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Men's Hormones Health Guide

Male hormones can significantly affect the quality of life and well-being. Checking your hormone levels could identify the cause of your low energy, mood and libido, among other things.

SHOP MALE HORMONE HEALTH TESTS Dr Sam Rodgers - Chief Medical Officer

Reviewed by Dr Sam Rodgers

20th February 2020


What are male hormones?

Chapter 1

What are male hormones?

Hormone levels

Chapter 2

Hormone levels

What is testosterone?

Chapter 3

What is testosterone?

High testosterone FAQs

Chapter 4

High testosterone FAQs

Low testosterone FAQs

Chapter 5

Low testosterone FAQs

Testosterone replacement therapy

Chapter 6

Testosterone replacement therapy

Blood testing for male hormones

Chapter 7

Blood testing for male hormones

What are male hormones?

Chapter 1

What are male hormones?

Over 50 hormones have responsibility for the balance and control of the body’s major systems.

Hormones are ‘chemical messengers’ produced by the endocrine glands that carry information through the bloodstream to our organs and body tissues.

Over 50 hormones are circulating in our bodies, each with its own goal. They are responsible for the balance and control of the body’s major systems including metabolism, homeostasis, sexual activity, and contraction of the smooth and cardiac muscles. Hormones also affect our growth and development, control mood, impact on stress, affect our sleep and influence our blood pressure.

What are male hormones?

Men naturally have both male and female hormones, but several male sex hormones (known as androgens) initiate the sexual differences between males and females. These androgens are also responsible for the development of male physical characteristics such as a deep voice and facial hair.

The most significant and well-known of the androgens is testosterone, which is found in far higher concentrations in men than in women. However, other male and female hormones also have a marked impact on a man’s quality of life.

Which are the important androgens?


Testosterone is the most important male hormone. Testosterone helps maintain bone and muscle mass, affects the way fat is stored in the body and affects the production of red blood cells. It is also associated with sex drive and plays a vital role in sperm production.

Low testosterone can affect the physical and mental health of men in many ways, including low libido, low energy, and decreased bone density. [See Chapter 5 for more information about low testosterone levels.]

Naturally occurring high testosterone is rare, but it can cause low sperm counts and increased risk of heart attacks, among other things. [See Chapter 4 for more information about low testosterone levels.]

Dehydroepiandrosterone (DHEA) and Dehydroepiandrosterone Sulphate (DHEA-S)

Dehydroepiandrosterone (DHEA) is a hormone that is produced by the adrenal glands and is responsible for male characteristics in both men and women. A precursor hormone, it is converted into other hormones such as testosterone and oestradiol, which then act upon the target tissues.

DHEA metabolises into DHEA-S (the sulphated form of DHEA) in the adrenal glands and liver. DHEA production peaks in the morning, and it is secreted quickly by the kidneys. DHEA-S, however, remains in the body much longer, which is why doctors test DHEA-S levels to determine the levels of DHEA in the blood.

In both sexes raised DHEA-S (often seen in those who use DHEA supplements) may indicate Cushing's disease (when the body produces too much cortisol) as well as possible adrenal tumour.

Low levels of DHEAS may indicate adrenal dysfunction and could contribute to low libido and fertility problems.

Dihydrotestosterone (DHT)

Dihydrotestosterone (DHT) is also a significant male hormone for adults because it contributes to balding, prostate growth and sebaceous gland activities. Almost 10% of the testosterone produced by a man each day is converted to DHT by the testes and prostate.

It is unlikely that adult men with too much DHT, often resulting from excess testosterone production, would undergo recognisable changes.


Androstenedione is an intermediate hormone, produced from DHEA, and then converted to testosterone or oestrone. It can be used as a marker of adrenal gland function, androgen production, and the function of the testicles.

Too much androstenedione in men may lead to an imbalance in oestrogen and testosterone production, which could produce changes such as breast development and shrinking testes.

In male adults, low androstenedione levels cause the same effects as too little testosterone (including impotence, difficulty concentrating and sleep problems).

Other relevant hormones


Oestrogen is the collective term for a group of female hormones, which men produce naturally in small amounts. It is required for healthy sexual functioning, including fertility and libido. Both high and low oestrogen levels are relatively rare in healthy males.


Oestradiol is the strongest of the three naturally produced oestrogens. Oestradiol is a female steroid hormone made from cholesterol, produced in low levels in men’s testes. Oestradiol in men is essential for modulating libido, erectile function, and sperm production.

Oestradiol can be raised in men due to excess body fat (which produces oestradiol) or linked to age-related decline in testosterone. Raised oestradiol in men can cause the growth of breast tissue, the loss of libido and infertility.

Follicle Stimulating Hormone (FSH)

Follicle Stimulating Hormone (FSH) is produced in the pituitary gland and is essential for both women and men. In men, FSH is involved in stimulating the testes to provide the nutrients and regulatory molecules needed for sperm production.

Raised levels of FSH in men are a sign of malfunction in the testes.

