Low Testosterone: How to Talk to Your Doctor

From the WebMD Archives

It’s the hormone that helps turn boys into men. During puberty, it brings about facial hair, a deeper voice, and bigger muscles. In grown men, it helps to control sex drive and make sperm.

When your testosterone levels dip below what they should be, you can have problems with your sex drive and ability to have kids. Many men have this condition, which is called hypogonadism. Still, you may be too embarrassed to voice your concerns. WebMD offers these tips to help you talk to your doctor about it.

What Causes It?

Testosterone levels drop in all men as they age. About 4 out of 10 men over age 45 have low testosterone.

“Nowadays, there’s a lot more attention paid to testosterone issues in men,” says S. Adam Ramin, MD, the medical director of Urology Cancer Specialists in Los Angeles. “Some of my patients are proactive and come in to my office to find out about their levels. But others may not want to talk about it all.”

The symptoms of low testosterone can include:

Many men confuse low testosterone with erectile dysfunction. But “low testosterone doesn’t necessarily have anything to do with the ability to get an erection,” Ramin says. “It’s more about low desire and libido.”

How It’s Tested

If your doctor suspects your testosterone levels are low, he’ll give you a blood test, probably first thing in the morning. Your levels go up and down during the day. Mornings are when they tend to be highest.

Still, you may need to have your blood taken more than once and at different times of the day. Once your results come back, your doctor may send you for other tests to gather more information.

A normal range of testosterone is anywhere between 300 to 1,000 ng/dL. But there’s no exact number it needs to fall below to be considered low, says Philip Werthman, MD, director of the Center for Male Reproductive Medicine & Vasectomy Reversal in Los Angeles. “Every lab has a different range of what’s ‘normal.’”

Men start having symptoms at different times, too. Some may notice changes around 250 ng/dL, for instance. Other men, Werthman says, “don’t get symptoms until their level is at 150 or even 100.”

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Treatment

Some men don’t require any, Werthman says. “There are natural ways to raise testosterone, including exercise and weight loss.”

Other times, your doctor may suggest you start hormone replacement therapy. He’ll give you testosterone in an injection, patch, gel, or tablets to raise your levels back to a normal range.

What to Tell Your Doctor

Ideally, your doctor will bring up the topic during an office visit. “That doesn’t mean coming right out and asking, ‘Do you have low testosterone?’ but ‘How’s your sexual function?’” Ramin says. “It’s usually the first question I ask.”

Still, you might need to broach the topic on your own. You can make an appointment with your primary care doctor or seek the help of a urologist, who specializes in male sex organs. If fertility is an issue, you can talk to a reproductive endocrinologist. They treat hormone imbalances in both men and women.

Since you may feel self-conscious, there’s no need to tell the scheduler at your doctor’s office that you think you have low testosterone. Nor do you have to tell the nurse when she comes into the exam room to take your vital signs. “It’s OK to list a few of your symptoms, then wait for the doctor before you go into more detail, Werthman says. “You can tell him, ’I’ve been having these symptoms lately.' Then after you list them, suggest, ‘Maybe it’s testosterone.’”

It’s normal to feel embarrassed, especially if low sex drive is one of your complaints. But it can help to think of this like any other health problem that needs attention, Werthman says.

“As medical providers, we’re not here to judge, but to help,” Ramin adds. “As we age, our bodies tend to change. It’s a natural process.”

You might have seen TV or magazine ads that make testosterone therapy seem like a cure for all problems that come with aging. It’s a trend that’s driven more and more men to worry about their testosterone levels and ask their doctor to be tested, Werthman says. But “if you don’t have any symptoms of low testosterone, there’s no need for a test.”

WebMD Feature Reviewed by Melinda Ratini, DO, MS on December 13, 2015

Sources

SOURCES:

Urology Care Foundation: “What is Low Testosterone?”

University of Rochester Medical Center: “Total Testosterone.”

Philip Werthman, MD, director, Center for Male Reproductive Medicine & Vasectomy Reversal, Los Angeles.

S. Adam Ramin, MD, medical director, Urology Cancer Specialists, Los Angeles.

Rajifer, J. Reviews in Urology, published online Spring 2000.

Cleveland Clinic Center for Continuing Education: “Male Hypogonadism.”

Medscape: “Hypogonadism Treatment & Management,” “Low testosterone levels can improve with weight loss and exercise.”

Bebb, R. British Columbia Medical Journal, published online November 2011.

FDA: “FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use.”

Seftel, A. International Journal of Impotence Research, published online 2006.

Bhasin, S. Journal of Clinical Endocrinology and Metabolism, published online July 2013.

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