WHY ARE SO MANY MEN BEING TOLD THEY HAVE LOW TESTOSTERONE?
THE AUTHOR: DR. ADAM STATEN
Dr Adam Staten is a NHS GP and part of the Clinical Governance team here at One Day Tests. Dr. Staten trained at Cambridge University and King's College London. He has served as a Medical Officer in the British Army. Dr. Staten is a firm believer in educating people about common health problems to empower them to understand and manage their own health.
The conversation around men's hormones has never been louder, particularly Testosterone.
Testosterone Replacement Therapy (TRT) has exploded into mainstream conversation, with many discussions taking place about how the prescription supports men (and women) to restore energy, libido, and drive. Here is just one recent example from The Guardian.
The messaging within the media reports are varied, and understandably this can be confusing for those looking into the merits of TRT, and how different healthcare organisations are diagnosing those with low Testosterone, and therefore offering TRT as a solution.
At One Day Tests, we want to explain the merits of TRT, and detail how we diagnose low testosterone, compared to other healthcare providers, to ensure only those people with low testosterone are being offered TRT.
HOW IS LOW TESTOSTERONE DEFINED?
Testosterone levels are measured through a blood test, and the unit of measurement used is called nmol/L (Nanomoles per litre), which is the concentration of Testosterone in the blood.
Breaking it down:
nano — one billionth (0.000000001)
mole — a standard unit in chemistry that counts the number of molecules of a substance
per litre — per litre of blood (or other fluid)
As per the British Society for Sexual Medicine guidelines, any level less than 12 nmol/L is classified as low Testosterone.
Specifically, if someone has symptoms suggestive of testosterone deficiency and a level below 12 then they should consider a trial of Testosterone Replacement Therapy.
At One Day Tests we follow the guidelines from the British Society for Sexual Medicine, and only suggest TRT for those customers who fall within the range and who have symptoms that might benefit from treatment with testosterone.
Any level 12 nmol/L and above should not be identified as low testosterone. If any healthcare provider is suggesting TRT as a course of treatment where the Testosterone level is 12 or above, we suggest you question this with that specific provider.
WHAT DOES THE NHS CLASSIFY AS LOW TESTOSTERONE?
Although guidance differs between trusts, NHS England generally considers low testosterone below 8 nmol/L.
The reason for this lower level is because the NHS will generally only treat those patients with severely deficient levels of Testosterone. It is generally considered that low testosterone is under-treated on the NHS.
WHAT ARE THE COMMON SYMPTOMS OF LOW TESTOSTERONE?
Symptoms tend to fall into a few broad categories:
Physical
- Reduced sex drive (libido)
- Erectile dysfunction
- Loss of muscle mass and strength
- Increased body fat, particularly around the abdomen
- Decreased bone density (which can lead to osteoporosis over time)
- Fatigue and low energy levels
- Reduced body and facial hair
- Hot flushes and sweating (less commonly known but documented)
Psychological and Cognitive
- Low mood or depression
- Irritability and mood swings
- Poor concentration and brain fog
- Reduced motivation and drive
- Loss of confidence
Sexual and Reproductive
- Reduced fertility (lower sperm production)
- Smaller testicular volume
- Delayed or absent puberty in younger males
HOW CAN YOU INCREASE TESTOSTERONE LEVELS?
There are two broad routes:
- Lifestyle changes
- Medical intervention
Most guidelines recommend exhausting the first before considering the second.
LIFESTYLE CHANGES
These can have a meaningful impact on testosterone levels, particularly if levels are in the low-to-borderline range.
Exercise
- Resistance training and weightlifting are the most effective forms of exercise for boosting testosterone.
- High-intensity interval training (HIIT) also shows positive effects.
Sleep
- The majority of daily testosterone is produced during sleep, particularly in the early morning hours.
- Studies show that sleeping fewer than 5 hours a night can reduce testosterone levels by up to 15%.
- Improving sleep quality is one of the most impactful and underappreciated interventions.
Weight loss
- Body fat, particularly abdominal fat, converts testosterone into oestrogen through a process called aromatisation.
- Losing excess weight can meaningfully raise testosterone levels without any medical intervention.
Diet
- Adequate intake of zinc (found in red meat, shellfish, seeds) and vitamin D are important for testosterone production
- Chronically low calorie intake or nutrient deficiency can suppress levels
- Excessive alcohol consumption is known to lower testosterone
Stress reduction
- Cortisol (the stress hormone) directly suppresses testosterone production
- Chronic stress is one of the more overlooked contributors to low levels
MEDICAL INTERVENTION
When lifestyle changes aren't enough and a clinical deficiency is confirmed, Testosterone Replacement Therapy (TRT) may be recommended.
WHATS IS TRT AND HOW CAN MEDICATION HELP
Testosterone Replacement Therapy works by supplementing the body with testosterone when natural production has fallen short.
The goal of treatment is not to push testosterone to exceptional levels, but to bring it back within a healthy, normal range. This targeted approach aims to relieve symptoms while keeping the risks of treatment to a minimum.
There are several ways testosterone can be delivered. Skin gels and regular injections are the most widely used methods, offering convenience and consistent dosing. Alternatives such as tablets, patches, and implants also exist, though these tend to be prescribed less often in routine clinical practice.
Here at One Day Tests we offer Testosterone Replacement Therapy.
Our TRT Programme includes:
- An initial 25 minute GP consultation fee
- All medication and postage and packages fees
- Monitoring blood tests every 3 months
- An online consultation with our clinical team, every 3 month to review your results and progress
- You can cancel any time
- You can change medication if required