Symptoms of Low Testosterone

Understanding the Symptoms of Low Testosterone

At Omniya Clinic, we understand how low testosterone (also known as andropause) can impact your quality of life. Testosterone is a vital hormone that controls energy, mood, muscle mass, and sexual health in men. As testosterone levels naturally decline with age, some men may experience a range of symptoms that affect both physical and emotional well-being. This is why we offer Testosterone Replacement Therapy at Omniya Clinic.

Here’s  what to look out for:

To speak with one of our experts, book now.

Fatigue and Low Energy

One of the commonest signs of low testosterone is fatigue. If you’re feeling tired all day long even after a good night’s sleep it could be related to low testosterone. Men with low T report feeling drained or lacking the energy to do daily activities.The connection between testosterone and energy is well supported by scientific literature with multiple studies confirming the link between having low T and feeling fatigued and lethargic (1-4).

These studies suggest that testosterone should be considered as part of the initial investigations in men who suffer from fatigue above the age of 40 in particular. They also highlight, amongst many other studies, the dramatic improvement in energy levels in affected patients who commence TRT. It goes without saying that fatigue can be due to a number of causes and so it is best to have this thoroughly investigated as it can often be multifactorial.

Sleep Disturbances

Another way in which low T can result in low energy levels is through it’s deleterious effects on sleep quality. Whilst the relationship between sleep quality and testosterone has not been studied extensively (4-6), we have found anecdotally that poor quality sleep is a common presenting issue of patients with low T and something that can improve markedly with treatment. One small study documented an incidental finding of a significant improvement in REM sleep in patients on TRT who previously were hypogonadal (7).

There are multiple studies linking testosterone to sleep cycles and sleep quality and this appears to be a bidirectional relationship. The majority of research however concentrates on the impact of poor sleep on testosterone levels, finding poor sleep to adversely affect testosterone levels (8), and the effects of TRT on obstructive sleep apnoea discussed here

The above studies found that men with low testosterone suffer from sleep disturbances including insomnia and fragmented sleep patterns, based on the intrinsic relationship between testosterone, cortisol, sleep cycles and the circadian rhythm. These sleep issues can create a vicious cycle as poor sleep further suppresses testosterone production and worsens symptoms like daytime fatigue and low energy.

The studies look at the effect of testosterone on different aspects of sleep architecture and found that men with lower testosterone levels had reduced sleep quality including difficulty falling asleep, frequent nighttime awakenings and less restorative deep sleep.

Decreased Libido

Testosterone is involved in sexual function and its impact on libido and sexual health is well documented in scientific literature. A decrease in testosterone levels results in decreased libido or sex drive, which can have a profound impact on a man’s quality of life and relationships, particularly in the context of concurrent low energy levels.

Multiple studies have documented statistically significant findings between men, particularly those over the age of 40, having low testosterone levels and decreased sexual desire and activity (2,4, 9-11).

When testosterone levels drop many men notice a decrease in their interest in sex. This shows up as fewer sexual thoughts or fantasies, less frequent spontaneous erections, less desire to initiate sex and less responsiveness to sexual stimuli. Men may also become less interested in sex. Beyond desire, the studies found that men with low testosterone also had less sexual activity, even those in stable relationships relative to men with normal testosterone levels. This means testosterone affects not only sexual thoughts and desire but also behaviour. The hormone’s role goes beyond the mental aspect of sexuality and affects physical actions as well.

The Quality of Sexual Experiences

Furthermore, the studies found that testosterone levels do not just affect how often men think about or have sex – they also affect the quality of sexual experiences. Men with normal testosterone levels had better sexual experiences compared to their counterparts with low levels of testosterone.

Psychological and Relationship Effects

A decrease in sexual desire and activity affects not just physical health,it often has psychological ramifications as well. Men with these issues may have low self esteem, strained relationships or even depression; Highlightingthe importance of the role of testosterone in a man’s overall sexual health and well-being.

The TRAVERSE study (12), a large multi centre study, recently confirmed that by normalising testosterone levels TRT is likely to improve libido, sexual activity and overall sexual satisfaction. Sexual function is also influenced by lifestyle factors, relationship dynamics and most importantly psychosexual symptoms, and so when assessing sexual function these all need to be given equal consideration.

