Why Testosterone Testing Is Important for Men
Updated: 5 days ago
Many men assume that low energy, reduced motivation, poor gym performance, weight gain, or a lower sex drive are simply normal parts of ageing.
However, these changes are not always caused by age alone. Poor sleep, chronic stress, nutritional deficiencies, thyroid disorders, metabolic problems, medication use, and low testosterone can produce similar symptoms.
Testosterone levels may decline with age and can also be affected by medical conditions, medications, sleep, body weight, and other factors. Some men only become concerned after their energy, mood, muscle mass, sexual health, fertility, or quality of life has already been affected.
A testosterone blood test can help assess whether symptoms may be associated with testosterone deficiency, but the result must be interpreted alongside symptoms, medical history, and other clinical findings. However, total testosterone should not always be assessed alone. Additional tests may be appropriate when clinically indicated to assess testosterone availability, the hypothalamic-pituitary-gonadal axis, or possible underlying causes.
What Is Testosterone?
Testosterone is the main androgen hormone in men. It is produced primarily by the testicles following hormonal signals from the brain.
This process is controlled by the hypothalamic-pituitary-gonadal axis:
The hypothalamus sends a signal to the pituitary gland.
The pituitary gland releases luteinising hormone and follicle-stimulating hormone.
LH stimulates the testicles to produce testosterone.
FSH plays an important role in supporting sperm production, while LH stimulates testosterone production by the Leydig cells in the testes.
Testosterone circulates in the blood in several forms:
Testosterone bound to SHBG: strongly attached to sex hormone-binding globulin
Testosterone bound to albumin: more loosely attached to albumin
Free testosterone: the unbound fraction of testosterone in the circulation. It may be clinically useful to assess when total testosterone is borderline or when SHBG abnormalities are suspected.
A normal total testosterone result may require further interpretation when SHBG is abnormal or when clinical findings and total testosterone do not agree.
What Does Testosterone Do in Men?
Testosterone affects much more than sexual function. It plays an important role in several areas of male health.
1. Libido and Sexual Function
Testosterone helps maintain sexual desire and spontaneous erections. Testosterone deficiency may be associated with reduced libido and fewer spontaneous erections; erectile dysfunction can have many other causes and should be evaluated separately when appropriate.
However, erectile dysfunction can also be caused by vascular disease, diabetes, neurological conditions, medication, psychological stress, and relationship factors.
2. Sperm Production and Fertility
LH and FSH regulate testicular function and sperm production, while intratesticular testosterone is essential for normal spermatogenesis.
Men who plan to have children should inform their doctor before starting testosterone therapy. External testosterone can suppress the body's natural production of testosterone and sperm, potentially reducing fertility.
3. Muscle Mass and Strength
Testosterone contributes to the maintenance of muscle mass and strength. When testosterone is low, some men may find it more difficult to gain or maintain muscle despite following a consistent exercise program.
4. Bone Health
Testosterone contributes to bone formation and bone mineral density. Significantly low testosterone over a long period may increase the risk of bone loss and osteoporosis.
5. Body Composition
Testosterone is involved in maintaining muscle mass and regulating fat distribution. Low levels may be associated with increased body fat, particularly around the abdomen.
6. Energy, Motivation, and Mood
Low testosterone may be associated with changes in energy, mood, concentration, and well-being, although these symptoms are nonspecific.
Because these symptoms are not specific to testosterone deficiency, other possible causes such as anaemia, thyroid dysfunction, sleep deprivation, depression, chronic inflammation, or nutritional deficiency should also be considered.
Common Symptoms of Low Testosterone
The symptoms of low testosterone can develop gradually and vary significantly between individuals. Possible signs include:
Reduced sex drive.
Fewer morning or spontaneous erections.
Erectile difficulties.
Persistent fatigue.
Reduced physical stamina.
Decreased strength or gym performance.
Difficulty building or maintaining muscle.
Increased abdominal or total body fat.
Reduced motivation.
Changes in mood or increased irritability.
Difficulty concentrating or changes in cognitive function.
Sleep problems may coexist with testosterone deficiency, but sleep disorders can also affect testosterone levels.
Reduced body or facial hair.
Reduced sperm production or fertility problems.
Breast tissue enlargement in some men.
Reduced bone density or unexplained fractures.
Having one or more of these symptoms does not automatically mean that testosterone is low. A diagnosis requires an assessment of symptoms, medical history, physical findings, medication use, and properly timed blood test results.
What Can Happen If Testosterone Continues to Decline?
Confirmed testosterone deficiency may be associated with effects on sexual function, body composition, bone health, fertility, and quality of life.
Reduced Sexual Function
Sexual desire may continue to decline, and spontaneous erections may become less frequent. A complete evaluation may still be needed to identify vascular, neurological, metabolic, or psychological causes.