Low levels of FSH can be a sign of a problem in the pituitary gland and may cause issues with sperm production and fertility. They can also be a response to high levels of testosterone in the blood, caused by testosterone replacement therapy or anabolic steroid use.

Luteinising Hormone (LH)

Luteinising Hormone (LH) is produced by the pituitary gland and is vital for male and female fertility. In men, LH stimulates the testes to produce testosterone.

High levels of LH can indicate decreased sex steroid production from the testes, which may cause infertility.

Low levels of LH can be a sign of problems with the pituitary gland and can cause infertility because a critical level of LH is required to support testicular function. They can also be a response of the pituitary gland to high levels of testosterone in the blood, which can be found with testosterone replacement therapy or anabolic steroid use.

Sex hormone binding globulin (SHBG)

Most of the sex hormones found in the blood - testosterone, oestrogen and dihydrotestosterone (DHT) - are bound to sex hormone binding globulin (SHBG), which means that they are unavailable to act on our cells.


Prolactin is a hormone produced in the pituitary gland that plays a role in reproductive health. Its primary purpose is to stimulate milk production in women after childbirth. It is also present in men and can affect the reproductive system and help regulate the immune system.

Low prolactin levels in men are very rare, but raised levels in men can interfere with the function of the testicles and cause reduced sex drive, lack of energy, erectile dysfunction, breast tissue tenderness and enlargement, and fertility problems.


Cortisol is a steroid hormone found in men and women that regulates many of the vital processes throughout the body. Almost every cell contains receptors for cortisol, so it can do many things depending on the cell it is affecting. It is mainly known to have an essential role in regulating stress, the metabolism and the body's immune response.

Naturally occurring raised cortisol is rare, but if elevated cortisol levels are seen over a long time, they can cause impotence and loss of libido by inhibiting testosterone production. It can also cause Cushing's syndrome, which has symptoms including high blood pressure, thin bones, reduced libido and erectile dysfunction.

Too little cortisol can cause the rare condition of Addison's disease – primary adrenal insufficiency – with symptoms that may include abdominal pain, physical weakness, and weight loss.

Hormone levels

Chapter 2

Hormone levels

Home testing of hormone levels can identify imbalances and provide answers for a range of health issues, some of which are detailed below.

Hormone levels can be imbalanced when there is too little or too much of a hormone circulating in our blood.

Hormones are essential for regulating most major bodily processes, so even a small hormone imbalance can cause a range of side effects throughout the body. Both men and women can be affected by imbalances in insulin, steroids, growth hormones, and adrenaline. Men are most likely to experience irregularities in levels of the male sex hormone, testosterone.

Signs and symptoms of a hormone imbalance

In men, a hormone imbalances may be to blame for unwanted symptoms that range from low mood to weight gain and erectile dysfunction.

Other symptoms that could suggest a hormone imbalance in men include:

  • reduced muscle mass
  • hair loss
  • mood swings
  • irritability
  • trouble concentrating
  • fatigue
  • infertility
  • low sperm count
  • problems maintaining an erection
  • reduced sex drive
  • breast tissue growth
  • breast tissue tenderness
  • osteoporosis

Causes of a hormone imbalance

An imbalance in a hormone level can be caused by many factors, including puberty, ageing, medication, and lifestyle factors such as exercise and what you eat and drink.

Checking male hormone levels

Hormone testing could help provide answers for a range of health issues.

Most hormones can be detected in the blood, so a blood test can be taken to check testosterone, oestrogen, cortisol, and other hormone levels.

Other checks that doctors undertake in addition to blood testing can include checking the testes, ultrasound scans, biopsies, MRI scans, x-rays, thyroid scans, and sperm count testing. However, referrals for these tests will depend on the nature of the symptoms that are presented.

Blood tests for hormone levels

There are several options available for testing your blood for hormone levels with Blood tests can be done at home with our simple and personal blood testing kit, with a home visit from a qualified nurse, or at one of our local clinics around the country.

For more details about our blood testing options, see chapter 7.

Coping with hormone imbalance

Many hormone imbalances, particularly those that are only very slightly outside of the normal range, can be managed naturally by making simple lifestyle changes. Where a hormone level is significantly outside the normal range, it is advised to see a doctor for further investigation and to agree on a programme of treatment that is suitable for you.

Strategies to deal with a hormone imbalance naturally include:

  • Getting enough sleep - Regularly getting a full, undisturbed, night's rest may help the body regulate hormone levels.
  • Avoiding too much light at night - Too much artificial light at night can upset the body’s natural circadian rhythm. The body responds to artificial light from computers and screens as if it were daylight and adjusts hormones in response. Avoiding artificial lights may help regulate hormones and restore circadian rhythms.
  • Managing stress - Studies have shown that even low levels of stress can cause an endocrine response that can lead to an increase in adrenaline and cortisol. Meditation, mindfulness or doing more activities that are relaxing to you, such as gardening or reading, could help to regulate these hormone levels.

