Understanding Low Testosterone (Male Hypogonadism)
Low testosterone, also known as male hypogonadism, occurs when the body produces insufficient levels of the hormone testosterone. This condition can affect energy levels, mood, muscle mass, sexual function, and overall quality of life in men. While testosterone levels naturally decline with age, some men experience a more significant drop that requires medical evaluation and management.
Medically reviewed by Dr Ho Siew Hong
Senior Consultant Urologist
MBBS (NUS), FRCS (Edinburgh, Glasgow), FAMS (Urology), Singapore Board Certified Urologist
What Is Low Testosterone?
Testosterone is a key male hormone produced mainly by the testes under regulation of the pituitary gland and hypothalamus.
Low testosterone (hypogonadism) can result from:
Dr Ho Siew Hong was involved in Singapore’s national study showing that up to one in five men may have low testosterone levels contributing to metabolic and sexual health issues.
Symptoms of Low Testosterone
Men with low testosterone may notice one or more of the following:
Low testosterone is treatable — find out the cause and explore safe, effective options.
How Low Testosterone Is Diagnosed
Accurate diagnosis is essential to determine the cause and guide appropriate treatment. Evaluation typically includes:
Treatment Options & Related Procedures
For men with confirmed low testosterone who are not seeking fertility.
Methods:
Topical gels or creams applied daily to the skin
Injectable testosterone given every 8–12 weeks
Oral preparations (less commonly used)
Benefits: Improved energy, libido, mood, and muscle strength.
Monitoring: Regular testing for testosterone levels, PSA, red blood cell count, and liver function.
For men who wish to preserve fertility, medications such as clomiphene citrate, letrozole, or hCG (human chorionic gonadotropin) can stimulate the body’s own testosterone production while maintaining sperm production.
Lifestyle changes can help optimise testosterone levels and improve the effect of treatment:
Maintain a healthy weight and exercise regularly
Get sufficient sleep and manage stress
Reduce alcohol intake
Control chronic conditions such as diabetes or sleep apnoea
If low testosterone is associated with impaired sperm production or infertility, selected procedures may help restore fertility potential:
Microsurgical varicocele repair – improves sperm production when varicoceles are present
Microsurgical vasectomy reversal – reconnects the vas deferens to restore natural fertility
Microsurgical TESE (testicular sperm extraction) – retrieves sperm directly from the testes for IVF or ICSI
Fresh surgical sperm injection in IVF/ICSI – allows immediate use of retrieved sperm during assisted reproduction, enhancing fertilisation potential in suitable cases
Cryopreservation (sperm freezing) – preserves sperm for future fertility treatments or IVF cycles
Post-Treatment Care
Potential Risks
Regain Vitality and Confidence
If you experience low energy or reduced performance, schedule a men’s hormonal assessment. Personalised treatment can help you feel your best again.
Frequently Asked Questions
Normal total testosterone levels in men range from about 300–1000 ng/dL (8.3-30.2 nmol/L}, depending on the lab and age.
When prescribed and monitored by an experienced urologist, TRT is generally safe. Regular blood tests ensure hormone levels, PSA and blood concentration remain within safety levels.
Yes, TRT can suppress sperm production. Men wishing to have children should discuss alternative treatments like clomiphene or hCG therapy.
Most men notice improvements in energy and libido within a week, though muscle and mood changes may take several months.
In mild cases, weight loss, exercise, stress management, and better sleep can help improve hormone balance naturally.
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