Understanding and Managing Testosterone Deficiency: A Guide for Men’s Health
- Hazel Hayden
- Feb 27
- 3 min read
Testosterone deficiency (TD) is becoming an increasingly recognised health concern among men, with significant implications for physical, psychological, and metabolic well-being. As part of our commitment to comprehensive health screening at Bristol Health Hub, we offer testing for testosterone levels to help diagnose and manage this condition effectively.
This guide provides insights into the latest British Society for Sexual Medicine (BSSM) guidelines on testosterone deficiency, including symptoms, diagnosis, and treatment options. However, it is important to remember that 75% of men maintained normal testosterone levels into old age, suggesting that TD is not merely a function of aging. TD is more common in older men, especially those with obesity, type 2 diabetes, chronic kidney disease (CKD) and other comorbidities, including acute COVID-19 infection and its long-term manifestations, plus general poor health status or medications, especially opiates, anabolic steroids, antipsychotics and anticonvulsants.
Why Does Testosterone Deficiency Occur?
Testosterone deficiency, also known as hypogonadism, can result from several underlying causes:
Primary hypogonadism: Problems with the testes that lead to decreased testosterone production.
Secondary hypogonadism: Dysfunction of the hypothalamus or pituitary gland, which control testosterone release.
Combined primary and secondary hypogonadism: A mix of both causes.
Medication-induced suppression: Certain drugs, such as long-term opiate use, can impair testosterone function.
Recognising the Symptoms of Low Testosterone
The symptoms of testosterone deficiency can impact multiple aspects of health:
Psychological Symptoms
Mood changes, including irritability, sadness, and depression
Poor concentration and cognitive decline
Decreased overall sense of well-being
Metabolic and Cardiovascular Symptoms
Increased body fat and obesity
Metabolic syndrome and insulin resistance
Higher risk of type 2 diabetes
Sexual and Reproductive Symptoms
Reduced libido and sexual desire
Erectile dysfunction and absent morning erections
Infertility and small testes
Delayed ejaculation and reduced semen volume
Physical Symptoms
Reduced body hair and muscle mass
Fatigue and sleep disturbances
Hot flushes and sweating
Osteoporosis and increased risk of fractures
Who Should Be Screened for Testosterone Deficiency?
Testing for testosterone levels should be considered in men who experience multiple symptoms of deficiency, particularly those with:
Erectile dysfunction, loss of spontaneous erections, or reduced libido
Type 2 diabetes, chronic kidney disease, or obesity (BMI >30)
Prolonged use of opioids, antipsychotics, or anticonvulsants
How Is Testosterone Deficiency Diagnosed?
A confirmed diagnosis of testosterone deficiency requires both symptoms and laboratory evidence of low testosterone levels. Testing should be conducted between 7 AM and 11 AM (when testosterone levels are highest) on at least two separate occasions, preferably four weeks apart. Additional blood tests include:
Luteinising hormone (LH) & Follicle-stimulating hormone (FSH) to differentiate primary and secondary hypogonadism
Prolactin levels to exclude hyperprolactinaemia
Prostate-specific antigen (PSA) & haematocrit for safety assessment before testosterone therapy
Free testosterone calculation can also provide further insight, particularly for borderline cases.
Treatment Options for Testosterone Deficiency
Once diagnosed, testosterone replacement therapy (TRT) can be considered, but it must be carefully monitored. Treatment options include:
Short-acting testosterone preparations (injections, gels, patches)
Long-acting testosterone therapy (for those requiring more consistent levels)
Who Should Avoid Testosterone Therapy?
Testosterone therapy is not recommended for men with:
Prostate or male breast cancer
Severe heart failure (NYHA class IV)
High haematocrit (>54%)
Those actively trying to conceive (as TRT may reduce sperm production)
How Does Testosterone Therapy Help?
Restoring testosterone to optimal levels has been shown to:
Improve libido and erectile function
Increase bone density and muscle mass
Reduce fatigue and cognitive decline
Help regulate blood sugar and metabolic health
Lower the risk of developing type 2 diabetes by up to 41%
Contrary to some concerns, current research does not show an increased risk of prostate cancer or cardiovascular disease with testosterone therapy. In fact, some studies suggest potential cardiovascular benefits in men with existing heart conditions.
The Role of Bristol Health Hub in Men’s Health
At Bristol Health Hub, we offer comprehensive testosterone testing as part of our men's health screening services. If you suspect low testosterone levels, we encourage you to book an assessment with our specialists, who can guide you through diagnosis, lifestyle interventions, and if necessary, refer you on for treatment options.
If you would like to assess your testosterone levels, schedule an appointment here.