Loss of Muscle Mass and Strength
Low testosterone may make it harder to maintain lean muscle, strength, exercise performance, and physical recovery.
Increased Body Fat
Low testosterone is associated with higher adiposity in some men, while obesity and metabolic disease can also contribute to lower testosterone levels. Obesity can also reduce testosterone further, creating a cycle in which hormonal and metabolic problems reinforce each other.
Fertility Problems
Disruption of the hormones that control testosterone production may also affect sperm production. LH, FSH, prolactin, and semen analysis may be needed when fertility is a concern.
Reduced Bone Density
Long-term testosterone deficiency may contribute to osteopenia or osteoporosis, particularly when levels are significantly reduced.
Changes in Mood and Quality of Life
Some men may experience reduced motivation, lower mood, poor concentration, irritability, and a decline in their general quality of life.
Who Should Consider a Testosterone Test?
Testing may be appropriate for men experiencing:
Reduced libido or sexual performance.
Persistent fatigue.
Loss of muscle or strength.
Increased body fat without a clear explanation.
Fertility difficulties.
Reduced exercise capacity or physical performance.
Fewer morning erections.
Mood or concentration changes.
Osteoporosis or low bone density.
Previous testicular injury, infection, or surgery.
Pituitary gland disorders.
Obesity, type 2 diabetes, or other conditions associated with an increased likelihood of testosterone deficiency may support clinical evaluation, particularly when symptoms are present.
Long-term opioid or corticosteroid use.
Previous anabolic steroid use.
Testing may be considered when symptoms or clinical risk factors raise a specific concern about testosterone deficiency.
Routine testosterone screening is not necessarily required for every man without symptoms. Testing should be based on symptoms, risk factors, health goals, and medical evaluation.
Is Total Testosterone Testing Alone Enough?
Not always.
Total testosterone measures the overall amount of testosterone circulating in the blood. It does not necessarily show how much testosterone is available for use by the body.
For example, high SHBG can reduce free testosterone even when total testosterone appears normal. Low SHBG can also make total testosterone more difficult to interpret.
LH and FSH help determine whether low testosterone may be related to reduced testicular function or insufficient hormonal signaling from the pituitary gland.
Prolactin, thyroid tests, metabolic markers, and other blood tests may help identify additional factors contributing to low energy, sexual symptoms, weight changes, or hormonal imbalance.
Blood Tests for a Comprehensive Testosterone Assessment
BLOOD TEST | WHAT IT MEASURES | WHY IT IS IMPORTANT |
Total Testosterone | The total amount of testosterone in the blood | Total testosterone is generally the initial laboratory test used when testosterone deficiency is suspected. |
Free Testosterone | The unbound fraction of circulating testosterone, which may provide additional information when total testosterone is borderline or SHBG is altered. | Useful when total testosterone is borderline or SHBG may be abnormal |
SHBG | The protein that strongly binds testosterone | Helps interpret testosterone availability and may be used when free testosterone needs to be assessed. |
Albumin | A protein that loosely binds testosterone | Can be used with total testosterone and SHBG to calculate free testosterone |
LH | Pituitary signal that stimulates testosterone production | Helps distinguish a testicular problem from a pituitary or hypothalamic problem |
FSH | A hormone involved in testicular function and sperm production | Particularly relevant when fertility is a concern |
Prolactin | A hormone produced by the pituitary gland | High prolactin may suppress reproductive hormones and reduce libido |
Estradiol or Sensitive E2 | Oestrogen formed partly through testosterone conversion | May be considered in selected men, particularly when gynecomastia or other clinical findings suggest altered estrogen metabolism. |
TSH and Free T4 | Thyroid gland function | Thyroid disorders can cause symptoms that overlap with testosterone deficiency and can also affect SHBG and testosterone interpretation. |
Complete Blood Count | Haemoglobin, haematocrit, and blood cell levels | Haematocrit and haemoglobin provide important baseline information before and during testosterone therapy. |
Fasting Glucose and HbA1c | Current and longer-term blood sugar control | Diabetes and insulin resistance are commonly associated with hormonal and sexual health problems |
Lipid Profile | Cholesterol, LDL, HDL, and triglycerides | Assesses metabolic and cardiovascular risk |
AST and ALT | Liver health | Liver disease can affect hormone metabolism and SHBG levels; liver tests may therefore be relevant when clinically indicated. |
Urea and Creatinine | Kidney function | Provides a broader assessment of general health |
PSA | A marker related to prostate health | May be considered before testosterone therapy according to age, symptoms, and individual risk |
Ferritin and Iron Profile | Iron storage and availability | Iron studies may be considered when iron deficiency or iron overload is suspected based on symptoms or other clinical findings. |
DHEA-S or Morning Cortisol | Adrenal-related hormone testing may be considered when symptoms or clinical findings suggest an adrenal disorder. | Considered when symptoms suggest an adrenal or broader hormonal disorder |
When Is the Best Time to Test Testosterone?