  • Exercising - Doing more exercise can help moderate hormone imbalance. Just short, regular exercise sessions such as taking more walks can help regulate hormones that control appetite.

  • Eating healthily - Eating a healthy, balanced diet that includes fibre, healthy fats and fatty fish can help regulate hormones.

  • Eliminating alcohol - Studies have found that young men who drink even modest amounts of alcohol may see a disruption in their hormone levels. The researchers found a connection between regular alcohol consumption and reduced sperm quality and also saw changes in testosterone levels.

Age-related hormone imbalances

While male hormone levels do drop over time, middle-aged men don’t experience a sudden drop in hormones as women in middle age do. Instead, men experience a steady decline in hormone levels after the age of 30, by less than 2% a year.


Natural decline like this is unlikely to lead to symptoms such as erectile dysfunction, loss of libido and mood swings in men in their late 40s to early 50s, that people sometimes call the ‘male menopause’ or ‘the change’. These symptoms may instead be the result of societal issues such as work-life balance, relationship issues or money problems; or lifestyle factors such as lack of sleep, a poor diet, lack of exercise, drinking too much alcohol, and smoking.

Late-onset hypogonadism

Late-onset hypogonadism is an uncommon testosterone deficiency) that develops later in life. Its symptoms are like those associated with ‘male-menopause’, but it is not a normal part of ageing and is seen mainly in men who are obese or have type 2 diabetes.

You are advised to see your doctor if your blood tests identify hormone imbalances and you are experiencing symptoms such as those listed above.

Hormone levels and hair loss

Changes in hair follicles can be attributed to changes in male hormone levels. Inevitably, most men see some hair loss by the time they are in their 60s, but hair loss can begin a lot earlier for some men. About three in ten men aged 30 and half of men aged 50 are said to have significant balding.

There are a number of reasons for hair loss such as autoimmune conditions, iron deficiency or stress. However, the most common reason is 'male pattern baldness' (androgenic alopecia).

Male pattern baldness is caused by the effect of the male hormone dihydrotestosterone (DHT), on the hair follicles. Cells in the skin of the scalp convert testosterone into DHT, which then causes affected hair follicles to shrink. As the follicle shrinks, each new hair is thinner than the previous one until the hair does not grow out to the skin’s surface.

Medication is available to treat male pattern baldness, but it is expensive and not available on the NHS. It can block the production of DHT to prevent the hair follicles shrinking, but it must be taken continuously, it can take a long time to see results and side effects can include reduced libido and erectile problems.

What is testosterone?

Chapter 3

What is testosterone?

Understand the difference between total or free testosterone, and what their levels mean.

Testosterone, the most significant and well-known male hormone, stimulates the development of male characteristics.

Testosterone is an androgen that is produced mainly by the gonads – the testes in men and the ovaries in women – and in small quantities by the adrenal glands. It is present in much greater levels in men than in women, and in men it is responsible for the development of muscles, facial, pubic and body hair, maintaining sex drive, bone health, and it is essential for sperm production.

Total testosterone vs. free testosterone

Testosterone is secreted directly into the bloodstream from the testes – where the majority of it binds to the proteins sex hormone binding globulin SHBG and albumin.

The remaining testosterone that isn’t attached to proteins is known as free testosterone. Free testosterone can enter body cells to help moderate metabolism and other cellular functions.

‘Total testosterone’ is a measure of how much testosterone there is in the blood in total – both free and bound. So, it will always be a higher measure then free testosterone.

However, research suggests that free testosterone can be a key indicator of testosterone deficiency because it represents the testosterone that can act upon the body’s tissues. Total testosterone can be within the normal range while free testosterone levels can be low, so it is important to measure both free and total testosterone if low levels are suspected.

What is a normal testosterone level?

Men and women need the right amount of testosterone to develop and function normally, but it is not clear what the ‘right’ amount is. The ‘normal’ range of testosterone can differ depending on age (testosterone levels decline naturally with age from around 30 years), the existence of any underlying health conditions such as diabetes and whether medications are being taken.

When TT and FT are measured together, testosterone deficiency can be more accurately determined. The diagnosis of testosterone deficiency is based partly on finding low testosterone levels, and partly on having symptoms suggestive of deficiency, These include low libido, erectile dysfunction, fatigue and difficulty maintaining muscle mass:

When testosterone is out of normal range

High testosterone

It is unlikely that adult men will develop a natural disorder in which they produce too much testosterone, and it is often difficult to spot that an adult male has too much testosterone. However, the use of anabolic steroids (manufactured androgenic hormones) decreases the amount of testosterone and sperm produced within the testes. In men, this can result in behavioural changes, infertility, a decreased sex drive, shrinking of the testes and breast development. [See Chapter 4]

Low testosterone

In adult men, testosterone levels slowly decline naturally with age. Low testosterone may lead to a reduction in muscle bulk, loss of body hair and a wrinkled ‘parchment-like’ appearance of the skin. Excessively low testosterone levels can also cause mood disturbances, increased body fat, loss of muscle tone, inadequate erections and poor sexual performance, osteoporosis, difficulty with concentration, memory loss and sleep difficulties. [See Chapter 5]

Testosterone and anger

It is suggested that hormones do not directly change behaviour; instead, they influence the expression of behaviour within appropriate environmental and social contexts.

