Although testosterone is commonly known as the male sex hormone, its impact goes far beyond sexual function and fertility. Whether you’re a middle-aged athlete looking to optimize performance, or you’ve hit the 40s and have started feeling fatigued and foggy, there’s widespread curiosity about the topic—and some confusion. Atlantic Health System urologist Varun Vijay, MD, answers some of men’s most common questions about this important hormone.
1: What is testosterone and what does it regulate in my body?
Beyond sexual function and fertility, testosterone is the hormone that drives your masculine traits— facial hair, deeper voice, muscle growth. It also contributes to a man’s brain health, bone density, and heart health, too. Testosterone is made primarily in the testicles and peaks in men around age 17, gradually declining after age 30, and sometimes bringing on some bothersome symptoms.
2: I know low testosterone affects my sex drive; what else does it impact?
Men with low T often report a drop in sexual desire and may even experience erectile dysfunction. Other common complaints include fatigue, poor sleep, lack of motivation, and mood changes. Loss of muscle mass and bone density, increased body fat around the abdomen, and cognitive decline are also symptoms. Low testosterone can even put men at higher risk for osteoporosis or metabolic issues.
3: Could my testosterone levels ever be too high?
Naturally high testosterone is rare. It’s typically elevated from testosterone boosters for physical strength—and this has a downside. High T levels can increase red blood cell counts, which can subsequently raise the risk of blood clots. It can also lead to mood swings, aggression, and acne and breast tissue growth (gynecomastia), so medical supervision is important to minimize risks.
4: Is it normal for testosterone levels to decline with age?
Yes. Testosterone levels naturally decline starting around age 30. Men may start to notice natural signs of lower testosterone as they approach their 40s—and our modern lifestyle only makes things worse. Chronic stress, poor sleep, lack of exercise, a lousy diet, and environmental toxins all impact your testosterone, and all your hormone levels.
5: What are some natural ways to boost my testosterone?
Although the effect may be modest, there are a few lifestyle changes that can increase testosterone production. If you improve your sleep patterns, maintain a healthy weight by exercising regularly and eating nutrient-rich foods, avoid alcohol and drugs, and reduce the stressors in your life, you may see decreasing numbers level off, and maybe even rise a bit.
6: Should I consider testosterone replacement therapy (TRT)?
TRT can be helpful for men of any age group. Although it can significantly improve quality of life, if your symptoms are mild or you’re hesitant about remaining on a long-term medication, TRT may not be right for you. To measure testosterone, we start with a blood test, which is not part of a standard blood panel. Low T is diagnosed with two readings of testosterone below 300 ng/dL.
7: Are there side effects or risks to TRT?
Medically supervised TRT is safe but can carry some risk. It can worsen sleep apnea, cause blood clots, acne, enlarged breasts (gynecomastia), and lead to mood swings. Your doctor will monitor your blood levels and symptoms to minimize any potential risks. Also, research connecting TRT to heart disease or prostate cancer is mixed. There’s no conclusive evidence at this point and more studies are needed to better understand these relationships.
8: How does TRT work?
TRT is not a one-size-fits-all solution. If a man qualifies and chooses to begin TRT, the commitment is long-term. Otherwise, your testosterone levels will drop back down. TRT can be administered with injections, patches, gels, or pellets implanted under the skin. The goal is to restore your testosterone levels to a normal range so it alleviates your symptoms.
9: What type of doctor do I see for TRT?
Testosterone can be managed by a primary care physician, endocrinologist, or urologist depending on their expertise. Your provider will help you take a thoughtful and informed approach to managing your testosterone levels. Men considering TRT should start with an open discussion with their provider about their symptoms and goals—and fully understand the risks and benefits of TRT. Your provider will monitor your testosterone and other health markers to guide you toward long-term well-being.
10: What’s the profile of a typical patient seeking TRT?
I can tell if a man has low T as soon as I meet him. Men with low T are often fatigued, don’t feel motivated, and have lost some self-confidence. The decision to start testosterone therapy is very personal, and each man’s symptoms, goals, and situation are different—but we can help. If you’re feeling your testosterone levels might be low, ask your doctor to get tested so you know your options.
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