Decreased Muscle Mass

Men with low testosterone lose muscle mass and strength even if they exercise regularly. This is because testosterone is involved in muscle growth and repair and without enough testosterone the body can’t build and maintain muscle. Testosterone is the most important anabolic hormone in the body and amongst it’s many functions it is responsible for maintaining an anabolic state of metabolism. One that promotes muscle growth and the burning of fat.

Research shows that Testosterone Replacement Therapy (TRT) can increase muscle mass, increase muscle protein production, which is important for muscle repair and growth after exercise and reduce fat deposition (13-15).

TRT also stimulates satellite cells which help muscles grow and recover by fusing with muscle fibers and increasing their ability to produce new proteins. The studies show that men on TRT have a significant increase in muscle fibre size, especially in type II muscle fibres which are for strength and power.

Research has shown that TRT is particularly beneficial in older men as it reverses age related muscle loss (sarcopenia) and thus helps maintain independence and quality of life as men age. It also improves insulin sensitivity so it is good for overall metabolic health, reducing the risk of diabetes when taken in conjunction with a healthy lifestyle.

Men on TRT have exhibit increased endurance during exercise and recover faster from exercise, and therefore experience greater results.  This can increase the risk of tendon and ligament injuries, as ligaments and tendons take longer to strengthen compared to muscle bellies.

Increased Body Fat

Low testosterone has a big impact on body composition especially as men age. Low testosterone levels push the body’s metabolism into a state of feeling it needs to store energy for a rainy day and so rather than expending energy on more muscle, which is felt unnecessary, it stores that energy as fat. This snowballs as fat cells contain the enzyme aromatase, which converts testosterone to oestrogen lowering testosterone levels further.

Impact on Insulin Sensitivity and Energy

Low testosterone also reduces how sensitive the body is to insulin and increases the risk of type 2 diabetes. Insulin is a hormone released by the body in response to sugar intake and it’s role is to manage the sugar levels in the blood. When the body’s sensitivity towards insulin is impaired one can develop diabetes and an important “organ” implicated in this process is muscle. The more muscle mass one has, the larger the area over which insulin can act and so in low testosterone states, with less muscle mass, there is less surface area for insulin to be effective.

Long-Term Health Risks

Addressing low testosterone with treatments like Testosterone Replacement Therapy (TRT) can help with weight loss, reduce midsection fat and maintain muscle mass, but also can help prevent long term complications of low testosterone including metabolic syndrome (16), cardiovascular disease (17) and dyslipidaemia (18).

While low testosterone is one of the factors, diet, exercise and genetics also play a role on all of the above.

Erectile Dysfunction

Testosterone and erectile function is complex and multifaceted. While testosterone is not the only driver of erections, it plays a big role in the physiological process that enables and maintains an erection. Men with low testosterone levels have difficulty achieving or maintaining erections, also known as erectile dysfunction (ED).

Several studies have found that men with low testosterone are at a higher risk of erectile dysfunction and other sexual performance issues(19, 20). The studies show a statistically significant correlation between low testosterone and incidence of erectile dysfunction i.e. men with clinically low testosterone were more likely to have ED compared to men with normal testosterone levels. As an aside they also found that low testosterone levels can cause a reduced ejaculate volume.

Testosterone is important for several aspects of erectile function. It stimulates the production of nitric oxide, a molecule that initiates and maintains erections. It maintains the health and responsiveness of erectile tissues and contributes to libido, which is often the precursor to arousal and erection.

Multiple studies have also looked then at the affect of TRT on erectile function in patients with low T. The results are mixed, with some studies showing no difference in erectile function on commencing TRT (12) and others showing significant improvements in erectile function including night time and early morning erections (21, 22). Other researchers have looked at the effect of TRT on patient response to viagra and found there to be a marked increase in effect of viagra in patients taking TRT compared to those who were not (23).

