormones.
When we prescribe testosterone — and when we don’t
We prescribe testosterone when deficiency is confirmed: matching symptoms, repeatedly low morning values and treatable causes ruled out. In that situation the treatment is well documented and effective.
We do not prescribe testosterone for normal values, for muscle building, for performance or as “anti-ageing”. In these situations the risks outweigh the benefits.
Before starting treatment we check the blood count (haematocrit), from middle age also PSA, and assess cardiovascular risk. Testosterone suppresses sperm production: men who want children need a different approach. During treatment we monitor testosterone, haematocrit and PSA regularly.
Workup and costs
If you have symptoms, the workup — consultation, examination and the medically necessary lab tests — is covered by basic insurance. Your deductible and co-payment apply.
If you would like a comprehensive assessment of hormones, metabolism and cardiovascular health, with follow-up over three months, see our Men’s Programme (self-pay).
Next step: Book a consultation to have your symptoms assessed.
Book Appointment