7 low testosterone symptoms: Get small daily joys back!

Low testosterone symptoms often look like normal aging, stress, or burnout. Understanding what is hormone-driven, and what is not, can help you get energy, sex drive, and daily motivation back on track.

The relationship

Testosterone is the main male sex hormone. It is a steroid hormone that supports sex drive, erections, muscle and bone strength, red blood cell production, and stable mood in men.^[1] The testes make most testosterone under orders from the brain.

Levels naturally peak in the early morning and slowly fall with age. A gradual, mild dip is expected. True testosterone deficiency, or hypogonadism, means the level is low enough to cause day-to-day symptoms and shows up as low on repeated morning blood tests.^[2] Hypogonadism is the medical term for under-function of the testes or the brain signals that drive them.

Major guidelines from the American Urological Association (AUA) and European Association of Urology stress that doctors should diagnose low testosterone only when both pieces match: ongoing low testosterone symptoms and consistently low blood levels.^[2] That “two-key” rule helps avoid over-treating men whose levels are normal for them, and prevents missing men who really are running on empty.

How it works

To understand low testosterone symptoms, it helps to know how the system is wired. A tight loop links your brain, pituitary gland, and testes, using chemical messages to keep levels in a healthy range.

Brain-to-testes signaling

The hypothalamus is a brain region that acts as your internal hormone clock. It releases gonadotropin-releasing hormone, a signal that tells the nearby pituitary gland to produce two key messengers: luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH is the hormone that tells the testes to make testosterone; FSH drives sperm production.^[1]

When testosterone in the blood is high enough, the hypothalamus and pituitary sense it and turn down LH output. When testosterone is low, LH rises to push the testes harder. Damage anywhere in this chain — brain, pituitary, or testes — can lead to hypogonadism and low testosterone symptoms.^[2]

Total vs free testosterone

In the bloodstream, most testosterone rides on carrier proteins. Sex hormone–binding globulin (SHBG) is a protein that tightly binds testosterone and keeps it inactive. Only a small portion of testosterone is free or loosely bound, and this fraction can actually enter cells and do work.^[3]

Standard lab tests usually report total testosterone, which includes both bound and free hormone. In some men, especially those with obesity, diabetes, thyroid problems, or liver disease, SHBG can be abnormal. In those cases, free testosterone testing can reveal a deficit that total testosterone hides, or can show that total levels look low even though free levels are adequate.^[3]

What counts as low: lab thresholds

Different labs and guidelines list slightly different “normal” ranges, but large studies and meta-analyses give practical cutoffs. Symptomatic men with total testosterone below about 350 ng/dL, or 12 nmol/L, are most likely to benefit from testosterone replacement therapy when other causes of symptoms are ruled out.^,[2]

When total testosterone sits in a gray zone, checking free testosterone can help. Free testosterone below about 100 pg/mL, or roughly 10 ng/dL, supports a diagnosis of hypogonadism in a man with clear low testosterone symptoms. In practice, many specialists use 350 ng/dL for total or 100 pg/mL for free as decision thresholds when bothersome symptoms persist.

Daily ups and downs

Testosterone follows a daily rhythm. Levels peak in the early morning and gradually fall through the day, with the steepest drop in younger men. That is why guidelines recommend drawing blood for testosterone between about 7 and 11 a.m., and repeating the test on a separate morning before making decisions.^[4],[2]

Acute illness, poor sleep, heavy alcohol use, or intense endurance exercise can temporarily knock testosterone down. Because of that, one low value on a bad week is not enough to label a man hypogonadal.

Conditions linked to it

Low testosterone is not just about sex drive. In men, it often travels with other medical problems. Some conditions can cause low levels, and in other cases low testosterone makes the condition worse.

