Understanding Low Testosterone in Aging Men

older couple fishing

Testosterone (T), the androgen hormone or “steroid” that is responsible for the development and maintenance of male characteristics, is a frequent concern for aging men and men that are experiencing decreased sexual function or low energy.

Low T in adult men, sometimes called andropause or androgen deficiency of the aging male (ADAM), is more frequently referred to as hypogonadism or testosterone deficiency syndrome (TDS). The treatment options for low T have progressed significantly over the past decade, and new medications to normalize and regulate testosterone levels continue to be developed.

Testosterone Production

T production is controlled by the pituitary gland at the base of the brain and is mostly produced in a man’s testicles. Its production increases during adolescence to develop masculine features and healthy sexual function, which include muscle development, hair growth, vocal changes, sperm production, and others. T levels continue to rise until a man is in their 30’s at which point it begins to slowly decline at a rate of about 1% each year.

Low Testosterone

The signs of low T in men are often subtle and can be easily missed by both men and their doctor. That said, typical signs and symptoms include lack of sexual desire, decreased erections, depression, low energy, fatigue, and osteoporosis.

While any man can suffer from low T, men with the highest risk are those with diabetes, erectile dysfunction, depression, men taking chronic opiate pain medications, and men with stressful, chronic diseases such as AIDS, COPD, and cancer.

How is low T diagnosed?

An initial suspicion of low T typically arises from a conversation with your doctor about symptoms and various high-risk conditions. A definitive diagnosis is made through the combination of these symptoms and blood tests for testosterone levels taken at different times. Other supporting tests for pituitary hormone levels and circulating proteins that inactivate T may also be performed. 

If the symptoms and blood tests confirm low T and your doctor feels that testosterone replacement therapy is needed and safe, there are many agents that can restore T to normal levels.


Once treatment is started, it is typically a long-term commitment that requires careful monitoring. Clinical guidelines suggest regular evaluation of T levels, blood counts, and Prostate-specific antigen (PSA) levels to track any effects the treatment may have on the prostate. 

Current treatment options include daily topical gels, injections ranging in frequency from weekly, biweekly, or every 10 weeks, testosterone suppositories, and nasal spray. Unfortunately, a convenient and safe pill is not currently available in the U.S., although several are being developed.

Is T replacement safe?

The goal of T replacement is normalizing T levels so that they are equivalent to the average healthy man while eliminating the experienced symptoms. While there has been controversy about the diagnosis and treatment of low T, for men who have been carefully diagnosed and are treated appropriately, T replacement is a safe treatment that often changes a man’s life by restoring strength, energy, vitality, and interest in sex.

Other Benefits of Treatment

Many studies illustrate a long-term benefit for men having normal T levels. Long-term survival studies of the causes of death of men suggest an advantage for those with normal T levels regardless of it is from their own production or from T replacement. Similarly, studies have shown an advantage to those with normal T levels for increased diabetes and obesity control.

Research on Risks

T replacement has been shown to lower sperm counts in some men and several studies have suggested that T replacement may have cardiovascular risks.
Other studies have highlighted a risk for prostate issues in men undergoing T replacement. While the development of the prostate in adolescence is dependent on T, there is no evidence that prostate cancer is caused or made worse by T replacement.

The clear message from the research is that for men considering children, who are frail and elderly or have significant heart disease, T replacement may not be advised and other methods for normalizing T should be considered.
For other men suffering from the symptoms of low T, T replacement can improve their lives remarkably and is a safe treatment option to review with your physician.

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