Some people believe that high testosterone causes uncharacteristically aggressive behaviour, but there is no clear evidence that having more testosterone makes men any angrier than having normal levels of it. Evidence suggests that the relatively modest doses of testosterone prescribed to increase low testosterone levels are also not associated with changes in aggressive or angry behaviour. In fact, most anger or mood problems in men are caused by decreased levels of testosterone.

High testosterone FAQs

Chapter 4

High testosterone FAQs

Discover the answers to the most commonly asked questions about high testosterone.

High testosterone levels rarely occur naturally, but men with high testosterone can experience a variety of symptoms and possible health consequences.

High testosterone levels most commonly occur with the use of anabolic steroids (synthetic versions of testosterone) or other related hormones, which are taken to increase muscle mass and athletic performance. More rarely, too much testosterone in men can result from testicular or adrenal tumours. In either case, high testosterone levels can cause symptoms that range from weight gain to impotence.

What does high testosterone do to a man?

Rare medical conditions such as testicular or adrenal tumours can cause excess testosterone, but too much testosterone usually occurs when men take synthetic hormones to build muscle mass and enhance athletic performance.

Abnormally high testosterone levels in men can cause problems such as:

  • Insomnia
  • Headaches
  • Mood swings
  • Weight gain
  • Acne
  • Low sperm count
  • Impotence
  • Testicular atrophy
  • High oestradiol levels, causing gynaecomastia
  • High blood pressure
  • High cholesterol
  • Heart muscle damage
  • Increased risk of blood clots and stroke
  • Difficulty urinating
  • Liver disease
  • Fluid retention – swollen legs, feet and ankles

Some men with high testosterone also find they may experience more aggressive and irritable behaviour, more oily skin, increased muscle mass and even worse pre-existing sleep apnoea. Studies have also found that it can increase the risk of heart failure and stroke-causing blood clots in some men.

Are there other drawbacks to having high testosterone?

As well as affecting men physically, high testosterone can also affect lifestyle and behavioural choices. It has been said that men with higher than average testosterone are more likely to:

  • Drink more alcohol
  • Smoke
  • Get injured
  • Participate in risk-taking behaviour

Are there any advantages to having high testosterone levels?

Modest advantages of men having higher than average testosterone levels include:

  • It can normalise blood pressure in some men
  • It can lower the chance of obesity in some men

What should men do to manage high testosterone levels?

Men with naturally high testosterone levels can try the following to reduce their testosterone levels:

  • Exercise regularly - Regular exercise can lower blood pressure, lower cholesterol, promote stronger bones and muscles and manage your weight.

  • Eat a healthy, balanced diet - A healthy balanced diet provides the right level of vitamins, minerals and nutrients that help maintain our hormone levels.

  • Avoid smoking - Stopping smoking can improve fertility, enhance your sex like and raise energy levels.

  • Watch their weight - Maintaining a healthy weight can lower the risk of heart disease, stroke, diabetes, and high blood pressure.

  • Keep an eye on their blood pressure - Monitoring blood pressure can help ensure that it does not get too high and put a strain on arteries and on the heart, leading to a heart attack or stroke.

  • Maintain blood sugar levels - High insulin levels can promote the production of testosterone.

Low testosterone FAQs

Chapter 5

Low testosterone FAQs

Recognising the symptoms of low testosterone can help you to understand the causes. Here we explore the most commonly asked questions about low testosterone.

Low testosterone can have significant health effects on men. Testosterone naturally decreases with age, but it can also occur for a variety of acquired or congenital reasons.

Low testosterone can affect men in many ways. From the age of 30, testosterone levels begin to steadily decline at a rate of less than 2% each year. However, for some, abnormally low levels of testosterone can be the result of many different medical issues or treatment for certain physical conditions. Low testosterone levels may cause decreased sexual function, the loss of body hair, low muscle bulk and strength, and increased body fat.

What does low testosterone do to a man?

Testosterone has a role in protecting against cardiovascular disease, bone density, concentration, memory, mood, muscle strength and fat metabolism, but symptoms of low testosterone can differ depending on how low the level of testosterone is.

Symptoms of low testosterone in men can include:

  • Erectile dysfunction
  • Hair loss
  • Reduced bone mass
  • Reduction in testicle size
  • Reduction in the amount of semen
  • Low sperm count
  • Enlarged breast tissue
  • Difficulty sleeping
  • Lowered sex drive
  • Reduced muscle mass
  • Hot flashes
  • A decrease in energy levels
  • Increase in body fat
  • Changes in mood such as irritability or sadness

How can low testosterone affect your sex life?

