Low Testosterone in Men

Low testosterone, also called testosterone deficiency, androgen deficiency, male hypogonadism, low T, andropause, or sometimes manopause, occurs when testosterone levels are too low to adequately support a man’s health and function.

Testosterone affects sexual desire, morning and spontaneous erections, sperm production, muscle and strength, bone health, body composition, energy, mood, motivation, and overall well-being.

Levels can begin declining gradually as early as a man’s 30s, although weight, medications, illness, sleep, and overall health can significantly affect that decline. [5] Loss of desire, energy, strength, or sexual function should not automatically be dismissed as aging.

Dr. Kanwal Bawa evaluates why testosterone is low and how it is affecting the whole man—not simply whether a laboratory number falls inside or outside a range. Men in Boca Raton, Palm Beach County, throughout South Florida, and from across the country and internationally seek her expertise in hormones and sexual medicine.

Low testosterone symptoms can involve much more than sex. Men may experience low libido, fewer sexual thoughts, reduced responsiveness, fewer morning erections, erectile dysfunction, delayed ejaculation, difficulty reaching orgasm, reduced sensation, or fertility concerns.

Physical and mental changes can include fatigue, weight gain, increased abdominal fat, reduced muscle mass or strength, poor exercise recovery, brain fog, difficulty concentrating, reduced motivation, irritability, low mood, sleep problems, or simply not feeling like yourself.

Some men have few or no obvious symptoms. In one study, 48% of men over 50 with low testosterone had no associated symptoms. [2] That is why symptoms, medical history, risk factors, and properly performed laboratory testing all matter.

Low testosterone does not have one universal cause. Finding the cause matters because treatment should address what is actually lowering testosterone.

Aging, Weight, and Metabolic Health

Testosterone can decline with age, while obesity, abdominal fat, insulin resistance, metabolic syndrome, and type 2 diabetes can further affect hormone function. In one study, 37% of men with type 2 diabetes had low testosterone. [3]

Low testosterone also commonly overlaps with other health conditions. One study found low testosterone in 24% of men with coronary artery disease. [6]

Sleep, Medications, and Previous Hormone Use

Poor sleep and obstructive sleep apnea can affect testosterone, energy, libido, erections, and metabolic health. Opioids, corticosteroids, some psychiatric medications, cancer treatments, previous testosterone, anabolic steroids, and bodybuilding hormones can also affect testosterone levels, hormone signaling, laboratory results, or fertility. [7][8]

Testicular, Pituitary, and Hormonal Causes

Testicular injury or disease, chemotherapy, radiation, pituitary disorders, elevated prolactin, thyroid disease, genetic conditions, and other hormonal problems can contribute to low testosterone. Chronic illness and nutritional deficiencies may also play a role.

Dr. Bawa identifies the cause before choosing treatment because low testosterone related to sleep, weight, medication, thyroid dysfunction, or another reversible problem may require a different approach than permanent testicular or pituitary dysfunction.

A man is more than a laboratory value. Dr. Bawa evaluates testosterone alongside symptoms, libido, erections, energy, strength, sleep, weight, medications, supplements, previous hormone use, fertility goals, medical conditions, and sexual function.

The Best Time to Test Testosterone

For men with a typical daytime schedule, testosterone is generally tested between 7 a.m. and 11 a.m. Men who work nights or sleep during the day should generally test within approximately three hours of waking from their main sleep period. [9]

For the most accurate baseline, testing should usually follow a normal period of sleep and an 8- to 12-hour fast. Food can temporarily lower total testosterone and make the result appear lower than it otherwise would. [10] Plain water is allowed.

Tell Dr. Bawa about prescription medications, supplements, testosterone, anabolic steroids, hCG, DHEA, prohormones, bodybuilding products, recent illness, surgery, significant sleep disruption, major calorie restriction, or extreme exercise. Do not stop prescribed medication unless instructed by Dr. Bawa or the prescribing physician.

To measure testosterone while taking Renew®: take your usual nighttime dose and have blood drawn the following morning after fasting for 8–12 hours and within approximately three hours of waking.

To measure an untreated baseline: stop Renew® two weeks before testing.

Testing at Bawa Medical is individualized. Dr. Bawa may evaluate total and free testosterone, the hormones that regulate testosterone production, estradiol, prolactin, thyroid function, vitamin D, CBC and hematocrit, PSA, glucose, hemoglobin A1c, cholesterol, metabolic health, and iron studies based on each man’s symptoms, health, medications, previous treatment, and goals.

A low, borderline, unexpected, or poorly timed result may need additional evaluation before treatment is recommended.

The Bawa Method treats low testosterone according to the cause, symptoms, laboratory results, sexual function, health, and fertility goals—not simply by trying to raise a laboratory number.

Treatment may include Renew®, Dr. Bawa’s U.S.-made testosterone booster, testosterone replacement therapy (TRT), treatment of an underlying medical problem, or a personalized combination.

