Building on the diagnostic approach, it is important to recognize that the most specific symptoms of low testosterone are reduced libido, poor morning erections, and erectile dysfunction, while other symptoms such as fatigue, depressed mood, and decreased muscle mass are less specific and may overlap with other medical or psychiatric conditions. The presence of multiple sexual symptoms in conjunction with low testosterone levels increases diagnostic specificity for hypogonadism.[2-3]
Laboratory confirmation requires two separate early morning (before 10 a.m.) fasting total testosterone measurements, as testosterone exhibits diurnal variation and can be transiently suppressed by illness, food intake, or certain medications. If total testosterone is borderline or if conditions affecting sex hormone–binding globulin (SHBG) are present (e.g., obesity, diabetes, thyroid disorders), free testosterone should be assessed by equilibrium dialysis or calculated from total testosterone, SHBG, and albumin. Acute illness, recent use of opioids, or glucocorticoids should prompt deferral of testing until recovery.[2][4][5]
At Total Virility, the evaluation includes a comprehensive symptom assessment, targeted physical examination, and laboratory testing as described above. If testosterone deficiency is confirmed and symptoms are present, further evaluation with luteinizing hormone (LH) and follicle-stimulating hormone (FSH) is performed to distinguish primary from secondary hypogonadism and to guide management.[5]
Testosterone replacement therapy (TRT) is considered for men with confirmed biochemical deficiency and relevant symptoms, after shared decision-making regarding risks and benefits. TRT is available in several formulations (e.g., intramuscular, transdermal, subcutaneous), and therapy is individualized. Monitoring for efficacy and adverse effects—including erythrocytosis, prostate health, and cardiovascular risk—is essential. The Endocrine Society and the American College of Physicians both emphasize that TRT is not indicated for men with low testosterone in the absence of symptoms, and that therapy should be avoided in men with prostate or breast cancer, uncontrolled heart failure, or untreated severe sleep apnea.[2][6][7][6][7]