Low testosterone: Do you need testing?

From spotting the warning signs to correctly testing, understanding your testosterone levels is more complicated than social media may lead you to believe.

Not everyone needs testing at the slightest change in muscle mass or libido, and ensuring you’re testing accurately is key to avoiding a misdiagnosis.

“We’re swimming against the tide with social media and advertisements that would seem to indicate that this is a test you need, when in reality most men don’t,” explains Clinton Hauxwell, MD, family medicine provider at MultiCare Rockwood Clinic.

In decades past, men avoided the topic of testosterone deficiency (TD), also known as male hypogonadism. That mindset has slowly shifted. While it’s now discussed more commonly, especially on social media, it’s unfortunately not always accurate.

“We never want to discourage the conversation, and if you see information that you have questions about it, talk to your physician,” Dr. Hauxwell says. “There’s a lot of media suggesting that all men need to get their testosterone checked, but that’s not the case.”

Who needs testing?

Decreasing testosterone levels, muscle mass and libido can be associated with aging, and may not indicate TD, Dr. Hauxwell explains. However, if these changes are sudden or excessive, it’s worth asking your primary care provider.

Other signs that may warrant asking your provider about testosterone deficiency:

• Significant changes in libido
• Unexplained and ongoing fatigue or lack of energy
• A diagnosis of diabetes, severe chronic obstructive pulmonary disease (COPD) or pituitary diseases
• A history of high-dose steroid use

“As men age, it’s more difficult to maintain muscle mass,” Dr. Hauxwell adds. “A lot of this will come down to what you’ve been doing throughout your life to care for yourself, especially as you get into those later years.”

Simply put, if you’re not showing signs of TD that would otherwise be associated with age, you likely don’t need to be tested, he says. If you have symptoms outside of age-related changes, your primary care provider can determine if a test is warranted.

Accurate testing is key

“I’ve seen multiple examples of men who come to me with abnormal test results, but it’s because testing was done incorrectly,” Dr. Hauxwell says.

For accurate testing, a blood draw must be completed in the morning after a 12-hour fasting period, he says. The normal range for testosterone is based on morning levels because of how they vary throughout the day.

It’s also important to know that a diagnosis of TD should never be made based on one abnormal result. If a first test comes back abnormal, it should be repeated to confirm.

From there, your doctor or other health care provider will determine the type of TD, either primary or secondary. Primary TD is a condition directly related to testicular function, while secondary TD is related to a problem somewhere else in the body, such as the brain not properly signaling the testicles to produce testosterone as it should.

There are several ways to treat testosterone deficiency, Dr. Hauxwell explains. But men should also know there are circumstances where treatment would not be safe, even with a TD diagnosis — for example, if you a history of heart attack, prostate cancer or untreated sleep apnea.

Stay educated

“The key for all of us, physicians and patients alike, is education,” Dr. Hauxwell says. “Many men have symptoms that warrant testing for TD, but it’s not appropriate to test everyone.”

Start by bringing your questions or concerns to your primary care provider, he adds. If your provider isn’t comfortable discussing TD, they can refer you to the appropriate specialist.

Dr. Hauxwell also warns to be careful using online consultation and testing services, especially if they’re not following established testing guidelines.

In the end, though, keep the conversation going and don’t be nervous to ask your trusted provider.