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If it feels like you’ve been hearing more about testosterone lately, you’re not wrong.
“The conversations are definitely shifting,” says Jamin Brahmbhatt, MD, a urologist and sexual health expert at Orlando Health and assistant professor of urology at UCF College of Medicine. “People are openly talking about it.”
While this is due in part to the general dissolving of stigmas around sensitive health subjects, like erectile dysfunction, fertility, and depression, it’s also the result of a widely reported study that found testosterone levels among men in the US have been steadily declining over recent years.
Meanwhile, online, the conversation around testosterone has been amplified by the algorithm-savvy marketing efforts of a booming industry of retail men’s health clinics eager to sell you treatments. “A lot of market forces go into driving our healthcare in one direction or another, for better or worse,” says Scott D. Miller, MD, MBA, medical director at Wellstar Urology.
Regardless, testosterone is something that’s worth paying attention to (at least to an extent—we’ll explain). The hormone is responsible for many vital functions throughout the body, including regulating sex drive and mood, generating red blood cells, producing sperm, and building muscle.
“It influences every system of our body,” Dr. Miller says. And when levels dip too low (the American Urology Association draws the line at 300 nanograms per deciliter), the symptoms can be all-consuming, including fatigue, lack of sex drive, depression, and brain fog, to name a few.
However, the question of whether or not you should get your own testosterone checked isn’t so straightforward.
Should you get checked?
To put it simply, if you’re not experiencing persistent symptoms associated with low testosterone, you have no reason to get your levels checked—regardless of what they might be.
“If you're otherwise feeling well, I really don't advocate just going on a fishing expedition,” says Sanjay B. Dixit, MD, medical director of cardiometabolic endocrine and wellness clinical solutions at Quest Diagnostics. “That's actually one of the key points in the Endocrine Society’s guidelines from 2018, that they do not recommend testing in otherwise asymptomatic men.”
What’s more, if nothing seems to be wrong, even a low result is irrelevant, because there’s no reason to change it. “Even if it was low, I would not treat it, and I would not recommend treatment, says Dr. Miller. That is a pretty well-established guideline among all societies.”
What if you’re experiencing symptoms?
The first thing to look out for is whether these symptoms are sustained or sporadic; the former is worth paying attention to, the latter is called being human. “There are going to be days when we're tired, there are going to be days when we have low libido, there are going to be days we just can't pump the iron at the gym,” says Dr. Brahmbhatt.
That said, even if you suspect you might be consistently experiencing one or two of the more common symptoms associated with low testosterone—for example, low libido, fatigue, or trouble focusing—they could stem from other causes unrelated to testosterone. “Those things are multifactorial,” says Dr. Dixit. “They could be affected by work, personal life, or other medical conditions.”
Before rushing to get tested, Dr. Dixit suggests first making sure you’re taking care of your overall health. “Do a lifestyle check. Sleep, exercise, and diet can go a long way,” he says. Even if your testosterone levels are in fact on the low side, this could set them right—the effects of a holistic lifestyle tune-up can impact testosterone considerably. “It could be hundreds of points,” Dr. Brahmbhatt says. “There are actually studies done that show the improvement.”
Overall, the prevailing advice seems to be to first do everything you can to optimize your general wellness—especially sleep—before you start thinking about your testosterone, which, even if low, could be corrected automatically as a result. Ultimately, while testosterone replacement therapy is common, it comes with its own set of considerations, and if your perceived symptoms are stemming from elsewhere, treating your testosterone isn’t going to make them go away.
“A lot of people think that [testosterone] is their answer to better health, longevity, weight control, muscle mass, or whatever their goals are,” Dr. Miller says. “It could be a component, but some people think that's the only component, and I think that's where the danger lies.”
But if you’re feeling persistent symptoms, consider getting a checkup. “If after several weeks of doing that things really haven't changed significantly,” says Dr. Dixit, “then I think checking testosterone is reasonable.”