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JAMA Internal Medicine Patient Page
April 20, 2020

I’m Worried About Low Testosterone—What Should I Know?

Author Affiliations
  • 1Division of General Internal Medicine, University of Utah, Salt Lake City
  • 2Division of Endocrinology and Metabolism, University of California, San Francisco
JAMA Intern Med. 2020;180(6):920. doi:10.1001/jamainternmed.2020.0787

Understanding the potential risks and benefits of treatment for low testosterone requires careful consideration. You should consult with a medical professional to make an informed choice.

What Is Testosterone?

Testosterone is a hormone mainly produced by the testes and is the primary sex hormone in men. It maintains lifelong balance of the changes associated with male puberty, including increased bone density, muscle mass, hair growth, and libido.

Could I Have Low Testosterone?

A small percentage of men do not produce enough testosterone. This can be caused by problems with the testes or the part of the brain that controls testosterone production. Many common conditions can lead to low testosterone, such as obesity, diabetes, sleep apnea, use of opioid drugs, and depression. In these cases, treatment should focus on the underlying problem. Testosterone levels also naturally decrease with aging and fluctuate throughout the day. Symptoms of low testosterone are not specific, but include sexual dysfunction, depressed mood, and low energy and muscle mass. Many other conditions can cause similar symptoms.

How Is Low Testosterone Diagnosed?

Evaluation should begin with a visit to your primary care physician. To diagnose low testosterone, blood samples should be drawn and tested by a certified lab on 2 different days. The samples must be drawn first thing in the morning while you are fasting to get an accurate measurement. At-home saliva or blood tests are not recommended because they are not accurate.

Does Low Testosterone Need Treatment?

Treatment should only be undertaken with the guidance of a medical professional and after a proven diagnosis. When low testosterone is caused by medical problems directly affecting the testes, treatment has significant health benefits; when it is caused by aging, the benefits of treatment are less clear. Certain men should not take testosterone without special consideration (see Figure). Regular checkups and laboratory monitoring are necessary for safe treatment with testosterone. Treatment should be stopped if you are not experiencing improvement in your symptoms.

What About Treatments Sold over the Counter or on the Internet?

Treatments sold over the counter and on the internet should be avoided, as they are often mislabeled and may contain harmful ingredients. Supplements should be manufactured by regulated pharmaceutical companies.

What Else Can I Do to Feel Better?

Talk to your health care provider about your concerns. Symptoms associated with low testosterone can be caused by many different health conditions. An accurate diagnosis will help you find the right treatment. Maintaining a healthy weight, exercising regularly, and leading a balanced lifestyle can address many of the symptoms of low testosterone without harmful side effects.

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Section Editor: Michael Incze, MD, MSEd.
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Article Information

Published Online: April 20, 2020. doi:10.1001/jamainternmed.2020.0787

Conflict of Interest Disclosures: None reported.

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    1 Comment for this article
    No guidance provided
    Richard Vance, MBA, BSEE | Aged but wanting quality life.
    It's a topic of interest but I found no guidance. And specifically on maintaining youthful levels if testosterone through life instead of assuming the aging loss of T should just be accepted. We are living longer but not better. We need real science.