ED can be due to hormonal, cardiovascular, neurological, metabolic and psychological factors. There may well be more than one reason why a patient has ED and so it is not always the case that by treating the hormone deficiency ED resolves. Often men find that after as few as one episode of ED and not being able to “perform”, the pyschological impact can be huge. It is likely that the studies that did not find a significant effect of TRT on ED were confounded by the psychological aspect of ED that is inevitable. Whilst psychosexual counselling can be extremely effective in managing this, some doctors will use a short course of a medication, like viagra, to “reset” the patient’s mindset once the hormone imbalance has been corrected.

Mood Changes

Studies have found that men with low testosterone are more prone to depressive symptoms and anxiety(24). Mood changes can manifest in many ways including increased irritability, persistent feelings of sadness or hopelessness which is characteristic of depression and increased anxiety. One theory is that testosterone affects mood due to its role in regulating neurotransmitters, especially serotonin, which is well known for its role in maintaining emotional balance and overall mental well being. Research has showed that TRT can help improve mental health in patients with low testosterone(25, 26), though one has to be careful in the interpretation of this. What we have found is that many patients presenting with symptoms of low T have symptoms similar to those of anxiety and depression and hence whilst they may not have responded well to traditional treatments, for example antidepressants, they may respond better to TRT.

Memory and Concentration Issues

Cognitive function, memory, concentration and overall mental clarity are all potentially affected by testosterone. Men with low testosterone often experience “brain fog” which is a difficulty to focus, forgetfulness or mental sluggishness. This cognitive decline can impact daily life, work and relationships. There are a number of research papers that document the link between a decline in testosterone levels and cognitive dysfunction. They show testosterone to have neuroprotective properties, a role in memory formation and recall and an effect on attention span and processing speed(27-31). As men age, both testosterone levels and cognitive function decline and the studies suggests they are related. An important distinction to make is that the studies mentioned correlate declining testosterone levels with reduced cognitive function mostly in older men. The obvious confounding factor being that age itself is a risk factor for declining cognitive function. Many studies have then gone on to examine the effects of TRT on older men with cognitive dysfunction and have found it to be of generally little to no effect. Many of the studies had design limitations that meant their results were not strong enough to be considered significant, or perhaps flaws in the way the research was carried out that made the significance of the findings questionable.

In relation to healthy younger men with low T and “brain fog”, there has not been sufficient research carried out to confirm whether TRT has any benefit in these circumstances. Anecdotally, when treating patients with TRT, we tend to see good improvements in brain fog however.

Reduced Bone Density

Testosterone maintains bone density and its effect on skeletal health is well documented in the literature. Men with low testosterone are at risk of osteoporosis, a condition characterised by weak and brittle bones that are prone to fractures. This is more significant as men age since both testosterone levels and bone density decline naturally over time.

Several studies have been published since the 1980’s that have reported that men with low testosterone have lower bone mineral density (BMD) compared to those with normal levels(32).

Testosterone affects bone health in several ways. It stimulates bone formation and decreases bone breakdown.Men with low testosterone have particularly low BMD in areas prone to osteoporotic fractures, such as the hip and spine..

The TRAVERSE study published in 2024 has shown that surprisingly there were more fractures in the patient group treated with TRT than the group with low T who were not treated. Underlying theory as outlined above would propose the opposite finding(33). The researchers from the TRAVERSE study commented however that as their study was primarily looking at cardiovascular outcomes in TRT patients, larger robust studies are needed that focus on the benefits of TRT in patients with low T and reduced BMD. The general consensus understanding however remains that there is a large body of robust research on more classical therapies for osteoporosis and therefore those should be preferred to TRT when treating patients for low BMD.

Hot Flashes

Hot flashes in men with low testosterone is a lesser known but significant symptom that can affect quality of life. While hot flashes are more common in menopausal women, men with testosterone deficiency can also experience these sudden and often distressing episodes of warmth, sweating and flushing.

Reduced Testicular Size

The relationship between testosterone and testicular size is an important aspect of male reproductive health. Testosterone is the primary male sex hormone that develops and maintains testicular function and size.

The mechanism behind this is in the complex feedback system of the male reproductive system. Testosterone is produced primarily in the Leydig cells of the testes and is regulated by the hypothalamic-pituitary-gonadal (HPG) axis. When testosterone levels are low, it not only affects the body’s overall hormonal balance but also the testes itself.Low testosterone leads to decreased stimulation of the seminiferous tubules in the testes. These tubules are responsible for sperm production and occupy a big portion of the testicular volume. With less testosterone, the tubules may shrink and consequently the testes may also shrink in size.

