Low testosterone result? What happens before any treatment

It might be a printout from a wellness kit. It might be months of tired afternoons, a quieter sex drive, or a friend who started testosterone and swears by it. Somewhere along the way, one low number has started to look like the answer.

Sometimes it is, but usually the picture is wider. The NHS calls the phrase male menopause unhelpful, because it suggests a sudden drop in middle age, similar to the female menopause, and that isn't what happens. Testosterone falls steadily, at about 1% a year from around the age of 30 to 40, and that decline on its own is unlikely to cause problems. Tiredness, a lower libido, softer erections, a bigger belly and low mood can all arrive in the same decade, and only some of those stories have a hormonal cause.

If you'd rather skip the reading, you can send an enquiry about doctor-led hormone assessment at our Harley Street clinic, or call 0207 499 1991. A GP consultation is £150, or £250 if you'd like review by a Consultant Endocrinologist.

What counts as low testosterone? The numbers doctors use

Total testosterone is reported in nanomoles per litre (nmol/L). The British Society for Sexual Medicine guidance, which UK clinics work from, uses these bands, always on morning samples repeated on at least two occasions.

Testosterone bands for men with symptoms. Source: British Society for Sexual Medicine guidelines on adult testosterone deficiency (2023).

The borderline band is where most of the confusion lives. SHBG (sex hormone binding globulin) holds testosterone in the blood. If your SHBG is high, more of your testosterone is bound up and less is free to act, so a total of 10 nmol/L can mean different things in two men. That is why the free testosterone figure, or the Free Androgen Index, matters in this range.

LH and FSH, the pituitary hormones, then tell the doctor where the problem sits. A low testosterone with a high LH points to the testes. A low testosterone with a low or normal LH points to the pituitary, which is when prolactin and further tests come in. Our guide to a raised PSA result explains how prostate checks fit alongside this.

The Male Hormone Profile measures all of these together: testosterone, SHBG, the Free Androgen Index, LH, FSH and prolactin. It costs £238.75 plus the £50 phlebotomy fee, is usually back in 1 working day, and you can walk in seven days a week. A morning appointment gives the most reliable testosterone reading.

What symptoms are linked to low testosterone?

The NHS describes some men developing depression, loss of sex drive, erectile difficulty and other physical and emotional symptoms in their late 40s to early 50s. Its list also includes mood swings and irritability, loss of muscle mass and a reduced ability to exercise, fat redistribution such as a large belly or gynaecomastia, a general lack of enthusiasm or energy, difficulty sleeping or increased tiredness, and poor concentration and short-term memory.

These can interfere with everyday life, which is why the NHS says finding the underlying cause matters. Lifestyle and psychological problems are behind many of them. Stress, anxiety, work, relationship trouble, money worries or concern about ageing parents can all bring on erectile difficulty, low sex drive and mood swings, and the NHS describes a midlife crisis sitting in the same picture. Lack of sleep, a poor diet, lack of exercise, drinking too much, smoking and low self-esteem can play a part too, and physical causes of erectile difficulty such as smoking or heart problems can sit alongside any of them. With that many possible causes, a conversation with a doctor tells you more than a printout.

What is late-onset hypogonadism?

The NHS describes it as an uncommon and specific medical condition rather than a normal part of ageing. When lifestyle or psychological problems don't seem to explain the symptoms, they may be due to hypogonadism, where the testes produce few or no hormones. Sometimes it's present from birth, which can cause delayed puberty and small testes. Occasionally it develops later in life, particularly in men who are obese or have type 2 diabetes, and that later form is late-onset hypogonadism.

A diagnosis can usually be made from your symptoms and blood tests that measure your testosterone. The two work as a pair: symptoms need a confirmed low level, and a low level needs a matching history.

The NHS advises seeing a GP if you have these symptoms. They'll ask about your work and personal life to see whether stress or anxiety may be responsible. If a blood test suggests a deficiency, you may be referred to an endocrinologist, a specialist in hormone problems. If the specialist confirms the diagnosis, you may be offered testosterone replacement to correct the deficiency, which should relieve your symptoms. The NHS notes it can be given as an injection or a gel.

Why isn't one blood result enough?

Testosterone levels move. The time of day, a recent illness and some medicines can all shift a result, so a sample taken when you were unwell, after a poor night or without a proper history can mislead. That's why diagnosis needs two early-morning samples, taken before 11:00 on different days. A number from a home kit, a gym or a previous laboratory is useful information, and a good place to start.

At Medical Express Clinic, treatment is considered only after the history and the blood results have been reviewed together. New tests are arranged only if they're needed, and they're charged separately from the consultation. A prescription isn't guaranteed at the first visit, and if one is issued later, pharmacy charges are extra.

If all you want is the laboratory number, the male hormone blood test does that, and a GP can go through the result with you afterwards. If you'd like wider heart and metabolic context, a Well Man examination can add it, though it's optional and you don't need one before a hormone assessment.

How is a hormone assessment arranged?

The service offers assessment and monitoring for suspected testosterone deficiency, led by Dr Mohammad Bakhtiar, GMC 4694470. You send an enquiry first, and the clinic contacts you to arrange the visit, choosing either a GP consultation or a specialist endocrinology appointment depending on your situation.

A GP consultation reviews your history and any suitable hormone results you already have. A specialist consultation adds consultant endocrinology review when the picture is more complex. The history covers energy, mood, sleep, libido, erections, exercise, weight, alcohol and any long-term illness. An examination is used only if it would help, the clinician explains it first, and you can ask to pause. Further bloods are arranged only if they would change the decision.

What is monitored if treatment starts?

Monitoring is agreed before treatment begins: testosterone, haematocrit and PSA at 3, 6 and 12 months, then yearly. If replacement is still appropriate after the review, the doctor talks you through the treatment and that monitoring plan together.

A man who feels well with a borderline result is in a very different place from a man with a confirmed deficiency and a matching history. How either is treated, if at all, is a clinical decision made after reading both, with no promise that adding a hormone will improve erections.

A few things can change whether replacement is suitable at all: unexplained polycythaemia (a high blood count), a prostate cancer investigation, and any plans to father a child. Each of these belongs in the consultation.

Getting the most from your appointment

• If you have recent results, attach them to your enquiry with a short note on what has changed. It helps the clinic decide whether a GP or a specialist endocrinology appointment fits better.
• If you can, note when the tiredness, lower libido or softer erections began, and whether morning erections are still there. Timing is part of the history.
• Bring a written medication list, including opioids, steroids and anything for pain, sleep, mood, the prostate or the heart.
• If you have type 2 diabetes, if your weight has gone up or your sleep has fallen apart, say so. The NHS names obesity, type 2 diabetes, sleep, alcohol and smoking among the things that can sit behind the same symptoms.
• If fertility still matters, a prostate investigation is under way, or you've been told your blood count is high, tell the doctor early.
• If stress, money, work or a relationship feels like the bigger problem, say that too.
• If you're tempted by testosterone from an unregulated website, or a friend's leftover gel, talk to a doctor first.

Which hormone appointment to book

Start with the concern that matters most to you. If erection is the main concern, book an erectile dysfunction assessment, where the GP checks cardiovascular risk and can discuss first-line oral treatment when it's safe. Prostate screening is a doctor-led visit of its own.

Which concern fits which visit

Chest pain, severe breathlessness or a suspected heart attack needs 999 or A&E.

Related reading: erection problems and your wider health.