Private low testosterone clinic in London, same-day men's health.

Symptoms

The difficulty is that these overlap almost entirely with the symptoms of poor sleep, depression, obesity, excess alcohol and simply being middle-aged — which is why the diagnosis rests on testing, not on how you feel.

• reduced sex drive, fewer spontaneous and morning erections
• fatigue, low mood, irritability, poor concentration
• loss of muscle bulk and strength, increased body fat, particularly around the abdomen
• reduced body and facial hair, small or shrinking testicles
• hot flushes and sweats; reduced bone density over time

What to exclude and address first

• Obesity — fat tissue converts testosterone to oestrogen. Weight loss alone raises levels significantly in many men.
• Obstructive sleep apnoea — a common and frequently missed cause of low testosterone and fatigue.
• Type 2 diabetes and metabolic syndrome.
• Excess alcohol, opioid painkillers, and anabolic steroid use, past or present.
• Depression and chronic stress, which produce identical symptoms.
• Thyroid disease, haemochromatosis and high prolactin, all of which are specifically treatable.

Treatment

• Testosterone is given as a gel, or as an injection at intervals from two weeks to three months depending on the preparation.
• It takes three to six months to judge the effect, and sexual symptoms usually respond first.
• Monitoring is essential: testosterone level, haematocrit, PSA and prostate assessment, at three, six and twelve months and then annually.
• Raised haematocrit — thickening of the blood — is the commonest problem and increases clot risk, sometimes requiring dose reduction or venesection.
• Not suitable with untreated prostate or breast cancer, and used with caution with severe heart failure or untreated sleep apnoea.