Low testosterone can significantly affect a man’s health and lifestyle, particularly in terms of sex life and relationships. Often men with low testosterone have some erectile dysfunction, which can include difficulty in getting and keeping an erection, and erections occurring less often and not as strongly as in the past. In addition, as testosterone drops, a man's libido (sexual desire) can also drop.

Does low testosterone cause infertility?

Low testosterone is not directly to blame for male infertility. Men with low testosterone can still produce healthy sperm because sperm production is mainly stimulated by other hormones. Also, the levels of testosterone in the testicles, where sperm is produced, is much higher than testosterone levels in the blood. However, when low testosterone levels are seen, they can decrease the production of sperm.

An indirect effect of low testosterone on fertility is its role in reducing a man’s sex drive, resulting in a lack of desire to even have sex. It can also cause erectile dysfunction, making it harder to have sex when desired. Having fewer erections or erections that aren't as strong as they once were can make it difficult to reach a climax or to have sex often enough for reproduction.

What are the main causes of low testosterone?

Testosterone starts to drop naturally in men after the age of 30. However, several causes other than ageing can also cause low testosterone. These causes might be due to congenital conditions (from birth), acquired conditions (developing after birth) or medical interventions. Acquired conditions might include injuries to or infection of the testicles, or diseases of the pituitary gland. Medical interventions can include chemotherapy or radiation for treating cancer in the genital area or medicines such as steroids or opioids.

Other potential causes for low testosterone include:

  • Genetic conditions like Klinefelter syndrome, hemochromatosis, Kallmann syndrome, Prader-Willi syndrome, myotonic dystrophy
  • Alcohol abuse
  • Cirrhosis of the liver
  • Chronic kidney failure
  • Inflammatory conditions
  • Obesity or extreme weight loss
  • Uncontrolled type 2 diabetes mellitus
  • Obstructive sleep apnoea
  • Previous anabolic steroid abuse
  • Severe primary hypothyroidism
  • Trauma such as head injury
  • Radiation exposure or prior surgery of the brain
  • Vitamin D deficiency

What is hypogonadism?

Hypogonadism occurs in men when the testicles don’t produce enough testosterone. It is defined as the presence of abnormally low testosterone levels in the blood, combined with physical symptoms such as loss of libido and erectile dysfunction. There are two types of hypogonadism – primary and secondary. Primary hypogonadism is related to the testicles, and secondary hypogonadism is related to the hypothalamus or pituitary gland.

Primary hypogonadism (testicular)

Primary hypogonadism occurs when the testicles do not respond to the hormones follicle-stimulating hormone (FSH) and luteinizing hormone (LH). In people with primary hypogonadism, FSH and LH levels are elevated because there is not enough testosterone available to inhibit their production.

Acquired causes of primary hypogonadism include:

  • Chemotherapy or radiation therapy
  • Testicular infection
  • High doses of antiandrogen drugs
  • Ageing
  • Alcohol use disorders
  • Systemic disease (e.g. liver failure, AIDS, sickle cell disease)
  • Drugs (ethanol, corticosteroids)

Secondary hypogonadism (hypothalamic/pituitary)

Secondary hypogonadism is a failure of the hypothalamus to produce gonadotropin-releasing hormone (GnRH), or of the pituitary gland to produce enough FSH and LH. In secondary hypogonadism, testosterone levels are low, and levels of FSH and LH are low or borderline normal.

Acquired causes of secondary hypogonadism include:

  • Any acute systemic illness
  • Defects to the pituitary gland
  • Hereditary haemochromatosis (too much iron in the body)
  • Certain drugs (e.g. oestrogens, psychoactive drugs, opioids)
  • Cushing’s syndrome
  • Cirrhosis
  • Obesity
  • Ageing
  • Alcohol use disorders
  • Systemic disease (e.g. liver failure, AIDS, sickle cell disease)
  • Drugs (ethanol, corticosteroids)

How do you test for hypogonadism?

A blood test for hypogonadism should be taken in the morning, before 10 am, to give the most accurate reading. This is because testosterone levels are naturally at their highest in the 2-3 hours after waking.

Total testosterone (TT), free testosterone (FT), follicle-stimulating hormone (FSH) and luteinising hormone (LH) should be measured at the same time to get the complete picture.

Is low testosterone dangerous?

Abnormally low testosterone levels can sometimes have serious long-term effects, such as osteoporosis. Studies have also linked low testosterone in older men to a shorter life expectancy due to the higher risk of death from heart disease and other causes. However, it is not clear if this is just due to low testosterone or if many other factors are involved. More recent research has identified that men with naturally high testosterone are also at increased risk of cardiovascular disease such as stroke.

Dangerously low levels of testosterone may only occur under certain conditions, usually following treatment, or medication for, diseases such as prostate cancer, or the surgical removal of the testes. Prostate cancer can be fuelled by testosterone, so treatment known as androgen deprivation therapy (ADT) may be given to block testosterone in cases of advanced prostate cancer.

Men with low testosterone are also at increased risk for insulin resistance and type 2 diabetes.

