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Low Testosterone: How to Talk to Your Doctor

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WebMD Feature

Asking about symptoms of low testosterone might seem embarrassing. Just talking about it  might make you feel like you’re light in the manhood department. But if you’re wondering about low testosterone, you’re far from alone.

Low testosterone becomes more common with age, affecting millions of men in the U.S. Although it may cause no symptoms, low testosterone can also result in poor libido, erectile dysfunction, depression, and loss of energy. These symptoms of low testosterone can masquerade as ordinary aging -- when, in fact, it’s a treatable condition.

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“Most men don’t ask about it,” says Karen Herbst, MD, an endocrinologist with the University of California at San Diego. “It would be great if they would.” Talking with your doctor is the only way to find out if increasing testosterone levels would help reduce symptoms.

Testosterone levels naturally decline with age. Men lose about 1 percent per year of their testosterone levels after age 40. In middle age and later, levels can dip below the threshold of what’s considered normal.

Population studies suggest that 10% to 25% of men over 50 may have low testosterone. When asked about symptoms, though, only about one-half to two-thirds of these men report any symptoms of testosterone deficiency.

And the symptoms are what matters, Herbst tells WebMD. Unless a man has symptoms, Herbst believes that he should not have a testosterone test.

Low Testosterone: Symptoms and Treatment

Low libido and erectile dysfunction are two common symptoms of low testosterone. But other symptoms are often vague and nonspecific. For example, fatigue, difficulty concentrating, depression, and irritability are common in men, and frequently occur with normal testosterone levels.

Low testosterone symptoms can also be insidious. Unlike menopause, when women’s estrogen levels abruptly fall to very low levels, “andropause” in men is a slow, steady decline in testosterone over decades. Changes in muscle mass, libido, and mood can be subtle, even unnoticed by a man himself.

Herbst thinks physicians could do more to ask about the symptoms of low testosterone. She adds, “Most of the time, it’s the last thing I ask about. ‘How’s your libido? Are you having any symptoms of ED?’” If a man over 50 mentions problems, a testosterone test is the appropriate next step, Herbst says.

Testosterone replacement therapy can help reduce symptoms. But talking with your doctor about any problems you have can be a tough conversation to start. In one study, 82 percent of men with erectile dysfunction wished their primary doctor had asked them about symptoms earlier. The vast majority of these men said they felt too embarrassed to initiate the discussion about ED themselves.

Andre Araujo, PhD, an epidemiologist focused on testosterone deficiency and treatment patterns, found treatment rates to be surprisingly low in a recent study in Boston. “Only about 12 percent of men with [symptoms of low blood testosterone levels] were receiving testosterone,” Araujo says. “We can’t say they should have been treated, but the low treatment rate didn’t seem due to poor access to care or unwillingness on their part.”

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