Low Testosterone

What is Testosterone?

Testosterone is the main male hormone.  About 90% of the body’s testosterone comes from the testicles and about 10% comes from the adrenal glands.  Testosterone is necessary for male–type hair growth, normal sexual function, fertility, bone health and many other bodily functions.

How Do I Know if I Have Low Testosterone?

There are many signs and symptoms of low testosterone.  The most common of these are low sex drive, weight gain, feeling unusually tired during the day, loss of muscle tone and strength and decreased hair growth.  Problems that have been linked to low testosterone but are often  due to other things include diabetes, bone density loss, problems with concentration, memory problems, depression and erection problems.

What Causes Low Testosterone?

There can be many reasons for testosterone production to decline.  We know, for example, that testosterone levels normally go down as men get older.  This normal change in testosterone levels does not usually cause symptoms or problems.  About 2% of younger men will have problems with low testosterone that do cause symptoms or problems.  Some of the reasons for this include:

  • Severe injury to both testicles

  • Congenital/genetic problems like Klinefelter’s syndrome

  • Problems with the pituitary gland such as shrinkage or a benign tumor

  • Exposure to radiation, chemotherapy or other toxins

  • Smoking, alcohol or drug abuse

  • Sleep apnea

  • Obesity

  • Diabetes

  • Infection

  • Severe, prolonged stress

  • Sometimes, there is no identifiable reason.

How is Low Testosterone Diagnosed?

First of all, your family doctor or urologist will talk to you to find out about your overall health and the specific problems you’re having.  A physical exam is always important to check the condition of the testicles, penis and prostate.  Finally, a blood test to determine the level of testosterone is necessary.  It is best to do this blood test between 8 AM and 10 AM to get the best accuracy.  If a first testosterone level is low, it should be repeated 2 more times at least one week apart to be certain it is correct.  If testosterone levels are consistently low, a few additional hormone levels should be checked.  Occasionally, imaging studies such as a testicular ultrasound or MRI of the head are necessary.

How do We Treat Low Testosterone?

If you have testosterone levels below 300 ng/dl AND symptoms of low testosterone, you may need treatment. The most important thing is to know if there is an underlying cause for low testosterone and to treat the cause.  If testosterone levels do not improve with treatment or if there is no identifiable reason for low testosterone, testosterone replacement therapy might be necessary.  There are several ways to supplement your testosterone levels.

  • Injectable testosterone which is administered every week or 2 weeks

  • Testosterone gel that you apply to the skin every day

  • Testosterone pellets that are implanted under the skin

  • Testosterone nasal spray

There is a number of things that usually do not work.

  • Over-the-counter medicines do not usually help.

  • So-called male enhancement products

  • Supplements such as DHEA that are designed to increase natural production of testosterone

The final, important thing to know is that you should not take testosterone supplements unless you truly have a low testosterone level.  Men who take testosterone supplements for body building or to treat low energy level but do not actually have low blood levels of testosterone can develop serious health problems such as blood clots, strokes and infertility.  It is best to consult with a knowledgeable physician and do the appropriate testing if you think you may need testosterone supplements.


We hope that this brief overview was helpful.  Call Gallatin Urology (406-551-2306) for an appointment if you would like more information or if you think you may be having problems with low testosterone.