It’s unlikely that otherwise healthy adult men will experience dangerously low levels of testosterone.

Is low testosterone a sign of cancer?

There is no evidence to show that low testosterone is a sign of cancer. In fact, a study carried out by scientists at the University of Oxford suggests that men with naturally low levels of testosterone are less likely to develop prostate cancer than those with higher levels of testosterone. So, while high levels of testosterone don't increase the risk of developing prostate cancer, low levels can lower the risk.

How do you fix low testosterone?

Testosterone replacement therapy could be prescribed by your doctor if you both decide that the benefits would outweigh the risks in your situation. [See Chapter 7 for more information about testosterone replacement therapy.] However, borderline levels of low testosterone can often be treated by managing lifestyle factors.

Does low testosterone need to be treated?

A low testosterone level alone doesn't need treatment. Only men with symptoms of low testosterone and low blood levels should consider testosterone replacement therapy if it is suitable for them. Testosterone replacement therapy can have side effects, and the long-term risks and benefits aren't known.

What happens if low testosterone goes untreated?

Even if your levels are low, and you have symptoms, treatment with testosterone replacement therapy is not always the first course of action. In the first instance, your doctor will try to identify why testosterone levels are declining, for reasons such as weight gain or medication, for example, and address these problems first.

Treatment can cause greater side effects than those experienced from having low testosterone, particularly for those whose low testosterone level is close to ‘normal’. It is important to speak to your doctor to decide if the benefits of treatment would outweigh the risks for you.

Testosterone replacement therapy

Chapter 6

Testosterone replacement therapy

Testosterone replacement therapy is the bodily administration of testosterone for men with low levels or hypogonadism, aiming to increase the levels to a normal range and help improve quality of life.

Testosterone replacement therapy has been shown to significantly improve many symptoms of hypogonadism (low testosterone) when administered safely by a medical professional.

Testosterone replacement therapy can help reverse the effects of hypogonadism in men who exhibit symptoms of low testosterone as well as having low testosterone blood levels. It has been shown to significantly improve symptoms such as erectile dysfunction and low libido, whether it improves depression and other associated symptoms is less clear. There are also potential side effects to treatment, as testosterone replacement therapy may increase the risk of deep vein thrombosis and pulmonary embolism if not appropriately monitored.

It is less clear whether testosterone replacement therapy helps with age-related decline in testosterone, which is milder and more common than hypogonadism. Guidelines published in 2020 by the American College of Physicians advise that TRT may help with the low libido and erectile dysfunction that older men with the condition may experience, but advises that there is unlikely to be any benefit for symptoms such as low energy and poor concentration.

What is testosterone replacement therapy?

Testosterone replacement therapy is the administration of testosterone to the body for men with low testosterone, or hypogonadism, to increase the levels of testosterone to within normal range and help improve quality of life.

It is not suitable for everyone, and often even if testosterone levels are low and you are experiencing symptoms, your doctor will usually first try to address the reasons that testosterone is declining.

You should be fully informed about the expected benefits and side effects of therapy so a joint decision can be made between you and your doctor. Testosterone replacement therapy is not a quick fix, and it is an ongoing process that will usually continue long term. If the therapy is stopped, testosterone levels will drop back down to below-normal levels.

If testosterone replacement therapy is suitable for you, it must be prescribed by a medical professional to ensure the right amounts are delivered in the right way for your individual situation and given alongside weight-loss and lifestyle guidance.

Testosterone can be administered in many ways by using either:

  • Gel or patches put on the skin
  • Cream
  • Injections
  • Tablets that stick to the gums
  • Pellets inserted under the skin
  • Pills

Testosterone treatment must be administered and monitored for at least six months before many tangible reversals in symptoms are seen, and it can take longer than twelve months before maximum benefit is seen. Some men may see improvement sooner, but for most men it's a gradual process.

However, the range of effects of testosterone replacement therapy can greatly vary over time. A review in the European Journal of Endocrinology in 2011 found the following for men who have been diagnosed with hypogonadism who were being treated with testosterone replacement therapy:

  • Libido - Effects appear after three weeks, but they plateau at six weeks with no change expected beyond this.

  • Erectile dysfunction - Changes in erections/ejaculations may require up to six months of testosterone replacement before any effects are seen.

  • Quality of Life - Quality of life improvements can be seen within 3-4 weeks, but maximum benefits can take longer.

  • Depressive mood - Improvements in depressive mood can be seen after 3-6 weeks, and these stabilise after 18-30 weeks.

  • Erythropoiesis (red blood cell formation) - Effects on erythropoiesis can be seen at three months, peaking at 9-12 months.

  • Prostate-specific antigen (PSA) - Prostate-specific antigen and volume rise marginally over time, plateauing at 12 months; any further increase should be attributed to ageing rather than therapy.

  • Lipids (fatty acids) - Effects on lipids appear after four weeks and reach their maximum after 6-12 months.

  • Insulin - Insulin sensitivity may improve within a few days, but effects on glycaemic control only become evident after 3-12 months.

