Bespoke Health & Wellness
Men’s Health
Patient Guide

Careful testing. Evidence-based treatment. A plan built around you.

Low testosterone, explained

Testosterone levels slowly decline with age, but most men keep levels in the normal range. When levels fall below normal and cause symptoms, it’s called testosterone deficiency (also called hypogonadism or “low T”). It is a medical diagnosis, not a normal part of aging, and it is treatable.

You may have heard it called “andropause” or “male menopause.” We don’t use those terms, because men don’t go through a sudden, universal hormone change the way women do at menopause.

Symptoms that may be linked to low testosterone

• Low sex drive

• Erectile dysfunction

• Fewer morning erections

• Fatigue and low energy

• Low mood or irritability

• Loss of muscle mass and strength

• Increased body fat

• Bone loss

These symptoms have many possible causes, including sleep apnea, depression, thyroid problems, medications, alcohol, and obesity. That’s why careful testing matters.

How we diagnose it

We follow American Urological Association and Endocrine Society guidelines:

1. Symptoms first. We start with a full history and exam.

2. Two morning blood tests. We check total testosterone, before 10 a.m., on two separate days, because levels are highest and most reliable in the morning. Low testosterone is generally a total level below 300 ng/dL on both tests.

3. Finding the cause. Additional labs can include LH, prolactin, blood count, PSA, A1c, and lipids, to find out why your level is low.

Treatment options

Lifestyle first, and always. Weight reduction, better sleep, treating sleep apnea, strength training, and less alcohol can raise testosterone naturally. For men with obesity, treating the obesity can make a meaningful difference.

Testosterone therapy is offered to men with confirmed testosterone deficiency and symptoms. Options include gels, injections, and other forms. We help you choose the best fit.

If you want children now or in the future, tell us. Testosterone therapy lowers sperm production and can cause infertility. Other treatments can raise your own testosterone while protecting fertility.

What testosterone therapy can and can’t do

In men with confirmed deficiency, research shows testosterone therapy can improve:

• Sex drive and sexual function

• Mood and energy, modestly

• Bone density

• Anemia

• Muscle mass and body fat

Testosterone therapy is not recommended for men with normal levels. It is not an anti-aging treatment or a performance enhancer.

Risks and safety

Large recent studies, including the TRAVERSE trial, did not find a higher risk of heart attack or stroke with testosterone therapy in men with confirmed deficiency. Like any treatment, it still has risks we monitor closely:

• High red blood cell count (higher hematocrit), which can raise clot risk

• Higher blood pressure

• Effects on the prostate: We check PSA and prostate health before and during treatment

• Infertility and smaller testicles

• Acne, fluid retention, and worse sleep apnea

Testosterone therapy may not be right for you if you have prostate or breast cancer, are trying to conceive, have a high red blood cell count, have untreated severe sleep apnea, or have had a recent heart attack or stroke.

Monitoring

We recheck your testosterone, red blood cell count, and PSA at 3 to 6 months, then at least once a year. We also ask how you feel. If treatment isn’t helping your symptoms, we stop it.