Renew® Testosterone Booster

Renew® is Dr. Bawa’s U.S.-made DSF.me® testosterone booster, formulated to support the body’s natural testosterone production without introducing external testosterone.

It can support testosterone, energy, muscle health, metabolism, libido, and sexual wellness. Because Renew® contains no exogenous testosterone, it does not suppress LH and FSH through the same known mechanism as TRT.

Testosterone Replacement Therapy

When TRT is appropriate, Dr. Bawa may prescribe injectable testosterone such as Depo-Testosterone® (testosterone cypionate) or Xyosted® (testosterone enanthate), or topical therapy such as AndroGel® (testosterone gel).

Treatment is monitored and adjusted according to symptoms, testosterone levels, sexual function, hematocrit, blood pressure, estradiol, PSA, sleep apnea, fertility goals, and overall health. [7]

Treating the Underlying Cause

Treatment may also address thyroid disease, vitamin D deficiency, sleep apnea, medications, insulin resistance, excess weight, nutrition, strength, and sleep when these are contributing to low testosterone.

Why Dr. Bawa Does Not Recommend Testosterone Pellets

Dr. Bawa does not recommend testosterone pellets because they can produce high testosterone levels early after insertion followed by progressively lower levels later in the treatment cycle. Once the pellets are implanted, the dose cannot be readily reduced, increased, or fine-tuned if testosterone is too high, falls too low, symptoms change, or side effects develop. [11] Even the supposedly slow release pellets cannot be managed once they are implanted.

Pellets also require an invasive procedure and can cause pain, bruising, bleeding, infection, fibrosis, scar tissue, nodules, tissue damage, or pellet extrusion. [11] Injectable TRT prescribed by Dr. Bawa provides an adjustable alternative that allows treatment to be modified as a man’s needs change, and her U.S.-made Renew® testosterone booster is available over the counter, and can be shipped anywhere in the world.

Low testosterone and erectile dysfunction frequently overlap, but they are not the same condition. In a study of 2,794 men with erectile dysfunction, 23% had testosterone below 300 ng/dL. [1]

Testosterone supports libido, morning and spontaneous erections, sexual responsiveness, and overall sexual function. But strong, reliable erections also depend on blood flow, nerves, erectile tissue, metabolism, sleep, medications, pelvic function, and psychological health.

A man can therefore have low testosterone without erectile dysfunction—or significant ED despite normal testosterone. Through the Bawa Method, Dr. Bawa can address both hormonal and non-hormonal causes of sexual dysfunction. Treatment may combine Renew® testosterone booster or TRT with BawaWave®, BawaRF®, BawaShot®, medical weight loss, medication review, sleep-apnea treatment, pelvic-floor care, performance-anxiety treatment, or targeted DSF.me® supplements.

Bawa Medical in Boca Raton treats men throughout South Florida as well as patients who travel from across the United States and internationally. Private virtual consultations with Dr. Bawa are also available.

1. Köhler TS, Kim J, Feia K, et al. Prevalence of androgen deficiency in men with erectile dysfunction. Urology. 2008;71(4):693-697.

2. Araujo AB, Esche GR, Kupelian V, et al. Prevalence of symptomatic androgen deficiency in men. Journal of Clinical Endocrinology & Metabolism. 2007;92(11):4241-4247.

3. Al Hayek AA, Khader YS, Jafal S, et al. Prevalence of low testosterone levels in men with type 2 diabetes mellitus: a cross-sectional study. Journal of Family and Community Medicine. 2013;20(3):179-186.

4. Fantus RJ, Chang C, Platz EA, et al. Serum total testosterone and premature mortality among men in the USA. European Urology Open Science. 2021;29:89-92.

5. Feldman HA, Longcope C, Derby CA, et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts Male Aging Study. Journal of Clinical Endocrinology & Metabolism. 2002;87(2):589-598.

6. Malkin CJ, Pugh PJ, Morris PD, et al. Low serum testosterone and increased mortality in men with coronary heart disease. Heart. 2010;96(22):1821-1825.

7. Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism. 2018;103(5):1715-1744.

8. Crosnoe LE, Grober E, Ohl D, Kim ED. Exogenous testosterone: a preventable cause of male infertility. Translational Andrology and Urology. 2013;2(2):106-113.

9. Morales A, Bebb RA, Manjoo P, et al. Diagnosis and management of testosterone deficiency syndrome in men: clinical practice guideline. CMAJ. 2015;187(18):1369-1377.

10. Gagliano-Jucá T, Li Z, Pencina KM, et al. Oral glucose load and mixed meal feeding lowers testosterone levels in healthy eugonadal men. Endocrine. 2019;63(1):149-156.

11. Shoskes JJ, Wilson MK, Spinner ML. Pharmacology of testosterone replacement therapy preparations. Translational Andrology and Urology. 2016;5(6):834-843.