When a man’s energy, strength, or sex drive changes, it’s worth finding out why.
You’re still getting everything done. Work, family, the things people count on you for.
But the workout you used to look forward to feels like another obligation. Sex has dropped further down the list. You get through the week, but then spend part of the weekend just recovering from the week!
Maybe you’ve wondered whether this is just what your forties or fifties are supposed to feel like. Maybe a friend started testosterone and says he feels better than he has in years.
Now you’re wondering: could it help me, too?
It’s a reasonable question. I want you to feel comfortable asking it.
When a testosterone result comes back low, there can be a sense of relief. Finally, something that might explain why you haven’t felt like yourself.
As a gynecologist, I’ve seen something similar happen with women. Once menopause enters the conversation, changes in sleep, weight, energy, and mood can all get attributed to hormones. Sometimes that explanation fits so well that we stop asking what else might be contributing. Sometimes that same thing happens for men.
Hormones work in concert with the rest of your body, which is why I look at hormone health as part of the bigger picture. Hormone treatment is an important part of my practice, including testosterone therapy for men. When low testosterone is contributing to how you feel, I want to help you address it while also looking at anything else that may be affecting your health. The goal is to help you get back to enjoying your workouts, your sex life, and your time outside of work.
Low testosterone can accompany less energy, lower sexual desire, and changes in muscle mass. Yet the evidence is inconclusive on whether testosterone treatment improves energy and fatigue.1
That can be frustrating when fatigue is the reason you wanted testing in the first place. Testosterone replacement might help. A low result, though, doesn’t tell us how much of your exhaustion it explains.
Are you waking up exhausted after eight hours in bed, or struggling to get enough sleep in the first place? Have you stopped looking forward to exercise, or are you training as hard as ever and noticing that your strength is slipping? Has your interest in sex changed, or is something getting in the way when you do want it?
A man can have low testosterone and untreated sleep apnea at the same time. Stress, medication effects or cardiometabolic concerns may also be part of the picture, while iron deficiency anemia and vitamin B12 deficiency can contribute to fatigue and weakness.2–4 Finding low testosterone doesn’t make those other possibilities disappear.
I consider gut health foundational, so microbiome testing is a standard part of my evaluation. I review it alongside your digestive symptoms, nutrition, and health history, together with a complete hormonal assessment, heart and metabolic health, strength and body composition, nutrient testing, cognitive evaluation, and a sleep assessment. Bringing those findings together helps us build a treatment plan around your health and what you want to improve.
Which treatments belong in your Vibrant Life Medicine Healthspan Roadmap — the care plan we build around your findings and priorities — depends on what we find and which changes matter most to you.
Testing helps clarify whether testosterone deficiency is part of the picture. The American Urological Association uses a total testosterone level below 300 ng/dL as a reasonable cutoff supporting the diagnosis, together with symptoms or signs that fit. We have to take into account that levels vary throughout the day and illness can temporarily lower them. But the number alone can’t tell us how much of what you’re feeling it explains.1,2
The next question is why. The testes make testosterone in response to messages from the brain. Further blood testing helps us understand whether the testes are having trouble producing testosterone or aren’t receiving enough of that signal. Understanding where the problem starts helps guide treatment.2
For men with low testosterone, treatment may improve sexual desire, lean body mass, bone mineral density, anemia, and depressive symptoms. The AUA guideline also includes possible improvement in erectile function, although benefits vary.1
Bone deserves a caveat. Density improves with treatment, but in TRAVERSE men taking testosterone had more fractures than men on placebo, not fewer. If bone health is already a concern for you, that’s worth discussing before starting.7
Sexual health shows why we need to get specific about what you want treatment to accomplish. A man who has lost interest in sex and a man who wants sex but struggles to maintain an erection may both ask about testosterone, while hoping for very different improvements. A large randomized trial illustrates the distinction. In TRAVERSE, 1,161 men with low desire and confirmed low testosterone improved in desire and sexual activity compared with placebo, with no statistically significant improvement in erectile function in that study.1,5 The participants were on average 64 years old with cardiovascular disease or increased cardiovascular risk.5 How closely these findings apply to you depends on your age and health history, but the takeaway message is: If low libido is your main concern, treatment could help. If erections are, we may need to look further.
Before beginning treatment, we should agree on what you hope will change. More interest in sex? Feeling stronger? Having enough energy left on Saturday to enjoy the day?
Your health history and future plans matter too. Testosterone can suppress sperm production and should not be prescribed to men currently trying to conceive. We also review blood counts, sleep apnea, prostate health, bone health, and cardiovascular history. Sleep apnea matters particularly here: testosterone treatment can make untreated apnea worse, so that gets addressed first. Treatment can also raise red blood cell levels and blood pressure, making follow-up an important part of care.1,2,6,7
At follow-up, we return to the concerns that brought you in. If testosterone levels normalize without improvement in symptoms after three to six months, the AUA recommends discussing whether treatment should continue.1 That gives us a reason to reconsider the treatment’s benefit and what else may need attention.
Feeling this way doesn’t mean you’ve reached a limit you simply have to accept. When we identify concerns we can treat, there’s an opportunity for meaningful improvement. Testosterone may be an important part of that plan, alongside better sleep, correcting a deficiency, or addressing another condition. What matters is whether those changes help you feel and function better in the life you actually want to live.
“I’m getting older” may be part of the story. It doesn’t have to be the end of the conversation.
About the author: Erica Song, MD, is the founder of Vibrant Life Medicine, a physician-led precision longevity practice in Bergen County, New Jersey. She is double board-certified in Obstetrics and Gynecology and in Anti-Aging and Regenerative Medicine.
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