Testosterone levels naturally change throughout the day and are usually highest in the morning.
Testing conditions
For the most reliable result, the test should generally be performed:
Between approximately 7:00 and 10:00 AM.
Morning testing is important for diagnostic assessment; fasting is commonly recommended in current Endocrine Society guidance, particularly for confirmatory testing.
Ideally when the patient has had their usual sleep and is not acutely ill.
When not acutely unwell.
Avoid testing during acute illness or other temporary conditions that may substantially affect testosterone levels; recent strenuous exercise should also be reported to the clinician.
Before taking morning hormonal medication or supplements, when instructed by a doctor
Shift workers or men with irregular sleeping schedules may require individual timing based on their main sleep period.
A single low result is not normally enough to confirm testosterone deficiency.
When Should Testosterone Testing Be Repeated?
The correct timing depends on the reason for testing and whether the patient is receiving treatment.
1. When the First Testosterone Result Is Low
Repeat the total testosterone test on a different morning to confirm the result. Both tests should ideally be performed:
Early in the morning
Under similar conditions
Preferably while fasting
When the patient is not acutely ill
After adequate sleep
There is no mandatory number of days between the two diagnostic tests. In clinical practice, a second early-morning measurement should be obtained on a separate day to confirm a consistently low result. Once temporary factors such as illness, sleep deprivation, heavy training, or acute stress have resolved.
A diagnosis should not normally be based on only one low result.
2. When the Result Is Borderline
If total testosterone is close to the lower limit of the laboratory range, repeat testing should include:
Total testosterone
SHBG
Albumin
Calculated or accurately measured free testosterone
Repeat testing and assessment of free testosterone should be individualized based on the initial result, SHBG, symptoms, and clinical context, under standardised morning conditions.
LH, FSH, and prolactin may also be added to investigate the cause.
3. When the First Result Is Normal but Symptoms Continue
A normal testosterone result means that other causes of the symptoms should also be investigated.
Depending on the clinical situation, if symptoms persist despite an initially normal result, the clinician should consider other causes first; repeat testosterone testing may be considered if clinical suspicion remains. Particularly when:
Symptoms continue or worsen
The first result was near the lower limit
Sleep, weight, stress, or acute illness may have affected the original result
New medications or medical conditions develop
There is no need to repeat testosterone frequently when levels are clearly normal and there are no significant symptoms or new risk factors.
4. After Lifestyle or Weight-Management Changes
When low or borderline testosterone may be related to obesity, poor sleep, excessive training, nutritional problems, or metabolic dysfunction, Repeat testing may be considered after an appropriate period of sustained lifestyle or medical intervention, depending on the clinical situation.
This allows enough time to evaluate whether changes in sleep, body composition, exercise recovery, nutrition, or metabolic health have affected hormone levels.
5. Before Starting Testosterone Therapy
Before treatment is considered, testosterone deficiency should generally be confirmed with two separate early-morning testosterone measurements in a man with compatible symptoms and/or signs. Baseline assessment may also include:
Complete blood count and haematocrit
LH and FSH
Prolactin
SHBG and free testosterone when indicated
Prostate cancer risk assessment, including PSA when appropriate, should be based on age, risk factors, shared decision-making, and relevant clinical guidance.
Additional tests such as liver or kidney function may be considered according to the patient's medical history, medications, and treatment plan.
Blood glucose or HbA1c
Lipid profile
Fertility assessment when relevant
Men planning to have children should discuss fertility-preserving options before using testosterone.
6. After Starting Testosterone Therapy
Follow-up should occur after treatment initiation to assess symptoms, adverse effects, testosterone levels, haematocrit, and other monitoring needs according to the formulation and individual risk.
Once treatment is stable, ongoing monitoring should continue at intervals appropriate to the formulation, response, adverse effects, and individual risk.
The exact time of blood collection depends on the type of testosterone being used.
For example, testosterone injections must be tested at a specific point in the injection cycle, while gels are assessed according to the time since the product was applied. Patients should follow the clinic's instructions carefully before having blood taken.
7. After a Testosterone Dose or Formulation Change
Testing should be repeated after the new dose or formulation has had enough time to reach a stable level.
Repeat testing is generally performed after sufficient time for the new formulation or dose to reach a stable level, with timing depending on the specific testosterone preparation. Although the correct timing depends on whether the patient is using:
Short-acting injections
Long-acting injections
Testosterone gel
Transdermal preparations
Other prescribed formulations
The blood sample must also be timed correctly in relation to the most recent injection or application.
