Testosterone is linked to sexual function, muscle mass, bone health, energy and fertility. That does not mean every man needs regular testosterone testing. Current guidelines do not recommend routine screening of men who have no symptoms. Testing is more appropriate when symptoms or specific medical factors raise a concern about testosterone deficiency.

Which symptoms may lead to testing?

Low testosterone, also called testosterone deficiency or hypogonadism when diagnostic criteria are met, can affect men in different ways.

Symptoms that may lead a doctor to consider testing include:

- reduced sex drive,


- erectile problems or fewer spontaneous erections,


- lower energy,


- loss of muscle mass,


- reduced fertility,


- changes in mood or concentration,


- reduced body hair,


- low bone density or unexplained anemia in some cases.

However, none of these symptoms alone proves that testosterone is low. Fatigue, low mood and concentration problems, for example, can have many different causes.

One low result is not enough

One of the most important points about testosterone testing is that diagnosis is not based on a single number.

Testosterone levels change during the day and are generally higher in the morning. Levels can also vary from one day to another. For this reason, guidelines recommend an early-morning measurement and, when the result is low, a repeat test on a separate day.

The Endocrine Society states that a diagnosis should combine symptoms and signs consistent with testosterone deficiency with consistently low testosterone levels, confirmed by repeat morning testing.

When should the test be done?

Testosterone is usually measured in the morning, when levels are higher. Several guidelines recommend a morning, fasting sample when investigating possible testosterone deficiency.

Testing should also generally be avoided during an acute illness. A significant illness can temporarily lower testosterone and affect the interpretation of the result.

What happens if the first test is low?

A doctor will usually not rely on that result alone. A second morning measurement may be needed to confirm that testosterone remains low.

If low testosterone is confirmed, the next step is not automatically testosterone treatment. The underlying cause also needs to be investigated. Depending on the situation, additional hormone tests such as LH and FSH may help determine whether the problem is mainly related to the testes or to hormonal control from the brain.

Is age alone a reason to get tested?

Testosterone levels tend to decline gradually with age. This does not mean that every older man has hypogonadism or needs hormone treatment.

The Endocrine Society states that there is not enough evidence to recommend population-wide screening of asymptomatic men simply because they are getting older. Assessment should consider symptoms, test results and the man's overall medical history.

What about weight, sleep and other factors?

Low testosterone does not always have a single cause. Obesity, some chronic diseases, sleep disorders and certain medications can be associated with lower testosterone levels. The evaluation should therefore look at the man's overall health rather than focusing only on one hormone result.

For some men, addressing an underlying issue such as obesity may be an important part of the initial approach before testosterone replacement therapy is considered.

What if a man wants to have children?

This is an especially important point. Testosterone therapy can suppress sperm production. Urological and endocrine guidance therefore advises against using exogenous testosterone in men who are trying to conceive or planning fatherhood in the near future without appropriate medical assessment.

In other words, a man who has symptoms and is also concerned about fertility needs a different conversation with his doctor from a man who is not planning to have children.

So, when does testosterone testing make sense?

Testosterone testing is most useful when a man has symptoms that may be related to testosterone deficiency or when there is a specific medical reason to investigate. It is not a test that every man needs as part of routine screening, and the result should not be interpreted on the basis of one number alone.

A proper evaluation includes a review of symptoms, an early-morning testosterone measurement and, when necessary, repeat testing and further investigation of the underlying cause. This allows the decision to be based on the man's overall health rather than on a single laboratory result.

Note: Testosterone testing and treatment decisions should be discussed with a healthcare professional who can interpret the results in the context of symptoms, age, medical history and the laboratory's reference range. https://healthpont.com/when-should-a-man-check-testosterone/