• Obesity and metabolic syndrome: Higher body fat, especially around the waist, lowers testosterone by driving inflammation and converting testosterone into estrogen in fat tissue. In turn, low testosterone promotes fat gain and muscle loss, forming a vicious cycle.^,[5]
• Type 2 diabetes and insulin resistance: Men with low testosterone are more likely to have impaired blood sugar control and full-blown diabetes. Testosterone therapy in clearly deficient men can modestly improve insulin sensitivity and waist circumference, although it is not a standalone diabetes treatment.^[5]
• Bone thinning and fractures: Testosterone supports bone building. Chronically low levels raise the risk of low bone density and fractures in men, especially in the spine and hips.^[1]
• Anemia and low stamina: Testosterone stimulates red blood cell production. Men with low testosterone are more likely to be anemic, which can aggravate fatigue and shortness of breath. Correcting low testosterone can reverse anemia in many cases.
• Mood disorders: Low testosterone is linked to higher rates of depressed mood, irritability, and reduced sense of well-being. In controlled trials, testosterone therapy in deficient men modestly improves mood scores and vitality.^,[6]
• Cardiovascular risk: Men with chronically low testosterone tend to have more cardiovascular risk factors, including higher fat mass, lower HDL cholesterol, and more insulin resistance. Research is still mixed on whether low testosterone itself directly raises heart attack or stroke risk, and on whether testosterone therapy is neutral, beneficial, or harmful for long-term heart health.^,[6]

Limitations: Many of these links come from observational studies. That means they show association, not guaranteed cause and effect. Not every man with diabetes or obesity will have low testosterone, and not every man with low testosterone will develop these problems.

Symptoms and signals

Low testosterone symptoms can be vague at first. Men often blame work, kids, or age. The pattern over time is what matters most. Below are red flags that deserve attention if they stick around for several months.

• Sex drive and erections
  • Sex drive is noticeably lower than in past years, with less interest in initiating or fantasizing about sex.
  • Morning erections are less frequent or less firm than they used to be.
  • Erections during sex are weaker, shorter-lasting, or harder to achieve, even when desire is there.
  • Smaller volume of semen or weaker ejaculation force.
• Energy and motivation
  • Feeling tired most days, even after a full night’s sleep.
  • Needing more coffee or naps to get through normal tasks.
  • Less drive to take on projects, challenges, or social plans that once felt exciting.
• Muscle, strength, and body shape
  • Noticing muscle loss in the arms, chest, or legs, even if workouts have not changed.
  • Losing strength on basic lifts like bench press or squat, or struggling more with carrying groceries or climbing stairs.
  • Gaining fat around the waist or chest, sometimes including increased breast tissue (gynecomastia) that feels rubbery or tender.
• Mood and thinking
  • Feeling more down, irritable, or emotionally flat.
  • Less mental sharpness, with more “brain fog,” trouble concentrating, or forgetting details.
  • Less sense of reward from hobbies, achievements, or time with friends.
• Other physical signals
  • Reduced shaving frequency because facial hair grows more slowly.
  • Lower testicle size or softer testicle texture on self-exam.
  • Unexplained infertility despite regular unprotected sex, often due to impaired sperm production.
  • Occasional hot flashes or night sweats in more severe cases.

No single symptom proves low testosterone. Many of these overlap with depression, sleep disorders like sleep apnea, thyroid problems, or side effects from medications such as opioids or steroids. The key clue is when several low testosterone symptoms appear together and persist.

What to do about it

If you recognize several low testosterone symptoms in your own life, there is a clear, stepwise way to move forward. The goal is not to chase perfect numbers, but to feel and function better in a safe, sustainable way.