8. When Haematocrit Is High or the Patient Has a Higher Risk
Testosterone can increase red blood cell production. Patients with sleep apnoea, significant obesity, chronic lung disease, smoking history, or previously elevated haematocrit may require closer monitoring.
Higher-risk patients may need:
Patients with elevated haematocrit or other risk factors may require closer monitoring, with management guided by the degree of elevation and the treating clinician.
Monitoring at least every six months after the first year
A significant rise in haematocrit requires prompt medical review and possible adjustment or interruption of treatment.
9. When Symptoms Suddenly Change
Testing may need to be performed earlier when a patient develops:
A sudden reduction in libido
New erectile problems
Severe fatigue
Breast tenderness or enlargement
Significant mood changes
Testicular pain or shrinkage
Headaches or visual changes
New fertility concerns
Symptoms or findings that may indicate adverse effects of treatment, including symptoms associated with erythrocytosis or other clinically significant complications.
The timing should be determined by the treating doctor rather than waiting for the next routine follow-up.
Does a Low Testosterone Result Always Require Testosterone Therapy?
No. A single low testosterone result does not by itself establish hypogonadism.
The first step is to identify why testosterone is low. Potentially reversible causes may include:
Obesity
Poor sleep
Obstructive sleep apnoea
Excessive alcohol intake
Severe calorie restriction
Overtraining
Acute illness
Uncontrolled diabetes
Thyroid dysfunction
Certain medications
Previous anabolic steroid use
Severe nutritional deficiency or inadequate energy intake
Addressing obesity, sleep disorders, inadequate nutrition, excessive training, relevant medications, and other reversible contributors may improve testosterone levels in some men.
Testosterone therapy should be considered only after an appropriate diagnosis of hypogonadism and assessment of potential benefits, risks, contraindications, and fertility plans. It is not suitable for every patient and may suppress natural sperm production.
Comprehensive Male Hormone Testing at Reset Room Clinic Bali
Reset Room Clinic provides personalised blood testing for men who want to assess their hormonal, metabolic, sexual, and general health.
Testing can include:
Total testosterone
Free testosterone
SHBG and albumin
LH and FSH
Prolactin
Estradiol
Thyroid function
Complete blood count
Fasting glucose and HbA1c
Lipid profile
Liver and kidney function
PSA when appropriate
Iron, vitamin, inflammatory, and additional metabolic markers based on individual needs
Blood collection can be arranged at Reset Room Clinic Bali or through a convenient home service, depending on location and availability.
The results can then be reviewed together with your symptoms, sleep quality, exercise routine, medical history, fertility plans, medication use, and personal health goals.
The purpose of testing is not simply to identify a high or low number. It is to understand what may be affecting your hormone balance and determine the safest and most appropriate next step.
Take Control of Your Hormone Health
You do not need to wait until your energy, libido, physical performance, or quality of life has significantly declined before assessing your hormonal health.
An appropriately selected evaluation can help determine whether testosterone deficiency is present and whether other conditions may be contributing to the symptoms.
FAQ
Q: Can younger men have low testosterone?
A: Yes. Testosterone deficiency can affect younger men due to obesity, sleep disorders, pituitary or testicular conditions, medication use, previous anabolic steroid use, chronic illness, or other hormonal disorders.
Q: Is one low testosterone result enough for a diagnosis?
A: No. A low result should normally be confirmed with a second early-morning test on a separate day under similar conditions.
Q: How soon should I repeat a low testosterone result?
A: A low result should generally be repeated on a separate morning under appropriate testing conditions. The exact timing should be determined by the clinician.
Q: Should testosterone be checked every year?
A: Routine annual testosterone testing is not necessary for every healthy man without symptoms. Testing is appropriate when symptoms, risk factors, or treatment monitoring justify it.
Q: Is total testosterone enough?
A: Not always. Free testosterone, SHBG, albumin, LH, FSH, prolactin, and other health markers may be needed for a more complete assessment.
Q: Do I need to fast?
A; For diagnostic evaluation, testosterone should generally be measured in the early morning, and current Endocrine Society guidance recommends fasting for confirmatory testing.
Q: How often should testosterone be checked during treatment?
A: Monitoring should occur after treatment initiation and subsequently according to the testosterone formulation, clinical response, haematocrit, adverse effects, and individual risk.
Q: Can testosterone therapy improve fertility?
A: External testosterone does not usually improve fertility and may significantly suppress sperm production. Men who want to preserve fertility should discuss alternative management options with a doctor.
Q: Can the blood test be done at my hotel or villa?
A: Reset Room Clinic provides clinic-based testing and home blood collection services, depending on the patient's location and appointment availability. Medically reviewed by Dr. Suryantara on July 09, 2026.
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