In brief
- Symptoms of low testosterone overlap with many other health problems.
- A diagnosis requires compatible symptoms or signs together with consistently low blood-test results.
- Testing is usually repeated in the early morning, under appropriate conditions, before treatment is considered.
- TRT is prescription treatment and requires an individual risk discussion and ongoing monitoring.
Men often arrive at a consultation with a list that feels familiar: lower energy, reduced drive, poorer recovery, changes in sexual function, difficulty concentrating, lower mood or a loss of strength. These concerns are real. The important next step is not to assume the cause—it is to assess it properly.
Low testosterone is a diagnosis, not a symptom
There is no single symptom that proves testosterone deficiency. Fatigue can relate to sleep disruption, anaemia, thyroid disease, metabolic health, medication effects, mood, high stress or several factors at once. Changes in libido, strength and concentration are also not unique to low testosterone.
For that reason, recognised clinical guidance recommends diagnosing hypogonadism only when a man has relevant symptoms or signs and testosterone levels that are unequivocally and consistently low. The consultation and the laboratory result carry meaning together; neither should be treated as the whole answer.
“The goal is not the highest number. The goal is a defensible diagnosis, a plan that fits your health, and follow-up that keeps the plan honest.”
Dr Luhard
Why one blood test is usually not enough
Testosterone levels can vary through the day and may be affected by acute illness, sleep, nutrition, some medicines and the circumstances in which the sample was taken. A single low or borderline result can therefore mislead.
Current Endocrine Society guidance recommends confirming a low result with a repeat early-morning, fasting total testosterone measurement. Depending on the result and the clinical picture, further hormone testing may be needed to understand whether the problem may arise primarily from the testes or from signalling higher up in the hormone system.
What a proper assessment considers
A useful assessment looks beyond one laboratory marker. The exact work-up differs from person to person, but may include:
- Your symptom pattern, when it began and how it affects daily life
- Medical history, current medicines, supplements and previous hormone or anabolic use
- Sleep quality, snoring and possible sleep apnoea
- Blood pressure, body composition and metabolic risk factors
- Thyroid function, blood count or other investigations where clinically indicated
- Current or future fertility plans
- Further hormone tests to investigate the cause of a confirmed low result
This wider view matters because treating a number without identifying the underlying problem can delay more appropriate care.
When TRT may be appropriate
Testosterone replacement therapy may be considered for adults with confirmed testosterone deficiency when the likely benefits, limitations and risks have been discussed. It is not a general anti-ageing shortcut, a gym-performance product or the automatic response to tiredness.
Before treatment, Dr Luhard will consider factors that may make TRT unsuitable or require specialist input. Fertility deserves particular attention because external testosterone can suppress sperm production. Prostate-related risk, blood count, untreated severe sleep apnoea, recent cardiovascular events and other medical factors may also influence the decision.
The purpose of shared decision-making is to arrive at a plan that fits the diagnosis and the person—not to chase a universal “optimal” number.
Why monitoring is part of treatment
Starting treatment is not the end of the assessment. Follow-up checks whether symptoms are responding, whether testosterone levels are in the intended range and whether adverse effects or safety concerns are emerging.
Monitoring may include a clinical review, testosterone measurement, blood count and haematocrit, blood pressure and prostate-related assessment where appropriate for age and individual risk. The exact schedule is determined by the treatment route and the patient’s health profile.
In South Africa, suspected medicine side effects can also be reported through SAHPRA’s pharmacovigilance channels. If you experience concerning symptoms after starting any prescribed treatment, contact your treating doctor promptly rather than changing or stopping treatment without medical advice.
How to prepare for your consultation
You do not need to arrive with a diagnosis. A short, accurate history is more useful than a list of internet protocols. Consider bringing:
- A timeline of the changes you have noticed
- A list of medicines, injections and supplements you use
- Previous blood results, including the date and time of testing
- Information about sleep, snoring, training, alcohol and recent illness
- Your current or future fertility priorities
- The questions you most want answered
Private consultations · Waterkloof
Concerned about your testosterone?
Start with a private medical consultation with Dr Luhard at Medify in Waterkloof, Pretoria. Your symptoms and health context come before any treatment decision.