You have less energy than you used to. Your workouts feel harder. Your motivation is down, your mood feels different or your interest in sex has changed.
But you are young, busy and otherwise healthy…so you assume it must be normal.
Maybe it is stress. Maybe you need more sleep. But it could also be worth checking your testosterone.
Low testosterone is often discussed as an older man’s concern, but age alone does not determine whether a man can experience a hormonal imbalance. Younger men can also develop low testosterone because of certain medical conditions, medications, obesity, sleep disorders, injury or problems affecting the testicles, pituitary gland or brain.
And if treatment is appropriate, your only option is not necessarily a lifetime of weekly shots.
Testosterone therapy is available in several forms, including topical creams or gels, injections and oral medication. Men who want children may also need a different approach—one that supports testosterone levels without unnecessarily compromising sperm production.
The right first step is understanding what is happening in your body and choosing a plan based on your symptoms, laboratory results, health history and future goals.
What does testosterone do?
Testosterone is best known for its role in male sexual development, but its influence extends beyond libido.
Healthy testosterone levels help support:
- Sexual desire and function
- Sperm production
- Muscle mass and strength
- Bone health
- Red blood cell production
- Body-hair growth
- Mood and overall well-being
Testosterone levels naturally change throughout the day and are usually highest in the morning. They can also fluctuate because of illness, inadequate nutrition, excessive exercise and certain medications.
That is one reason low testosterone should not be diagnosed from symptoms, or from one isolated blood test, alone.
The Endocrine Society recommends diagnosing testosterone deficiency only when a man has relevant symptoms and consistently low testosterone levels confirmed through appropriate testing. It also recommends evaluating the underlying cause rather than immediately treating the laboratory number. Review the Endocrine Society’s clinical guidance.
What are the symptoms of low testosterone in men?
Low testosterone does not feel exactly the same for every man. Symptoms can also overlap with depression, chronic stress, poor sleep, thyroid disorders, medication side effects and other health concerns.
Possible symptoms include:
- Reduced sex drive
- Fewer spontaneous erections
- Difficulty achieving or maintaining an erection
- Low energy
- Reduced motivation
- Irritability or depressed mood
- Difficulty concentrating
- Loss of muscle mass or strength
- Increased body fat
- Reduced facial or body-hair growth
- Breast tenderness or enlargement
- Reduced testicular size
- Low sperm count or infertility
- Weaker bones over time
- Hot flashes when testosterone is extremely low
Experiencing one of these symptoms does not automatically mean you need testosterone. But persistent or combined symptoms deserve a closer look.
“I’m young. Isn’t feeling this way normal?”
Being tired during a demanding season of life can be normal. Feeling consistently depleted, physically weaker or unlike yourself should not automatically be dismissed because of your age.
Younger men can experience low testosterone. Potential contributors include:
- Testicular injury or disease
- Pituitary or hypothalamic disorders
- Certain genetic conditions
- Obesity or metabolic illness
- Untreated sleep apnea
- Severe or chronic illness
- Some medications, including opioids and corticosteroids
- Previous chemotherapy or radiation
- Anabolic steroid use
- Significant nutritional deficiencies
- Excessive training without adequate recovery
The point of an evaluation is not to place every tired man on testosterone. It is to determine whether testosterone is actually low, why it may be low and whether treating it is appropriate.
How is low testosterone diagnosed?
A responsible evaluation should include more than an online symptom quiz.
Your provider may consider:
- Your symptoms and how long you have experienced them
- Your personal and family health history
- Prescription medications and supplements
- Sleep, stress, nutrition and exercise
- Your plans for future children
- Morning testosterone testing
- Repeat testing to confirm an abnormal result
- Additional laboratory work to investigate the cause
The Endocrine Society notes that testosterone levels should be measured more than once because they can vary from hour to hour. A provider may also assess hormones such as luteinizing hormone and follicle-stimulating hormone to help determine whether the problem begins in the testicles or in the hormonal signals coming from the brain.
Testosterone creams and gels offer a daily, needle-free option
Topical testosterone is applied to the skin, usually once a day. Depending on the prescription, it may be provided as a commercially manufactured gel or a compounded cream.
