male hormone risks and benefits for patients

Overview

Male hormone therapy, usually called testosterone replacement therapy, is a treatment that brings a man's testosterone level back to a healthy range. Testosterone is a hormone that plays a role in sex drive, muscle strength, mood, and energy. The treatment can help with symptoms of low testosterone, but it also has risks that you and your doctor should consider together.

Low testosterone becomes more common as men age, but not all older men have it. Many men with low testosterone have no symptoms at all.

It mainly affects men with a condition called hypogonadism, where the testicles do not make enough testosterone. It can also affect men who have had testicular injury, certain infections, or problems with the pituitary gland.

Symptoms

Common symptoms

• Low sex drive (libido)
• Tiredness and low energy
• Mood changes, including irritability or low mood
• Loss of muscle strength or difficulty building muscle
• Weight gain, especially around the belly
• Difficulty getting or keeping erections

Symptoms in older adults

• Feeling weaker or more tired than usual
• Loss of interest in activities you once enjoyed
• Aches and pains that are hard to explain
• Memory or concentration problems

Causes

Main causes

• Aging: testosterone naturally declines over time.
• Damage to the testicles from injury, infection, or medical treatment.
• Problems with the pituitary gland that controls hormone signals.
• Certain long-term health conditions like diabetes or obesity.

Risk factors

• Being overweight or obese
• Type 2 diabetes
• High blood pressure
• Heavy alcohol use
• Certain medicines, such as some painkillers or steroids

When to see a doctor

See a doctor urgently if:

• See a doctor the same day if you have pain or swelling in one leg, difficulty passing urine, or a lump in the breast.

Book a routine appointment if:

• If you have long-term tiredness, low mood, or low sex drive that is affecting your life, make an appointment.

Diagnosis

Your doctor will ask about your symptoms and health history, and may do a blood test to measure your testosterone level. Often the test is done in the morning, because levels are highest then.

Tests that may be done

• Blood test for total testosterone
• Blood test for free testosterone (if needed)
• Haemoglobin and haematocrit (to check the thickness of your blood)
• PSA test (a blood test for prostate health) in older men

What to expect at your appointment

A single low result may not be enough to diagnose you. If your first test is low, your doctor may repeat it to confirm, and may also test other hormones from the pituitary gland.

Treatment

Treatment is not right for everyone. Your doctor will only suggest testosterone replacement if your levels are low and you have symptoms. The goal is to reduce symptoms and improve wellbeing, while balancing the risks.

Self-care at home

• Aim for a healthy weight – losing extra weight can naturally raise testosterone.
• Stay active, but avoid overtraining or extreme diets.
• Get enough sleep – poor sleep can push hormone levels down.
• Limit alcohol and avoid steroid misuse.

Medical treatments

There are several ways to take testosterone, including gels, patches, injections, and pellets placed under the skin. All of these must be prescribed by a qualified healthcare provider. You will need regular check-ups to monitor your blood counts, heart health, and prostate health. Some treatments are not recommended if you have heart disease, breast or prostate cancer, or a high risk of blood clots.

When is surgery considered?

Surgery is rarely used to treat low testosterone. It might be considered if a tumour or other physical problem in the pituitary gland is causing the problem. That decision would be made by a specialist.

Living with this condition

If you are on testosterone therapy, you will need to keep a steady routine. Follow your prescribed method exactly, and do not change the dose on your own. Keep all your follow-up appointments.

Lifestyle tips

• Exercise at a level that feels right for you – combine strength training with aerobic activity.
• Manage stress with mindfulness, hobbies, or talking to someone you trust.
• Get between 7 and 9 hours of sleep each night.
• Avoid recreational drugs and anabolic steroids.

Diet and exercise

Eat a balanced diet with plenty of vegetables, fruit, lean protein, and whole grains. Regular activity helps your body respond to hormones and keeps your heart healthy.

Mental health and emotional wellbeing

Low testosterone can affect mood, confidence, and body image. Starting hormone therapy can improve mood, but it is not a cure for anxiety or depression. If you feel low or anxious, tell your doctor or reach out to a mental health professional. In a crisis, contact your local emergency services or a crisis helpline.

Prevention

Not always, because aging and some health conditions can cause low testosterone. But you can lower your risk by staying at a healthy weight, being active, and managing medical conditions like diabetes.

Screening programmes

There is no routine screening test for men with no symptoms. If you are at higher risk, for example because you have diabetes or are very overweight, your doctor may check testosterone levels as part of a full health review.

Complications

If left untreated

• Long-term low testosterone can reduce bone density and increase the risk of fractures.
• It may also affect mood, energy, and quality of life.
• In some cases, low testosterone is linked to a higher risk of heart disease, but the exact relationship is still being studied.

Long-term outlook

For men who truly have low testosterone and bothersome symptoms, treatment can make a real difference to their energy, mood, and quality of life. With regular monitoring and a healthy lifestyle, many men manage well. The key is to make the decision together with your doctor, based on your personal risks and benefits.

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