  • Body mass - Changes in fat mass, lean body mass, and muscle strength occur within 12-16 weeks, stabilise at 6-12 months, but can marginally continue over the years.

  • Inflammation - Effects on inflammation occur within 3-12 weeks.

  • Bone weakness - Effects on bone are detectable after six months and continue for at least three years.

Benefits of testosterone replacement therapy

  • Beyond six months there is evidence that testosterone replacement therapy can benefit body composition, bone mineralisation, and features of metabolic syndrome
  • Testosterone replacement therapy improves sexual desire, erectile function, and sexual satisfaction
  • It decreases BMI and waist size and improves glycaemic control.
  • Long term testosterone replacement therapy can improve the lipids profile in men with hypogonadism and pre-existing cardiovascular disease. Improving the lipid profile may be a contributing factor to a reduction in cardiovascular events and mortality.
  • Long-term testosterone replacement therapy can stimulate profound and sustained weight loss in men with hypogonadism and obesity.
  • Testosterone therapy can halt the progression of prediabetes to overt type 2 diabetes in men with testosterone deficiency and prediabetes.

Risks of testosterone replacement therapy

Serious adverse effects of testosterone therapy are relatively rare. TRT is not thought to cause prostate cancer, and providing treatment is being managed effectively by a doctor it has not been found to increase the risk of deep vein thrombosis or cause serious cardiovascular conditions. Adverse effects are more significant in the elderly or obese, or they are linked to the method of delivery.

Side-effects may include:

  • Too much testosterone being administered (causing supraphysiological levels) - This can be easily managed by adjusting the dosage, stopping treatment or switching to a different formulation.
  • Problems with intramuscular injections - These are associated with pain at the injection site, changes in mood, energy, and sexual desire, and, rarely, coughing straight after the injection.
  • Problems with transdermal gels - These carry a risk of interpersonal transfer, skin irritation, and fluctuations in absorption.
  • Polycythemia - An increase in both the number of red blood cells and the haemoglobin content of the blood. This occurs because testosterone stimulates the body to make red blood cells, so the blood is thicker than usual. This usually only occurs when testosterone replacement leads to high levels of testosterone in the blood and can lead to deep vein thromboses, pulmonary emboli, heart attacks, and strokes.
  • Gynecomastia - Enlarging or swelling breast tissue, that sometimes includes breast discharge, can be tender, uncomfortable and disconcerting.
  • Oedema - Fluid retention in the body can lead to uncomfortable swelling of the legs, feet, or ankles.
  • Skin conditions - Increased acne and other skin reactions such as oily skin can greatly affect the quality of life.

  • Sleep apnoea
  • Disturbed breathing while sleeping can lead to fatigue, difficulty concentrating and high blood pressure.

How to increase your testosterone levels naturally.

There are also natural solutions to boosting testosterone that involve adapting lifestyle factors. These include:

  • Getting just the right amount of exercise to increase testosterone levels.
  • Getting the right amount of sleep.
  • Reducing the stress in your life by learning stress management techniques
  • Eating a healthy diet, including sources of vitamin D and zinc.

Exercise training

Exercise training has been proposed as one of the first-line treatments for mild age-associated testosterone deficiency. Studies have shown that endurance and high-intensity interval training have the most promising effects for increasing basal testosterone in older men. However, they also showed that basal testosterone was not influenced by resistance training; in fact, resistance training was found to have negative effects on levels of free testosterone. Getting too much exercise can have as detrimental an effect upon testosterone levels as too little, so it is important to find the level that works for you.

Sleeping well

Studies have found that skipping sleep reduces a young man's testosterone levels by the same amount as ageing 10 to 15 years. Low sleep duration and poor sleep quality are increasingly recognised as endocrine disruptors. After just one week, having just five hours of sleep a night can decrease testosterone levels by 10% to 15%. Like exercise, sleep also has a goldilocks relationship with testosterone levels, sleeping for more than nine hours per night is associated with lower levels when compared to sleeping between 7 and 9 hours per night.

Reducing stress

Stress can increase cortisol levels, which in turn inhibits testosterone production in men, decreasing testosterone levels. It is therefore important to take steps to manage stress levels, which might include breathing exercises, time-management techniques, mindfulness, and cutting down on caffeine – a natural stimulant.

Eating the right foods

There are very few dietary changes which have been proven to raise testosterone levels. Vitamin D, which is found in oily fish (tuna, salmon, mackerel, herring, sardines and trout), may help to increase testosterone levels naturally. Eating more zinc-containing foods (e.g. shellfish) can help to improve testosterone levels in people who have low levels of zinc, but it will not help people who already have normal levels.

Blood testing for male hormones

Chapter 7

Blood testing for male hormones

Blood tests can give an indication of health and well-being via a finger prick or venous test. Below, we examine the range of blood tests available.

Having an imbalance of male hormones can be disruptive to your health and wellbeing. Testing your hormone levels is the first step to making changes that can greatly improve your quality of life.