Potential benefits
- No injections are required.
- The dose may be adjusted as treatment progresses.
- Application can be completed at home.
- It can provide relatively steady daily testosterone delivery.
- It may appeal to men who prefer a daily routine.
Important considerations
Topical testosterone must be applied consistently. Absorption can vary, and follow-up testing is still necessary.
There is also a risk of transferring testosterone to another person through skin contact. Men using topical testosterone must follow instructions about washing their hands, covering the application area and avoiding contact with women and children until the medication has dried or the area has been washed.
FDA-approved topical products carry specific warnings about secondary exposure, particularly for children. See an example in the FDA prescribing information.
Testosterone injections are effective, but not the only choice
Testosterone injections are one of the most familiar forms of testosterone replacement therapy. Depending on the medication and plan, injections may be administered at different intervals.
Potential benefits
- The medication and dose can be measured precisely.
- Treatment does not require daily application.
- There is no risk of transferring medication through skin contact.
- Injections can be administered at home or in a clinical setting, depending on the prescription.
Important considerations
Some men dislike needles or experience soreness at the injection site. Testosterone levels may also rise after an injection and decline before the next dose, potentially causing fluctuations in symptoms. A provider may adjust the amount or frequency to create a steadier response.
Most importantly, testosterone injections are not the only option. A man should not assume that seeking help for low testosterone automatically commits him to weekly shots.
Oral testosterone: yes, a pill may be an option
FDA-approved oral testosterone medications are available for certain men with medically diagnosed testosterone deficiency. These are generally testosterone undecanoate capsules taken by mouth.
Potential benefits
- No injections or topical application
- Familiar pill or capsule format
- No possibility of skin-to-skin transfer
- Convenient for some daily routines
Important considerations
Oral testosterone is not appropriate for everyone. Different products have specific instructions, contraindications and monitoring requirements. Some can affect blood pressure, red blood cell levels or other health markers.
The FDA currently lists oral, topical, injectable, transdermal and buccal testosterone formulations among the approved delivery options for men who have low testosterone associated with a medical condition. Read the FDA’s testosterone information.
A pill may make treatment easier, but it does not eliminate the need for proper diagnosis and ongoing monitoring.
Planning to have children? Talk about fertility before starting testosterone
This is one of the most important (and most frequently overlooked) parts of the testosterone conversation.
Testosterone is involved in sperm production, so it is easy to assume that taking additional testosterone will improve fertility. In reality, testosterone medication can signal the brain that the body already has enough testosterone. The brain may then reduce the hormones that tell the testicles to produce testosterone and sperm.
As a result, external testosterone can significantly reduce sperm production. In some men, sperm production can stop temporarily.
This effect can occur with testosterone injections, creams, gels and pills. Choosing a different delivery method does not necessarily protect fertility.
The Endocrine Society recommends against beginning testosterone therapy in men who are planning fertility in the near future. The American Urological Association and American Society for Reproductive Medicine similarly advise that exogenous testosterone can suppress the hormonal signals required for sperm production. Review the AUA/ASRM male-infertility guidance.
That does not mean men who want children must ignore their symptoms. It means their provider needs to know that fertility is a priority before creating the treatment plan.
What if you want to improve testosterone without committing to TRT?
Some men are interested in improving their testosterone levels but are not ready to begin traditional testosterone replacement therapy. Others want to preserve fertility, investigate the underlying cause or try correcting reversible contributors first.
Depending on the diagnosis, a provider may discuss:
Addressing underlying health factors
Poor sleep, untreated sleep apnea, excess body fat, certain medications, inadequate nutrition and some chronic illnesses can contribute to low testosterone. Addressing these factors may help improve hormone levels and overall health, although lifestyle changes will not correct every cause of testosterone deficiency.
Medications that encourage the body’s own production
For certain men, particularly those concerned about fertility, a qualified provider or fertility specialist may consider medications that stimulate the body’s hormonal signaling rather than directly replacing testosterone.
