Testosterone Deficiency in Men: Diagnosis and Treatment Considerations

Testosterone deficiency is a clinical diagnosis that requires both consistent symptoms and confirmed low serum testosterone. For men who meet criteria, treatment decisions should be individualized by a licensed provider with attention to benefits, risks, and ongoing monitoring.

Evaluating for Testosterone Deficiency

Serum testosterone declines gradually with age, but not every man with a lower-than-average level has a clinical deficiency. Symptoms are nonspecific and overlap with many other conditions, so a thorough evaluation is essential.

Symptoms That May Prompt Evaluation:

• Reduced libido and erectile dysfunction
• Fatigue and decreased energy
• Decreased muscle mass and strength
• Increased body fat
• Depressed mood or reduced concentration
• Low bone density

Elements of a Clinical Workup:

• History and physical examination, including medication review
• Morning serum total testosterone on at least two separate occasions, with free testosterone or SHBG where indicated
• Evaluation of contributing conditions such as obesity, sleep apnea, diabetes, thyroid disease, and opioid or glucocorticoid use
• Baseline hematocrit/hemoglobin, PSA where appropriate, lipids, and metabolic labs
• Discussion of fertility goals, since testosterone therapy can suppress sperm production

Treatment Considerations

For men with confirmed deficiency, testosterone therapy may be considered after a shared decision-making discussion. Delivery options prescribed by licensed providers include injections, topical preparations, and pellets. The choice depends on patient preference, clinical factors, and the provider's judgment.

Potential Benefits (Evidence Varies by Outcome):

• Improvement in sexual function and libido
• Improvement in energy and mood in some patients
• Increases in lean mass and bone density

Risks and Monitoring:

• Erythrocytosis, which requires periodic hematocrit monitoring
• Possible worsening of sleep apnea or edema
• Suppression of fertility
• Prostate monitoring in accordance with clinical guidelines
• Ongoing assessment of symptoms and serum testosterone to confirm appropriate dosing

Lifestyle and Whole-Patient Care

Weight management, resistance training, sleep, alcohol reduction, and management of metabolic disease can all affect testosterone levels and symptoms. In some patients these measures should be addressed before or alongside any hormone therapy.

Provider Support Through Purepell

Providers who include hormone therapy in their practice can work with Purepell through Halo Health Advisors. All diagnostic and prescribing decisions remain with the licensed provider.