Keep Testosterone in Balance

Medically Reviewed by Melinda Ratini, MS, DO on May 22, 2024
4 min read

Testosterone is the male sex hormone. As men get older, their bodies produce less of it. Starting in middle age, it often drops below levels that doctors consider normal.

Low testosterone -- also known as hypogonadism or low T -- can affect your overall health. But some doctors say it’s just a normal, harmless part of aging.

Here’s what you need to know to keep your concerns and your hormones in proper balance.

Testosterone levels are measured through blood tests. Most doctors agree that a “normal” reading falls anywhere between 300 to 1,000 nanograms per deciliter (ng/dL). About 40% of men over age 45 will have levels that come in below that range. But a low reading by itself isn’t enough to warrant alarm.

In fact, it’ll likely have a lot to do with the time of day doctors test your blood. The best time for testing is between 7 and 10 a.m. “Different hormones have different patterns of secretion,” says Ronald Swerdloff, MD, chief of endocrinology at Harbor UCLA Medical Center. “Normal testosterone ranges are based on morning samples, when the average person is at a higher level. Afternoon tests may give a false impression of low levels.”

Swerdloff says you should get multiple tests -- at least two over the course of a couple of weeks or months. You’ll want to make sure you have low T before you take any action.

Even if your testosterone levels are below the recommended range, you still might not have to worry. Doctors say that a reading between 200 and 300 ng/dL is sort of a gray area.

Levels that are just slightly low aren’t a cause for concern by themselves. But if you have other symptoms, you’ll want to see your doctor. “Everyone agrees that if you have a phenomenally low level, you’d benefit from treatment. But if it’s just slightly low, as is more common, you’d definitely want to have symptoms,” says Bradley Anawalt, MD, chief of medicine at the University of Washington.

Those symptoms may include:

  • Lower sex drive or desire
  • Lower quality and frequency of erections
  • Lower bone density
  • Reduced muscle mass and strength
  • Low energy
  • Fatigue
  • Depressed feelings

A decrease in this hormone could be caused by a number of things, like an injury or infection in the testicles, which make testosterone. It could also be caused by tumors and diseases of the pituitary gland, which regulates how much of the hormone your body releases.

It can also be linked to  other conditions, such as:

If you don’t have any of these conditions, your doctor may not be able to tell you why you have low T. That’s not unusual. Many older men have it, and no one knows exactly why.

But that doesn’t mean you can’t do something about it.

Your first course of action should be to look at your lifestyle. If you’re overweight, shed some pounds. Anawalt says that most men who lose 7% to 10% of their body weight see their testosterone levels improve. “Anything that affects overall health affects testosterone,” he says. “That includes diet, exercise, drinking less booze, and not smoking. All of those things can help maintain healthy testosterone levels.”

Some doctors say that getting a good night’s sleep and reducing stress can also have a positive effect.

If those things don’t work, you might be a candidate for testosterone therapy. You can get extra doses of the hormone in several ways:

  • Injections in your muscle about every 2 weeks or so. An extra-long-acting formulation is also available.
  • Patches applied to the skin daily
  • Gel rubbed into the skin daily
  • Tablets taken twice a day (but these are not usually recommended)
  • Pellets implanted under the skin once every 3 to 6 months

There are also pills available outside the U.S. But Anawalt warns, “When you read about something that claims to be a ‘magical cure,’ be very, very skeptical.”

How long you’ll need therapy can vary, depending on the symptom(s) you’re trying to treat. For example, if you have pituitary disease, you may need therapy for the rest of your life. If you’re trying to increase your sex drive, 6 months may do the trick.

But overall, you should see a gradual increase in muscle mass and bone density, as well as higher libido. Your doctors will also look for a deeper voice and beard growth as signs of getting your testosterone back on track.