Signs of Low Testosterone in Men (and When to Get Tested)
Testosterone deficiency is under-diagnosed in Canadian men over 35. Here are the symptoms that should prompt testing — and what a real evaluation looks like.
Why testosterone drops
Testosterone naturally declines about 1–2% per year after age 30. That's normal aging. What isn't normal is a symptomatic drop that meaningfully affects sleep, energy, sexual function, mood, or body composition — sometimes years before a man himself connects the dots.
On top of age, several modern factors accelerate the decline: chronic sleep deprivation, obesity (adipose tissue converts testosterone to estradiol via aromatase), untreated obstructive sleep apnea, chronic opioid use, high alcohol intake, some antidepressants, and certain chronic diseases.
Symptoms that should prompt testing
Persistent fatigue that doesn't improve with more sleep.
Loss of morning erections, decreased libido, or erectile difficulty.
Reduced muscle mass and increased fat around the abdomen despite unchanged diet and exercise.
Depressed mood, irritability, brain fog, poor concentration.
Reduced beard growth or shaving frequency, softer skin.
Poor recovery from workouts.
A single symptom isn't enough. When several of these cluster together, formal testing is warranted.
How proper testing works
A valid testosterone evaluation is more than one blood test. It typically includes:
Total testosterone and free (or bioavailable) testosterone, drawn in the morning (7–10 a.m.) when levels peak, on two separate mornings.
SHBG (sex hormone binding globulin) to interpret free testosterone accurately.
LH and FSH to distinguish primary (testicular) from secondary (pituitary) causes.
Prolactin, TSH, and estradiol to rule out contributing causes.
A CBC and PSA before considering any treatment.
Interpretation is context-dependent — a 'normal-range' number can still be inappropriate for a symptomatic man with the wrong SHBG or LH profile.
Treatment options if levels are truly low
First-line is always addressing the reversible causes: weight, sleep, alcohol, medications, sleep apnea, over-training. Many men see meaningful gains without hormone therapy at all.
When treatment is indicated, options include topical gels, intramuscular or subcutaneous injections, and long-acting formulations. Treatment requires structured monitoring — testosterone, estradiol, hematocrit and PSA at defined intervals — and is not appropriate for men trying to conceive without adjunct therapy. All this is discussed in detail during a private hormone consultation.
Frequently asked questions
Is testosterone therapy safe long term?+
For appropriately selected men with confirmed deficiency and proper monitoring, current evidence supports safety over multi-year use. It is not appropriate for men with untreated prostate cancer, untreated severe sleep apnea, or high hematocrit.
How long until I feel a difference on treatment?+
Libido and mood improve within 3–6 weeks. Energy improves within 1–2 months. Body-composition changes take 3–6 months and require training and nutrition to matter.