Levels of testosterone and other male hormones can be affected for a range of reasons from ageing to chronic illness or lifestyle factors, and hormone imbalances can cause a myriad of symptoms. There are different ways to treat changes in hormone levels, but before considering what treatment is best for you, you first need to test your blood to understand the severity of your hormone imbalance.

Blood testing

Blood tests can give an indication of health and wellbeing, either as part of a regular check-up, to help investigate symptoms and diagnose a condition or to manage your lifestyle including help to change diet, monitor hormones, train for a sporting event, or keep track of your risk of long-term chronic diseases like heart disease and diabetes.

You can have a blood test to check your hormone levels, your vitamin and mineral levels such as vitamin D, B12 and iron, your cholesterol status, organ function or to see how much sugar is in your blood.

Blood testing can be done at the GP or very simply at home using a Medichecks blood testing kit. Medichecks has an array of male hormone blood tests that you can do easily from the comfort and privacy of your own home.

The Medichecks male hormone blood tests available include:

Testosterone blood test

Testosterone imbalance can cause a range of unwelcome symptoms.

The simple testosterone blood test is useful if you:

  • have symptoms of abnormal testosterone, and you want to check your levels
  • are concerned that your testosterone is declining with age
  • take supplements aimed at raising testosterone levels

Advanced Hair Loss Blood Test

Hair loss can greatly affect wellbeing and self-esteem, especially at a young age.

This thorough test is useful if you:

  • have thinning hair, and you wish to investigate any health issues that might be causing your hair loss

Male Hormone Blood Test

Checking symptoms that you think might be associated with male hormone imbalance is important for your health and wellbeing.

This comprehensive test is useful if you:

  • you want a thorough check of your reproductive hormones
  • you are experiencing symptoms such as low libido which you think might be hormone-related
  • you want to check your fertility

Testosterone replacement therapy monitoring

It is important to monitor your health and keep hormone levels within the normal range when on testosterone replacement therapy.

Medichecks has a range of blood tests available for monitoring Testosterone Replacement Therapy.

These tests are useful if you:

  • you take testosterone replacement medication, and you want to check your overall testosterone levels
  • you want to check your balance of male and female hormones whilst taking testosterone replacement therapy
  • you recognise there can-be side effects with testosterone replacement therapy, and you want to minimise your risks
  • you have changed your dose of testosterone replacement medication, and you want to check the impact on your hormone levels

Finger prick and venous blood tests

Most often, our laboratory can analyse results from the small amount of blood obtained from a finger-prick test, which involves using a lancet to prick your finger. However, you may not want to do a finger-prick test, or sometimes more blood is needed, so a venous blood test can be done by a qualified nurse in a local clinic or during a home visit. The venous blood test involves using a needle to puncture a vein, usually in your arm, which allows a larger volume of blood to be collected.

Many people are nervous before they have a blood test, but you will find that the process is quick and straightforward whether you have a venous blood test or a finger-prick blood test.

When a nurse takes a venous blood sample, usually from the arm, there is just a little scratch and pinch when the needle goes in and drawing the blood out is pain-free and quick. Your arm may bruise afterwards where the needle went in, but this is normal.

With a finger-prick blood test, you feel a quick scratch and pinch in the area of your fingertip where the lancet goes in. A small drop of blood will appear on your finger, and you gently squeeze your finger, dropping the blood into the small vial provided. The area where the lancet went in may be slightly tender for a little while after taking your sample.

Blood testing at home

Getting a blood test couldn't be easier – we will send you everything you need to collect your sample conveniently at home.

Our handy kit makes it easy to take a finger-prick blood sample at home, which you then return immediately by post for testing in our accredited lab (blood is generally stable in the post for up to three days). Your results will be interpreted by a doctor and then uploaded online where you can view them privately.

There are three simple steps to your at-home blood test:

  1. Collect sample: we send you our easy-to-use kit to collect your blood sample
  2. Post sample: Post your sample to our lab in the prepaid envelope provided
  3. View results: View results securely in your own personal online dashboard.

It’s so easy, we help thousands of people like you every year who want to understand their health and wellbeing.

When to check blood hormone levels

It’s best to do blood tests first thing in the morning as hormone levels can change as the day goes on.

Testosterone levels in particular naturally decline throughout the day because the levels produced by the testes are controlled by the hypothalamus in the brain and the pituitary gland. So, if testosterone levels are checked in the middle of the day or even later, you are much more likely to present low testosterone, which may not give an accurate picture of your true hormone levels.

Preparing for a blood test

To make drawing your blood easier, there are a couple of things you can do beforehand to help increase blood flow:

  • Drink plenty of water – staying hydrated will make it easier to collect your blood sample
  • Stay warm – try having a hot shower before you collect your sample or try jumping on the spot for a minute (this is especially useful for finger-prick blood collection)

Also, certain blood tests may require you to fast, which means not eating or drinking anything except water for 8-12 hours before your test, so do check beforehand. You will be notified if this is the case.