Testosterone 101: What Every Man Needs to Know

Esra Shermadou
Jul 25
4 min read

Have you been wondering if testosterone therapy might be right for you?

Maybe you’ve noticed it’s harder to build muscle, your energy is down, your sex drive isn’t what it used to be—or you’re struggling with erectile dysfunction.

These can all be signs of low testosterone, often referred to as low-T.

I’m Dr. Esra Shermadou, a board-certified Family Medicine physician, and in this post, I’ll walk you through the essentials of testosterone: what it is, what happens when it drops, and what you can do about it.

🔍 What Is Testosterone?

Testosterone is the primary male sex hormone. About 95% is produced by the Leydig cells in the testes, with the rest coming from the adrenal glands.

It plays a major role in male development during puberty—but its importance doesn’t stop there.

In adult men, testosterone supports:

Muscle mass and bone density
Sperm production
Sex drive
Energy and mood
Cognitive function

Normal testosterone levels typically range between 300–1000 ng/dL. Starting around age 40, testosterone levels naturally decline by about 1–2% per year. For some men, this drop leads to hypogonadism—a clinical term for low testosterone paired with symptoms.

⚠️ What Causes Low Testosterone?

The most common cause of acquired low-T is simply aging. But other factors play a role too:

Obesity
Chronic stress
Sleep apnea
Type 2 diabetes
Certain medications
Testicular injury or infection

In many cases, it's a combination of these that leads to low testosterone levels.

🚨 Common Symptoms of Low-T

Low testosterone can sneak up slowly—but its effects are real. Some of the most common signs include:

Low energy and motivation
Decreased sex drive and fewer spontaneous erections
Weight gain, especially around the midsection
Loss of muscle mass
Mood changes like irritability or depression
Brain fog or memory issues

If these symptoms sound familiar, it may be time to get checked.

🧪 How Is Low Testosterone Diagnosed?

Diagnosing low-T requires both symptoms and lab testing.

Because testosterone peaks in the morning—especially in men under 45—your levels should be tested early in the day, on two separate occasions.

In addition to total testosterone, your provider may check:

Free testosterone
Prostate-Specific Antigen (PSA)
Hematocrit (red blood cell concentration)
Cholesterol and lipid levels

These help determine if testosterone replacement therapy (TRT) is safe and appropriate.

💉 What Are the Treatment Options?

Before jumping into TRT, it’s essential to optimize the basics:

Sleep
Diet
Strength training
Stress management

These lifestyle changes can significantly improve testosterone levels.

If symptoms persist, your provider may discuss testosterone therapy, which comes in different forms:

Injections
Gels or creams
Patches
Pellets (implanted under the skin)

The best option depends on your lifestyle, preferences, and overall health.

⏱️ What to Expect From TRT: Benefits & Timeline

When medically indicated, TRT can bring powerful benefits:

Increased energy and stamina
Improved libido and sexual function
Lean muscle gain
Reduced belly fat
Better mood and focus

Some effects are noticeable within a few weeks, but full benefits can take several months. TRT is not a quick fix—it’s a long-term commitment often paired with lifestyle change.

⚠️ Risks & Side Effects of TRT

Like any treatment, testosterone therapy comes with potential risks:

Acne or oily skin
Water retention
Increased red blood cell count
Worsening of untreated sleep apnea
Reduced sperm production and fertility

TRT doesn’t cause prostate cancer, but because the prostate has testosterone receptors, PSA levels may rise initially. That’s why monitoring is critical.

🚫 Who Should NOT Use TRT?

TRT is not for everyone. You may not be a candidate if you have:

Uncontrolled heart failure or cardiovascular disease
Untreated sleep apnea
Active prostate cancer

In these cases, treating the underlying condition must come first. Once stable or cancer-free, TRT may be reconsidered under medical guidance.

🩺 Safety Monitoring: Why Follow-Up Matters

If you start TRT, ongoing follow-up is essential.

Your provider should check:

Testosterone levels
PSA
Hematocrit
Lipid and metabolic markers

These are usually monitored every 3 to 6 months to ensure your therapy stays safe and effective.

🧬 Alternatives to TRT

Not ready for direct testosterone therapy? Some men explore non-TRT options like:

Clomiphene citrate
hCG (human chorionic gonadotropin)

These medications can help your body increase natural testosterone production—especially useful if preserving fertility is a priority.

💬 Final Thoughts

Feeling “off” isn’t something to ignore. Whether it’s low-T or something else, getting answers matters.

Work with a provider who listens, investigates the root causes, and creates a personalized plan. Testosterone therapy may be one piece of your health puzzle, but it works best when paired with intentional lifestyle shifts.

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