Testosterone is a key hormone for men's health, but what happens when levels drop? In this episode, Dr. Alex Tatem and KG break down everything you need to know about testosterone—what it is, signs of deficiency, when to get tested, and the best treatment options.
Topics Covered:
* What is testosterone?
* Signs & symptoms of low testosterone
* Lab thresholds & when to get screened
* Treatment options, including lifestyle adjustments
* The role of diet, resistance training, and natural supplements (Boron, Ashwagandha, Tongkat Ali, DHEA-S, Pregnenolone)
* Non-testosterone medications & their benefits
* Testosterone therapy—what kind is best? (More details in the next video!)
Testosterone Therapy: Not Magic, But It Matters
By Kristen Gump, PA-C, and Dr. Tatem
At our Men’s Health Center, we frequently see men struggling with fatigue, low energy, reduced libido, and overall lack of motivation. The common question we hear is:
“Could this be low testosterone?”
In this post, Dr. Tatem and I walk through what testosterone is, what it does, when it’s low, and whether testosterone therapy might be right for you.
What Is Testosterone and Why Is It Important?
Testosterone is an anabolic androgenic steroid hormone. In men, it’s primarily made in the testicles, with smaller amounts from the adrenal glands. Women also produce small amounts in their ovaries.
Testosterone supports:
- Muscle growth
- Fat metabolism
- Energy and mood
- Sex drive and function
- Bone density
- Development of male traits (voice, body hair)
It’s part of a family of hormones called steroids, which include not only performance-enhancing ones but also corticosteroids like prednisone or nasal sprays for allergies.
What Is Low Testosterone (Hypogonadism)?
Low testosterone, or hypogonadism, is defined by:
- Symptoms such as fatigue, low libido, and muscle loss
- Lab results showing decreased testosterone levels
Important: A lab result alone doesn’t diagnose low T. Some men have low levels but no symptoms, and some have symptoms but normal labs.
Symptoms of Low Testosterone
Men with low testosterone may experience:
- Low sex drive or difficulty with erections
- Lack of motivation and focus
- Loss of muscle mass
- Increased fat, especially around the abdomen
- Generalized fatigue or "just not feeling like yourself"
When Should You Get Tested?
It’s wise to test if you're experiencing symptoms—regardless of age.
However, screening is especially important for men who:
- Are over 40 and symptomatic
- Have diabetes or metabolic syndrome
- Use opioids
- Have undergone organ transplant
- Have chronic illness or prolonged stress
How Do You Test for Low Testosterone?
We typically recommend:
- Two early morning testosterone tests (before 11 a.m.)
- Total and free testosterone levels
- Additional labs including:
- Estrogen
- FSH and LH
- Prolactin
- Hematocrit
- Vitamin D
- Comprehensive metabolic panel
Why morning labs? Testosterone follows a daily rhythm, peaking in the early hours.
Total vs. Free Testosterone
- Total testosterone includes all testosterone in your blood—both active and bound to proteins.
- Free testosterone is the biologically active form.
Even if your total level is “normal,” low free testosterone can still cause symptoms.
Is Testosterone All About Sex and Muscles?
No. Testosterone impacts:
- Mental health and motivation
- Metabolic function
- Sleep quality
- Energy levels
It’s not just about libido or gym performance.
Testosterone and Fertility: Know This First
If you plan to have children, testosterone therapy may not be for you—at least not alone.
Why? Exogenous testosterone shuts down sperm production. Your brain stops signaling the testicles to make both testosterone and sperm.
Alternatives like HCG or Clomid can preserve fertility while boosting testosterone.
Treatment Options for Low Testosterone
There’s no one-size-fits-all. Options include:
Injectable Testosterone
Most common. Typically self-administered weekly or biweekly.
Topical Gels or Creams
Applied daily. Less invasive but slightly more variable in absorption.
Oral Testosterone
Newer options available, with promising data.
Pellets
Implanted under the skin every few months. Longer acting.
Fertility-Sparing Options
- Clomid (Clomiphene Citrate)
- Enclomiphene
- HCG injections
- Aromatase Inhibitors (AIs)
These stimulate your body to produce its own testosterone.
What Results Can You Expect?
Common benefits:
- Increased energy
- Improved libido
- Better mood and mental clarity
- Improved gym recovery and muscle tone
But:
Testosterone isn’t instant or magical. It often takes 4–6 weeks to notice improvement, and up to 3 months for full effect.
Side Effects to Watch For
When medically supervised, testosterone therapy is safe. But potential side effects include:
- Hair thinning or loss
- Acne (especially shoulders/back)
- Mild mood changes
- Fluid retention
- Elevated red blood cell count (polycythemia)
- Suppressed sperm production
We monitor estrogen, PSA, hematocrit, and other markers regularly.
Does Testosterone Cause Prostate Cancer?
No.
That’s an old myth. Research has consistently shown that testosterone therapy does not cause prostate cancer or make it worse. We still monitor PSA as a precaution.
What About Heart Health?
Old studies suggested risk, but were flawed. Newer research—including the TRAVERSE trial—has shown:
- No increased risk of heart attack or stroke
- Improved cardiovascular outcomes in men with low testosterone who receive treatment
Can You Boost Testosterone Naturally?
Yes! If you’re borderline or not ready to start therapy:
- Lift weights and do resistance training
- Lose weight, especially belly fat
- Sleep well and consistently
- Eat zinc- and vitamin D-rich foods
- Avoid ultra-processed foods
- Consider supplements:
- Ashwagandha
- Tongkat Ali
- Boron
Final Thoughts: Is Testosterone Therapy Right for You?
Dr. Tatem:
Testosterone therapy can be life-changing—but it’s not a silver bullet. You still need to eat well, move your body, sleep, and manage stress.
For the right person, under the right medical supervision, it can be the final piece of the puzzle.
Up Next: Choosing the Right Testosterone Option
In our next blog post, we’ll cover how to choose the best form of testosterone therapy for your lifestyle and goals. Stay tuned!
Have questions or think you may be dealing with low testosterone? Reach out to our Men’s Health team to schedule a consultation.
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