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How do I verify that my testosterone is low?

Updated

Verifying low testosterone levels involves both clinical evaluation and laboratory testing. Clinically, symptoms such as fatigue, reduced muscle mass, increased body fat, decreased bone density, reduced libido, erectile dysfunction, mood changes, depression, and cognitive decline are assessed. A thorough medical history, including chronic illnesses and medications that might affect hormone levels, is reviewed. Laboratory tests start with measuring total testosterone in the morning when levels are highest. If results are borderline, free testosterone levels are checked, as well as sex hormone-binding globulin (SHBG), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) to understand the cause. Multiple tests might be needed due to fluctuating testosterone levels. Reference ranges typically consider total testosterone levels below 300 ng/dL and free testosterone below 50 pg/mL as low. Results should be correlated with symptoms to make an accurate diagnosis. It's also crucial to investigate and manage any underlying conditions that might contribute to low testosterone.

Further Reading:

  1. Infante, M., Pieri, M., S Lupisella, L D'Amore, Bernardini, S., Fabbri, A., Iannetta, M., Andreoni, M., & Morello, M. (2021). Low testosterone levels and high estradiol to testosterone ratio are associated with hyperinflammatory state and mortality in hospitalized men with COVID-19. DOAJ (DOAJ: Directory of Open Access Journals), 25(19), 5889–5903. https://doi.org/10.26355/eurrev_202110_26865
  2. Maggi, M., Rastrelli, G., & Corona, G. (2020). Both comorbidity burden and low testosterone can explain symptoms and signs of testosterone deficiency in men consulting for sexual dysfunction. Asian Journal of Andrology, 22(3), 265. https://doi.org/10.4103/aja.aja_61_19
  3. Rivas, A. M., Mulkey, Z., Lado-Abeal, J., & Yarbrough, S. (2014). Diagnosing and Managing Low Serum Testosterone. Baylor University Medical Center Proceedings, 27(4), 321–324. https://doi.org/10.1080/08998280.2014.11929145
  4. Cunningham, G. R., Stephens-Shields, A. J., Rosen, R. C., Wang, C., Ellenberg, S. S., Matsumoto, A. M., Bhasin, S., Molitch, M. E., Farrar, J. T., Cella, D., Barrett-Connor, E., Cauley, J. A., Cifelli, D., Crandall, J. P., Ensrud, K. E., Fluharty, L., Gill, T. M., Lewis, C. E., Pahor, M., & Resnick, S. M. (2015). Association of Sex Hormones With Sexual Function, Vitality, and Physical Function of Symptomatic Older Men with Low Testosterone Levels at Baseline in the Testosterone Trials. The Journal of Clinical Endocrinology & Metabolism, 100(3), 1146–1155. https://doi.org/10.1210/jc.2014-3818