A Closer Look at Testosterone, Aging, and Men’s Health
By: A Men’s Health Physician
It’s a common, almost routine question in clinic:
“Can I get my testosterone checked?”
Often it’s not phrased as “I think I have low testosterone,” but rather as a more cautious inquiry — motivated by symptoms like reduced libido, fatigue, mood changes, reduced motivation, or simply curiosity about aging.
There’s good reason for this growing interest. Testosterone plays a central role in many aspects of male health — but the science, as well as the clinical approach, is considerably more complex than many assume.
🧬 Testosterone, Aging, and the Concept of Late-Onset Hypogonadism
Testosterone levels do decline with age. Beginning around the third decade of life, total testosterone levels fall by approximately 1% per year, primarily due to changes in testicular function, hypothalamic-pituitary regulation, and increases in sex hormone binding globulin (SHBG), which reduces free (bioavailable) testosterone.
This age-related decline has been termed late-onset hypogonadism (LOH) or age-related testosterone deficiency. However, LOH remains somewhat controversial in the medical community:
- On one hand, multiple high-quality trials (e.g. The Testosterone Trials, TRAVERSE Trial) have shown that men with confirmed low testosterone and symptoms can benefit from testosterone replacement therapy (TRT), with improvements in sexual function, bone mineral density, lean body mass, and sometimes mood.
- On the other hand, many men with similar symptoms have testosterone levels within normal ranges. Their symptoms may arise from entirely different factors: sleep disturbances, obesity, depression, chronic illness, stress, relationship issues, or simply the natural variability of libido and energy that occurs across a man’s lifespan.
Thus, while LOH is a real entity for some men, not all symptoms of “feeling off” are caused by low testosterone, and not all men with lower testosterone necessarily require treatment.
🩺 Why Testing is More Complex Than It Seems
When a man asks for his testosterone to be checked, it’s important to understand that:
- Testosterone levels fluctuate substantially throughout the day (highest early in the morning).
- They can be affected by recent illness, sleep deprivation, alcohol use, stress, and even lab variability.
- A single measurement is often insufficient. Most guidelines recommend two morning fasting testosterone tests before making any diagnosis.
- SHBG levels influence how much testosterone is actually biologically active; thus, free testosterone may be more clinically relevant in many cases.
🔬 The Non-Specific Nature of Testosterone-Related Symptoms
Symptoms often attributed to testosterone deficiency — low libido, erectile dysfunction, fatigue, low mood, poor motivation — are non-specific and frequently overlap with numerous other conditions. For example:
Symptom – Possible Non-Testosterone Causes
Fatigue – Sleep apnea, anemia, thyroid disorders, depression
Low libido – Stress, relationship issues, psychological factors
Erectile dysfunction – Vascular disease, diabetes, hypertension
Low mood – Depression, chronic stress, poor sleep
Because of this overlap, testosterone levels should never be interpreted in isolation from the clinical picture.
🏋️♂️ Lifestyle Factors: The Underappreciated First Line Treatment
Perhaps one of the most overlooked aspects of this conversation is the potential for modifiable factors to influence testosterone levels and symptoms. Numerous studies have demonstrated that:
- Weight loss (especially in men with obesity or metabolic syndrome) can significantly increase both total and free testosterone.
- Exercise, particularly resistance and high-intensity interval training, can modestly raise testosterone and improve symptoms even without large shifts in serum levels.
- Improved sleep (both quality and quantity) often leads to better testosterone production.
- Stress reduction (including mindfulness and addressing mental health) can improve both subjective wellbeing and sexual function.
In many cases, addressing these factors leads to both symptomatic improvement and stabilization of testosterone levels — without the need for pharmacological intervention.
⚠️ The Rise of Overdiagnosis and Overprescription
Recent years have also seen an explosion of commercial telehealth services and private clinics offering testosterone therapy — often with limited evaluation. This has led to several concerns:
- TRT being offered to men with entirely normal testosterone levels.
- Lack of evaluation for underlying, reversible causes of low testosterone (e.g. pituitary disorders, prolactinomas, opioid or steroid use, sleep apnea).
- Inadequate counseling about potential risks of TRT, such as polycythemia, infertility, and possible cardiovascular implications.
While TRT can be life-changing for appropriately selected men, inappropriate or premature prescribing risks both overtreatment and missed diagnoses.
🔄 Testosterone: One Piece of a Larger Puzzle
Ultimately, testosterone matters — but it is not the sole determinant of male wellbeing. It sits within a broader physiological, psychological, and social context.
- Some men naturally have higher or lower testosterone levels without adverse symptoms.
- Libido, mood, and energy naturally vary across individuals.
- Aging, life transitions, chronic disease, and environmental factors all influence how we feel.
The decision to investigate or treat testosterone levels should be guided by a careful, individualized assessment — not by social media narratives or oversimplified lab targets.
🧾 In Summary
- Testosterone is worth checking in the right clinical context, but one lab test rarely tells the whole story.
- Lifestyle changes remain powerful tools to optimize testosterone and improve wellbeing.
- A thorough, evidence-based approach helps distinguish when testosterone is truly contributing to symptoms — and when other factors may be at play.
“The goal is not to chase numbers, but to improve health.”
For men experiencing symptoms, asking about testosterone is a valid and important question. But the best answers lie in careful, comprehensive evaluation — not in hormone marketing or one-size-fits-all treatments.
Stonewall Medical Centre.