A doctor has highlighted the signs and symptoms of a hormonal health condition that many men may not realise they have, despite it being common among millions worldwide. Dr Bhavini Shah, a general practitioner at LloydsPharmacy Online Doctor, says low testosterone can be easily overlooked as it often mimics other health conditions.
Testosterone levels rise during puberty, aiding boys in building muscle strength and developing body hair. It’s also essential for sperm production. However, after reaching 30, men typically experience a natural decline in testosterone levels. The extent of this decrease can vary from one man to another.
Some men maintain higher testosterone levels compared to their peers, while others may have lower levels. Generally, older men tend to have reduced testosterone levels.
Research suggests that around 2-5% of men globally may experience testosterone deficiency, with estimates showing one in four men over 40 have low testosterone. It’s challenging to determine the exact number affected, as definitions of ‘low’ testosterone can differ, reports Surrey Live.
Not everyone with low testosterone will exhibit clear symptoms of deficiency, meaning it can easily get overlooked. The Mayo Clinic also says that a lot of individuals are unaware that they have low testosterone levels because routine testing isn’t common and the symptoms can often be quite vague. The clinic adds that a blood test can measure testosterone levels, but tests aren’t routinely performed.
The (female) menopause
Dr Shah explains: “Menopause affects women and people who menstruate, occurring when a sudden drop in hormone levels causes menstrual periods to stop. It usually affects women between 45 and 55 but can happen earlier.”
“There are over 30 recognised symptoms of menopause. Those impacting mental health can include anxiety, mood swings, and difficulty concentrating. Hot flushes, difficulty sleeping, and changes in body shape are common physical symptoms. For women, symptoms of menopause can last for months or years, and some symptoms, such as joint pain, can continue after your periods have stopped.”
Low testosterone explained
However, Dr Shah notes that some symptoms of menopause overlap with those of low testosterone in men. When some men reach their 40s or 50s, they may experience mental and physical symptoms such as depression, loss of sex drive, and erectile dysfunction.
She clarifies: “Unlike menopause, which happens suddenly, men experience a steady decline in testosterone. From around the age of 30 to 40, men’s testosterone levels reduce by about 1% each year. This is why the NHS discourages the use of the term ‘male menopause’, as it falsely suggests symptoms are the result of a sudden drop in testosterone in middle age – when this is untrue.”
An NHS statement on its website clarified the misconceptions around ‘male menopause,’ saying: “The ‘male menopause’ (sometimes called the andropause) is an unhelpful term sometimes used in the media. This label is misleading because it suggests the symptoms are the result of a sudden drop in testosterone in middle age, similar to what occurs in the female menopause. This is not true.”
LloydsPharmacy Online Doctor conducted a study which highlighted a significant lack of public knowledge about ‘male menopause’ or low testosterone symptoms among UK adults. They discovered that although 95% were familiar with ‘menopause’, just under half (49%) were aware of ‘male menopause’ and similar terms.
Additionally, while a significant majority (84%) could define menopause, less than half had the same understanding of male menopause. Awareness of menopausal symptoms was high at 92%, but only 40% could identify symptoms related to ‘male menopause’.
Common signs of low testosterone
Dr Shah noted that low testosterone doesn’t necessarily lead to conspicuous symptoms. Nevertheless, various signs can suggest low testosterone levels, including:
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Mood swings and irritability
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Symptoms of depression
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Loss of muscle mass and reduced ability to exercise
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Fat redistribution, such as developing a large belly or ‘man boobs’ (gynaecomastia)
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A general lack of enthusiasm or energy
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Difficulty sleeping (insomnia) or increased tiredness
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Poor concentration and short-term memory
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Loss of sex drive
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Erectile dysfunction
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Decreased beard and body hair growth
Sometimes, individuals experience unexpected waves of warmth throughout their body, which can lead to sweating or a flushed appearance. You might also encounter night sweats, where the perspiration is more intense, and during these moments, you may feel chilly instead of warm.
These symptoms can disrupt daily life and overall happiness, making it essential to identify the root cause and determine possible solutions to address it. If you’re worried you have signs of testosterone deficiency, speak to your doctor.
The NHS says various lifestyle factors or psychological problems can be responsible for many of these symptoms. Erectile dysfunction, low sex drive and mood swings can sometimes be the result of stress, depression or anxiety. Other possible causes of the ‘male menopause’ include:
- Lack of sleep
- A poor diet
- Lack of exercise
- Drinking too much alcohol
- Smoking
- Low self-esteem
- Cancer treatment
- Injury to your testicles
- Certain medicines, such as some painkillers and antidepressants
- Genetic conditions, such as Klinefelter syndrome
In certain situations, when lifestyle choices or psychological issues don’t appear to be the cause, the signs of ‘male menopause’ could stem from hypogonadism, a condition in which the testes produce little to no hormones.
Treating and managing low testosterone
Your doctor may initially recommend some lifestyle adjustments to help alleviate your symptoms. This could involve boosting your physical activity, adopting a nutritious diet, managing stress, ensuring you get plenty of sleep, and cutting back on alcohol or smoking.
If these modifications don’t bring relief and blood tests indicate low testosterone levels, your doctor might refer you to a hormone specialist, also known as an endocrinologist. Dr Shah says that if your own body does not make enough testosterone and you have symptoms, testosterone replacement therapy (TRT) may be recommended.
“This can come in the form of injections or topical gels,” she added. It’s crucial to have a discussion with your specialist to determine if testosterone replacement therapy is right for you. NHS data shows an increasing demand for TRT, with prescriptions rising by 22% in 2023. In 2024, the NHS spent over £13.5 million on Testosterone.
She further explained: “It’s worth noting that TRT isn’t just prescribed to men experiencing symptoms of low testosterone, it can also be recommended as a treatment for women who have a low sex drive during menopause, and trans men as part of their transition. Like most medications, TRT carries some risks.”
“Side effects may include increased appetite, weight gain, acne, excessive sweating, and mood changes. Taking testosterone can also thicken your blood, and may increase your risk of heart attack, stroke and blood clots. It can also cause an enlarged prostate or other prostate disorders.”
“TRT can also affect sperm production which could impact your fertility. If you are considering having children in the future, you should discuss this with your endocrinologist before starting treatment.”
Risks with non-prescription testosterone
Dr Shah also warns against taking testosterone unless it has been prescribed by a doctor due to the associated risks with TRT. Anabolic steroids or testosterone boosters are manufactured drugs that mimic the effects of testosterone.
“There is a trend among gym-goers for taking this addictive, synthetic form of testosterone, believing they can increase muscle mass and decrease fat,” she cautioned. “But taking anabolic steroids carries serious health risks.”
“It is illegal to sell testosterone without a prescription in the UK – and for good reason. The potentially life-threatening risks associated with taking testosterone mean it should only be prescribed by a doctor after careful consideration. Regular monitoring including blood testing is required to screen for adverse side effects.”