The study showed that this reduction in testicular size is often accompanied by other physical changes. Men with low testosterone may notice that their scrotum looks less full or firm. This change in scrotal appearance is due to the combined effect of reduced testicular volume and potential change in scrotal skin elasticity which can also be influenced by testosterone levels.

Decreased Strength and Endurance

Sports medicine and endocrinology has produced a great study in The Journal of Strength and Conditioning Research on the role of testosterone in maintaining muscle strength and endurance especially as men age.

This study showed that testosterone is not just a hormone for masculinity but a vital component in physical prowess. The study showed that as testosterone levels decline with age, an individual’s ability to sustain physical activity decreases. This decline can manifest in many ways but is most noticeable in strength-based activities and overall exercise performance.

The researchers looked at the effect of testosterone on different aspects of physical fitness. They found that men with lower testosterone levels had reduced muscle strength, decreased endurance and decreased ability to recover from intense exercise. This was true across all age groups but more pronounced in men 40 and above when testosterone levels naturally decline.

The study didn’t stop at just observing this correlation. It went further by looking at the effect of testosterone supplementation in men with clinically low levels. The results were impressive: men who received testosterone replacement therapy showed significant improvement in both strength and endurance metrics. This is important as it means the negative effects of low testosterone on physical performance may be reversible to some extent.

This has big implications. For men who are experiencing decline in exercise performance or struggling to maintain strength despite consistent training, low testosterone could be a factor. This is especially true for men in their 40s and 50s who may attribute this to ageing when in fact hormonal factors could be at play.

Hair Loss

Hair growth has been a topic of endocrine interest in dermatology research. A study in The Journal of Investigative Dermatology has looked into the role of testosterone in maintaining healthy hair growth not just on the scalp but also on the body and face.

This study showed that testosterone is not just a hormone for masculinity but a vital component in stimulating and maintaining hair follicle activity. The study showed that as testosterone levels decline, hair follicle activity also declines resulting in reduced hair growth and in some cases, noticeable hair loss.

The researchers looked at the effect of testosterone on different aspects of hair growth. They found that men with lower testosterone levels had reduced hair density and thickness, especially on the face, chest and scalp. This was true across all age groups but more pronounced in men over 40 when testosterone levels naturally decline.

The study implies that the effects of low testosterone on hair growth may be reversible to some extent with treatment. This is important for men who are experiencing unexplained hair thinning or loss as it means hormonal factors could be at play and not just genetic predisposition or ageing. There are also treatments that target androgen related hair loss that can be effective, albeit not without the risk of side effects.

Sleep Disturbances

The Journal of Clinical Sleep Medicine looked into the role of testosterone in maintaining healthy sleep patterns in men with low testosterone.

This study showed that testosterone is not just a hormone for masculinity and physical vitality but also a key player in sleep cycles. The study found that men with low testosterone suffer from sleep disturbances including insomnia and fragmented sleep patterns. These sleep issues can create a vicious cycle as poor sleep further suppresses testosterone production and worsens symptoms like daytime fatigue and low energy.

The researchers looked at the effect of testosterone on different aspects of sleep architecture and found that men with lower testosterone levels had reduced sleep quality including difficulty falling asleep, frequent nighttime awakenings and less restorative deep sleep. This was true for men 40 and above when testosterone levels naturally decline.

The study went further by looking at the effect of Testosterone Replacement Therapy (TRT) on sleep quality. The results were impressive: men who received TRT had better sleep patterns, they slept more restfully and uninterrupted. This is important as it means that addressing low testosterone levels through TRT may be a pathway to better sleep and overall well-being for affected men.

Low testosterone can affect a man’s physical, emotional and mental well-being. The symptoms are many but many can be managed through Testosterone Replacement Therapy (TRT) or lifestyle changes. If you’re experiencing any of these symptoms, consult a doctor to determine the underlying cause and treatment options.

If you’re experiencing any of these symptoms and want to know more about how Omniya Clinic in London can help, contact us today.

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