1. Step 1: Get the right evaluation and tests
   • See a clinician who is comfortable with men’s health, such as a urologist, endocrinologist, or primary care doctor with hormone experience.
   • Be specific about symptoms: changes in sex drive, erections, energy, mood, strength, and body shape.
   • Ask for at least two early-morning total testosterone tests on different days, along with LH, FSH, and prolactin if levels are low. These extra tests help distinguish a testicular problem from an issue in the pituitary or hypothalamus.^[2]
   • If total testosterone is borderline and symptoms are strong, discuss free testosterone measurement, especially if you have obesity, diabetes, thyroid disease, or liver disease.^[3]
   • Expect a basic workup for other causes of fatigue and low mood, such as thyroid tests, sleep apnea screening, and a medication review.
2. Step 2: Fix what you can control and weigh treatment options
   • Address lifestyle drivers: Weight loss, especially around the waist, sleep of 7–9 hours, resistance training, and cutting back on heavy drinking can all nudge testosterone upward and improve low testosterone symptoms, even without medication.^,[5]
   • Review medications: Long-term opioids, high-dose steroids, and some psychiatric or cancer drugs can suppress testosterone. Never stop them on your own, but ask if alternatives exist.
   • Consider testosterone replacement therapy (TRT): In men with clear symptoms and repeatedly low levels, TRT can improve sex drive, erectile function, lean mass, bone density, anemia, and mood scores compared with placebo.^,[6] Options include gels or creams, injections, patches, and longer-acting pellets.
   • Protect fertility: External testosterone shuts down LH and FSH, which can sharply lower sperm count. TRT should not be used as a treatment in men trying to conceive; other medications such as clomiphene or hCG are preferred in that setting.^[7]
   • Understand risks: TRT can raise red blood cell counts, worsen untreated sleep apnea, and requires careful monitoring of the prostate in older men. Evidence on long-term cardiovascular risk is mixed, so shared decision-making is essential.^,[6]
3. Step 3: Monitor, adjust, and stay honest
   • Once on TRT, labs are usually checked after 3–6 months, then at least yearly. This includes testosterone levels, blood count, and prostate-specific antigen (PSA) in men over about 40–50.^[2]
   • Track how you actually feel: energy, sex drive, erections, mood, and gym performance. Numbers without symptom changes are not a success story.
   • Keep regular follow-up appointments. Adjusting dose, delivery method, or addressing side effects is part of the process.
   • If lifestyle has improved and testosterone stabilizes, some men can eventually taper off therapy under supervision.

Myth vs Fact

• Myth: “If I feel tired and low on sex drive, I probably need testosterone shots.”
  Fact: Many issues mimic low testosterone symptoms, including depression, poor sleep, high stress, and other hormone problems. Blood tests and a full exam are the only way to know.
• Myth: “A normal lab result means my testosterone is not the problem.”
  Fact: One test can miss the diagnosis. Levels must be checked on two separate mornings, and free testosterone can matter in borderline cases.
• Myth: “Testosterone therapy is a fountain of youth for any man over 40.”
  Fact: Trials show that TRT helps men who are clearly deficient. In men with normal levels, it adds risks without proven long-term benefits.^[6]
• Myth: “Testosterone will boost my fertility.”
  Fact: TRT usually lowers sperm counts and can make it harder to father a child while on treatment.^[7]
• Myth: “Over-the-counter ‘test boosters’ are safer than prescription testosterone.”
  Fact: Many supplements are unregulated, under-tested, and sometimes contaminated with hidden steroids. They can disrupt your own hormone production without proper monitoring.

Bottom line

Low testosterone symptoms in men are common and often overlooked. When ongoing issues with sex drive, erections, energy, mood, and body composition line up with repeatedly low morning testosterone levels, the evidence supports targeted treatment. Lifestyle changes, careful diagnosis, and, for the right men, well-monitored testosterone therapy can turn “I’m just getting old” into “I feel like myself again” without chasing unrealistic miracle cures.

References

1. Basaria S. Male hypogonadism. Lancet (London, England). 2014;383:1250-63. PMID: 24119423
2. Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. The Journal of urology. 2018;200:423-432. PMID: 29601923
3. Antonio L, Wu FC, O’Neill TW, et al. Low Free Testosterone Is Associated with Hypogonadal Signs and Symptoms in Men with Normal Total Testosterone. The Journal of clinical endocrinology and metabolism. 2016;101:2647-57. PMID: 26909800
4. Diver MJ, Imtiaz KE, Ahmad AM, et al. Diurnal rhythms of serum total, free and bioavailable testosterone and of SHBG in middle-aged men compared with those in young men. Clinical endocrinology. 2003;58:710-7. PMID: 12780747
5. Corona G, Monami M, Rastrelli G, et al. Testosterone and metabolic syndrome: a meta-analysis study. The journal of sexual medicine. 2011;8:272-83. PMID: 20807333
6. Huo S, Scialli AR, McGarvey S, et al. Treatment of Men for “Low Testosterone”: A Systematic Review. PloS one. 2016;11:e0162480. PMID: 27655114
7. Patel AS, Leong JY, Ramos L, et al. Testosterone Is a Contraceptive and Should Not Be Used in Men Who Desire Fertility. The world journal of men’s health. 2019;37:45-54. PMID: 30350483