You're more tired than you used to be. Building muscles feels harder. Your weight is creeping up. Is it simply part of getting older, or could low testosterone be playing a role?
About one in four U.S. men age 70 and older have low testosterone levels. But declining testosterone isn't limited to men in their 70s.
The Baltimore Longitudinal Study of Aging found that the prevalence of low testosterone increases with age, affecting 12% of men in their 50s and 19% in their 60s.
As a family medicine physician at PartnerMD, testosterone is a topic that comes up often with my male patients as they age. We talk about how to recognize when something may be off, when testing and treatment make sense, and lifestyle habits that can support healthy levels.
Let's walk through everything you need to know about testosterone, including:
Testosterone is a hormone that plays an important role in sexual and reproductive health, while also helping regulate muscle mass, bone strength, red blood cell production, body composition, mood, and energy.
One thing you may not realize is that testosterone levels aren't constant throughout the day. They fluctuate and are typically highest in the morning.
Additionally, the brain plays a major role as well. The hypothalamus and pituitary gland help signal and regulate the production of testosterone in the body.
Testosterone is measured through a testosterone levels test via blood sample. This measures the amount of the hormone present in your bloodstream.
Testing options include:
Total testosterone – Measures all testosterone circulating in the blood, including testosterone that is bound to proteins and testosterone that is unbound (free).
Free testosterone – Measures only testosterone that isn't attached to proteins and is readily available for your body to use.
Bioavailable testosterone – Measures free testosterone and testosterone attached to proteins other than sex-hormone-binding-globulin (SHBG).
Your physician can help you determine which test is appropriate and how to interpret the results. Results may mean different things based on when the test was done, age, symptoms, and other medical conditions.
The most familiar symptoms of low testosterone include low sex drive and problems with sexual performance.
While these are the most common signs, low testosterone can also show up in ways that may not make you immediately think about your hormone levels. These can include:
The challenge is that many of these symptoms aren't unique to low testosterone. Fatigue, weight gain, changes in muscle mass, mood changes, and sleep problems can have many potential causes and may be dismissed as simply getting older.
Make sure to discuss any concerns you have with your physician to see if testing may be right for you.
Key Takeaway
What feels like normal aging may be worth a closer look. Low testosterone can share many of the same signs, and testing can help provide answers.
You've found out your levels are low. What comes next?
It's important to look at the bigger picture.
Your physician may consider whether medications, weight, sleep problems, certain medical conditions, or other factors could be contributing.
With their guidance, access if there is a reversible cause for low testosterone levels before seeking other options. If there are no other causes, it might be time to explore replacement therapy.
Testosterone replacement therapy (TRT) is often driven by symptoms and clinical concerns rather than age alone.
Testosterone therapy has become increasingly common, with options including topical testosterone solutions, injections, and even implantable pellets and oral medications.
Each varies in how your body absorbs them and potential side effects.
Applied to the skin once or twice daily, this method allows testosterone to be absorbed directly into the bloodstream. This is typically the first recommendation for therapy and a minimally invasive way to provide steady hormone levels.
However, there can be user error. Topicals require patients to apply it correctly, wait for it to absorb, and wash hands after application. If done improperly, the hormone treatment can be transferred to other individuals.
Testosterone injections are either given intramuscular, which is deep into a muscle, or subcutaneous, which is just under the skin.
While intramuscular injections are typically given every one to two weeks and in the outer thigh, shoulder, or buttocks, subcutaneous injections are given in the fatty tissue just beneath the skin in either the abdomen or outer thigh.
Injections are a commonly used option because dosing can be adjusted and they don't carry the same risk of transferring through skin contact as topical treatments.
The following therapy options are less commonly used:
Key Takeaway
Testosterone therapy isn't a one-size-fits-all.
The right approach depends on your symptoms, health, testosterone levels, and how different methods fit into your life.
The overall goal of therapy is to bring a patient's testosterone into a normal range, not to create "superhuman" levels.
Depending on the individual and symptoms associated with low testosterone, potential benefits may include:
At the same time, testosterone therapy carries risks. This might include:
Current evidence has not shown that appropriately prescribed testosterone therapy causes prostate cancer. However, if someone has undetected prostate cancer and begins therapy, the addition of testosterone could potentially accelerate its growth.
Screening and monitoring during treatment are highly important. Your physician can pay close attention to any negative side effects and how your body is responding.
Patients going through testosterone therapy are initially monitored about every three months. Once they become stable, monitoring may extend to every six months.
The approach I usually aim for is:
The goal isn't to push testosterone as high as possible. Higher doses can increase the risk of side effects associated with treatment, which is why the focus should be on reaching an appropriate level while monitoring how you're responding.
Lifestyle habits can play an important role in supporting healthy testosterone levels as you age.
Consider incorporating the following into your routine:
One study of healthy men ages 64 to 74 found that the amount of nighttime sleep was an independent predictor of total and free morning testosterone.
Key Takeaway
Supporting healthy testosterone starts with supporting your overall health. The same habits that benefit your heart, muscles, metabolism, and sleep can also benefit your hormone health.
Changes in energy, strength, body composition, sleep, or sexual health can be easy to assume are simply part of aging.
Don't be afraid to ask about testing and know where you stand. This can help you determine what may be behind the changes you're noticing. And while it's perfectly appropriate to replace if needed, remember that it isn't a magic overnight fix.
Your physician can help you determine whether testing makes sense, understand where your testosterone levels stand, and look for other factors that could be contributing to your symptoms. And if your testosterone is low, you can discuss whether lifestyle changes, treatment, or a combination of both may be appropriate for you.
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