The hidden health crisis

Low testosterone (low T) is one of the most underdiagnosed and misunderstood health conditions facing men today. Studies show that nearly 40 percent of men over age 45 and 50 percent of men over 80 have low testosterone levels. However, what’s more troubling is that only 20 percent of these men are ever diagnosed or treated.

The symptoms are often subtle but profound, affecting physical health, mental well-being, and relationships. Left untreated, low testosterone isn’t just a quality-of-life issue—it can have long-term health consequences, increasing the risk of conditions like diabetes, cardiovascular disease, and osteoporosis.

As a men’s health urologist, I’ve seen firsthand how low testosterone can derail lives. Yet, many men delay or avoid seeking help, often because they don’t recognize the symptoms or feel too ashamed to discuss them.

Understanding low testosterone

Testosterone is a hormone produced primarily in the testicles, responsible for regulating muscle mass, bone density, sex drive, sperm production, and mood. While testosterone naturally declines with age—by about 1 percent per year after age 30—other factors like stress, obesity, chronic illness, and medications can accelerate this decline.

When testosterone levels drop below 300 ng/dL, it is considered clinically low. Symptoms can include:

• Chronic fatigue: A persistent lack of energy that makes even routine activities feel overwhelming.
• Mood changes: Depression, irritability, and anxiety are common and often overlooked as “mental health issues” rather than hormonal imbalances.
• Cognitive issues: Difficulty concentrating or experiencing “brain fog.”
• Sexual dysfunction: Reduced libido and erectile dysfunction are hallmark symptoms, but many men are hesitant to discuss them.
• Physical changes: Loss of muscle mass, increased body fat, and thinning hair can occur.

The societal stigma

One of the biggest challenges in addressing low testosterone is overcoming the stigma around men’s health. Society has long perpetuated the idea that men should “tough it out” and avoid showing vulnerability.

In a 2021 survey of 1,200 men, 65 percent admitted they were reluctant to talk to their doctor about symptoms like low libido or fatigue, and 45 percent said they felt discussing their health made them appear weak. This culture of silence leaves millions of men suffering unnecessarily.

The role of physicians

As doctors, we need to do more to create a safe and nonjudgmental space for men to discuss their health concerns. This starts with education—helping men understand that their symptoms are not “just aging” but could be signs of an underlying issue like low testosterone.

The diagnostic process for low T is straightforward. A simple blood test, performed in the morning when testosterone levels are highest, can confirm if levels are below the clinical threshold. But before we get to testing, we need to ask the right questions:

• Are you experiencing persistent fatigue or a lack of energy?
• Have you noticed changes in your mood or mental clarity?
• Has your sex drive decreased?
• Are you losing muscle mass or gaining unexplained weight?

These conversations can be life-changing.

Treatment options

If low testosterone is confirmed, there are effective treatments available. Testosterone replacement therapy (TRT) is the gold standard for men with symptomatic low T. This can be administered in several ways, including:

• Injections: Typically given every 1–2 weeks.
• Gels or patches: Applied daily for consistent hormone delivery.
• Implants or pellets: Inserted under the skin, lasting several months.

But TRT isn’t the only solution. Lifestyle changes can also have a significant impact on testosterone levels.

Lifestyle modifications to boost testosterone

For men with borderline low T or those looking to complement medical treatment, lifestyle changes are key:

1. Exercise: Regular physical activity, especially resistance training and high-intensity interval training (HIIT), has been shown to increase testosterone levels.
   • A study in the Journal of Strength and Conditioning Research found that men who engaged in strength training twice a week had a 20 percent increase in testosterone levels over 12 weeks.
2. Nutrition: Diet plays a crucial role. Foods rich in zinc (like oysters, nuts, and seeds) and vitamin D (like fatty fish and fortified foods) can support testosterone production.
   • Conversely, high sugar intake and obesity are linked to lower testosterone levels.
3. Sleep: Poor sleep quality reduces testosterone production, which primarily occurs during deep sleep. Men who sleep fewer than 5 hours a night have been shown to have testosterone levels that are 15 percent lower than men who sleep 7–8 hours.
4. Stress management: Chronic stress elevates cortisol, which suppresses testosterone. Practices like meditation, yoga, or even regular downtime can help.

Why this matters

Low testosterone isn’t just a “quality of life” issue—it’s a silent epidemic with far-reaching consequences. Men with untreated low T are at higher risk for:

• Type 2 diabetes: Testosterone helps regulate insulin sensitivity, and low levels increase the risk of metabolic syndrome.
• Cardiovascular disease: Emerging research links low T to higher rates of heart attacks and strokes.
• Osteoporosis: Low T weakens bones, making fractures more likely.

Addressing low T isn’t just about helping men feel better—it’s about preventing long-term health issues and improving overall well-being.

Breaking the silence

Men—If you’re experiencing symptoms like fatigue, low mood, or sexual dysfunction, don’t ignore them. These are not signs of weakness, and they’re not “just aging.” They’re your body’s way of telling you something is off.

Doctors—It’s time to prioritize conversations about men’s hormonal health. By normalizing these discussions and offering evidence-based solutions, we can make a profound difference in our patients’ lives.

Low testosterone is a silent epidemic—but it doesn’t have to stay that way.

Justin Houman is a urologist.