Understanding Low Testosterone in Older Men

About Nicole Pajer

Nicole Pajer is a Los Angeles-based freelance published in The New York Times, Woman's Day, AARP, Parade, Wired, Glamour, People and more.

Men, do you feel more tired than usual, notice yourself losing muscle strength or find yourself not as interested in sex as you once were? While these changes can be part of getting older, they can also be signs of low testosterone.

Testosterone is the primary sex hormone in men. And while both men and women produce it, testosterone plays an especially important role in men's health. It helps maintain everything from muscle mass and bone strength to sex drive and red blood cell production. Testosterone levels often decline gradually with age, but the amount varies from person to person. Aging alone does not establish a diagnosis of testosterone deficiency.

So how do you know if your testosterone is too low? And what can you do about it? Here's what to know.

What is low testosterone?

Low testosterone occurs when the body doesn't produce enough testosterone. And while some testosterone loss is age-related, some men experience a more significant drop that can affect their health and quality of life.

Having low testosterone doesn't always mean you'll experience symptoms. Some men may feel perfectly fine, with their low levels going unnoticed until they show up in bloodwork. Others may notice changes in their energy, strength, mood or sex drive.

According to the Endocrine Society, doctors diagnose testosterone deficiency when men have compatible symptoms or signs alongside consistently low testosterone levels confirmed by blood tests. Routine screening of all men without symptoms is not recommended.

Signs of low testosterone

Having low testosterone can affect men in different ways. When symptoms do occur, they can include:

Reduced sex drive: Having less interest in sex than usual.
Erectile difficulties: Trouble getting or maintaining an erection.
Fatigue: Feeling more tired than usual, even after getting enough rest.
Loss of muscle mass: Noticing a decrease in muscle size or strength.
Increased body fat: Gaining body fat, particularly around the abdomen.
Mood changes: Experiencing irritability, depression or difficulty concentrating.
Reduced bone density: Having weaker bones, which can increase the risk of fractures.
Loss of body hair: Noticing less facial or body hair.

These symptoms can also be caused by other health conditions, medications or changes associated with aging. Having one or more does not necessarily mean you have low testosterone. Discuss persistent or bothersome symptoms with your doctor, who can evaluate low testosterone and other possible causes.

What causes it?

Testosterone levels can decline with age, but health conditions, medications and other factors can also contribute. These include:

Obesity: Carrying excess body fat may disrupt levels.
Chronic health conditions: Type 2 diabetes, kidney disease and some other medical conditions may have an impact.
Sleep problems: Conditions such as obstructive sleep apnea may contribute to lower testosterone levels.
Medications: Opioid pain relievers and glucocorticoids, particularly long-term systemic treatment, can suppress testosterone production. Do not stop a prescribed medicine without discussing it with your doctor.
Injuries or medical treatments: Damage to the testicles, chemotherapy and radiation treatments can affect the body's ability to produce testosterone.
Hormonal problems: Conditions affecting the pituitary gland, which helps control testosterone production, can also lead to low levels.

Your doctor can help you to figure out the cause behind your declining levels, which can also help to determine whether treatment is needed.

How is low testosterone diagnosed?

The first step is typically recognizing symptoms of low testosterone and then visiting your doctor. Your provider will likely recommend a blood test to check your hormone levels.

Testosterone levels vary during the day and from day to day. Diagnosis requires at least two early-morning blood tests on separate days; the Endocrine Society recommends fasting samples. Testing during an acute illness can be misleading because testosterone may temporarily fall.

Your physician will interpret the results with your symptoms, medical history and the laboratory’s reference range. A total testosterone level below 300 nanograms per deciliter (ng/dL) commonly supports further evaluation, but a single low result does not establish the diagnosis. If results are borderline, your doctor may also check free testosterone, the portion not tightly bound to proteins. Additional hormone tests can help identify the cause.

What are my treatment options?

Treatment for low testosterone depends on your symptoms, overall health and what's causing the condition. These can include:

Lifestyle changes such as losing excess weight, exercising regularly, getting enough sleep and managing chronic health conditions support overall health. Treating reversible causes, particularly obesity, may improve testosterone levels without hormone therapy.

Testosterone replacement therapy (TRT) may improve sexual symptoms in men with confirmed testosterone deficiency. Options include gels and injections; the choice depends on individual needs and product-specific risks. For age-related low testosterone, the American College of Physicians recommends discussing treatment for sexual dysfunction, rather than starting it to improve energy, physical function or memory.

TRT can increase red blood cell counts and blood pressure and suppress sperm production. It should not be used when trying to conceive. Untreated severe sleep apnea, elevated red blood cell counts, uncontrolled heart failure, a recent heart attack or stroke, and certain cancers or clotting disorders may make treatment inappropriate. Your clinician should review these risks before prescribing.

If using testosterone gel, follow the product’s instructions to prevent skin transfer to others, especially children and pregnant people.

For men 65 and older, treatment decisions should be individualized rather than based on age or a low laboratory value alone. Follow-up should assess symptoms, testosterone, red blood cell counts, blood pressure and appropriate prostate monitoring. For age-related sexual symptoms, reassess benefit within 12 months; the clinician should discontinue treatment if sexual function does not improve.

If changes in your energy, strength or sex drive are affecting your daily life, a conversation with your doctor is a great place to start. Together, you can explore what may be causing your symptoms, whether testosterone testing makes sense and what options fit your health and needs. The goal is to understand the changes you’re noticing and find a path forward that works for you.

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