A growing number of men are undergoing testosterone replacement therapy (TRT), but experts caution that common symptoms often attributed to low testosterone may actually indicate other underlying health problems. Dr. Justin Dubin, a urologist and director of men's sexual health at Miami Cancer Institute, noted that the signs of low testosterone are often general and can be caused by separate or coexisting conditions.
This trend toward TRT is partly fueled by the ease of obtaining prescriptions online. However, studies suggest that many men receiving testosterone may not actually need it, with one study indicating only 12% of men with a prescription had genuinely low testosterone levels.
Low Sex Drive
While a decreased sex drive is frequently linked to low testosterone, Dubin explained it can also be a symptom of mental health issues such as depression and anxiety, or even a side effect of certain medications. Antidepressants (like SSRIs), blood pressure medications, and anti-seizure drugs can all impact libido. Dubin emphasized that a doctor's comprehensive assessment is crucial to differentiate between low T and other causes. "Sexual problems may be a warning sign of or a direct result of some other health issues that you may have," he stated.
Fatigue
Low energy is another symptom commonly associated with low testosterone. However, Dubin pointed out that fatigue can also be attributed to insufficient sleep, sleep apnea, hypothyroidism, mental health conditions, anemia, or lifestyle factors. Sleep apnea, in particular, is a serious disorder that can lead to significant cardiovascular problems if left untreated. Hypothyroidism can suppress testosterone production, and low testosterone can, in turn, lead to anemia by impacting red blood cell production. Dubin also noted the stigma surrounding men's health, with a Cleveland Clinic survey revealing that a majority of men would rather perform household chores than visit a doctor, leading many to suffer in silence.
Erectile Dysfunction
Erectile dysfunction (ED) can be a sign of low testosterone but is also a well-known early indicator of heart and vascular disease. The cardiovascular system's ability to pump blood is essential for achieving an erection, and ED can signal underlying heart conditions that could lead to life-threatening events like stroke or heart attack. Diabetes is another significant contributor to ED, affecting blood vessels, and untreated diabetes can cause severe complications including kidney failure, nerve damage, and vision loss. Smoking also damages blood vessels, and men who have undergone pelvic treatments such as radiation or surgery for prostate cancer may also experience ED.
Dubin further explained that coexisting medical issues can complicate the effectiveness of TRT. Conditions such as a history of cancer, chronic illness, obesity, and treatments for cancer can all put men at risk for low testosterone. He highlighted cases where men seeking treatment for low T were actually experiencing issues related to mental health, stress, or relationship problems, despite having normal testosterone levels. He stressed the importance of a medical evaluation to accurately diagnose and treat the root cause of these symptoms.