These may include human chorionic gonadotropin, selective estrogen receptor modulators or aromatase inhibitors. Some of these treatments are used off-label in men and are not appropriate in every situation. Their risks, limitations and likelihood of benefit should be discussed carefully.
The goal is not to simply “boost” a number. It is to select an approach that fits both the medical diagnosis and the man’s long-term priorities.
Is testosterone therapy a lifelong commitment?
Not every man who receives an evaluation will need testosterone therapy, and treatment should not begin casually.
When external testosterone is used, the body may reduce its own production. Stopping treatment can therefore result in a period of low levels and returning symptoms. Recovery varies depending on the individual, the cause of the original deficiency, treatment duration and other factors.
Before starting, ask your provider:
- What evidence shows that I have testosterone deficiency?
- Do we know what is causing it?
- Could an underlying condition be treated first?
- How might treatment affect my fertility?
- What happens if I decide to stop?
- How will we know whether it is working?
- Which ongoing tests will I need?
A good treatment decision accounts for what you want next month, next year and several years from now.
What monitoring is needed during testosterone treatment?
Testosterone therapy requires ongoing medical supervision. Depending on your age, health and treatment, monitoring may include:
- Testosterone levels
- Red blood cell count and hematocrit
- Blood pressure
- Prostate health and prostate-specific antigen when appropriate
- Symptom changes
- Side effects
- Fertility considerations
- Cardiovascular and sleep-related risk factors
Possible adverse effects can include acne, oily skin, increased red blood cell production, breast tenderness, fluid retention, worsening sleep apnea, reduced sperm production and testicular shrinkage. Individual risks should be reviewed before treatment begins.
Testosterone should be prescribed to correct an appropriately diagnosed deficiency—not solely to accelerate muscle gain, athletic performance or appearance changes.
A more personal approach to men’s hormone health
At GOTOX Aesthetics & Wellness, we believe men deserve more than a quick prescription based on one symptom or one laboratory result.
Our functional medicine approach considers the broader picture: your symptoms, bloodwork, medical history, daily health and future goals. If testosterone treatment is appropriate, your provider can help you compare creams, injections and oral options rather than assuming shots are your only choice.
If fertility matters to you, even if children are only a possibility several years from now, say so at the beginning. That information can meaningfully change the recommended approach.
The goal is not simply to raise your testosterone level. It is to help you understand what your body is communicating and make an informed treatment decision that supports your health and plans.
Schedule your virtual consultation today for $100.
Feeling persistently tired, unmotivated or unlike yourself? Contact GOTOX to ask about the laboratory work required and schedule a men’s hormone consultation.
Frequently Asked Questions
Can young men have low testosterone?
Yes. Although testosterone levels tend to decline gradually with age, younger men can experience low testosterone because of medical conditions, medications, obesity, sleep disorders, testicular injury and other causes. Symptoms and consistently low laboratory results are both important to the diagnosis.
Is testosterone always given as a shot?
No. Testosterone is available in injectable, topical and oral forms, among others. The best delivery method depends on the diagnosis, preferences, health history, cost and required monitoring.
Is there a testosterone pill for men?
Yes. FDA-approved oral testosterone medications are available for certain men with testosterone deficiency caused by an associated medical condition. Oral therapy is not appropriate for everyone and still requires medical monitoring.
Will testosterone therapy affect my fertility?
It can. External testosterone may suppress or stop sperm production, regardless of whether it is delivered by an injection, cream, gel or pill. Men who want future children should discuss fertility before beginning treatment.
Can low testosterone be treated without testosterone replacement?
Sometimes. When low testosterone is connected to a reversible factor, addressing that cause may help. Certain fertility-conscious medications may also encourage the body’s own testosterone production in appropriately selected men. These options require individualized medical supervision.
How many testosterone tests do I need?
Clinical guidelines generally recommend confirming low testosterone with more than one appropriately timed blood test, along with an evaluation of relevant symptoms and the potential underlying cause.
This article is for educational purposes only and does not replace individualized medical advice, diagnosis or treatment. Testosterone therapy has potential benefits and risks and may affect fertility. Consult a qualified healthcare provider to determine whether testing or treatment is appropriate for you.
