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⚡ Men's Health

Low Testosterone (Male Hypogonadism)

The most underdiagnosed hormonal condition in Nigerian men — and one of the most treatable.

Low testosterone (hypogonadism) affects up to 40% of men over 45, but is frequently attributed to "normal ageing" or "stress" and never tested. Identifying it matters because it is associated with metabolic syndrome, cardiovascular risk, depression, osteoporosis, and infertility — all of which improve with appropriate treatment.

Signs and Symptoms

✓ Low libido — reduced interest in sex, often gradual
✓ Erectile dysfunction — difficulty achieving or maintaining erection
✓ Persistent fatigue and low energy not explained by sleep
✓ Loss of muscle mass and strength despite exercise
✓ Increased body fat — especially central/abdominal
✓ Low mood, depression, irritability, and reduced motivation
✓ Poor concentration and memory ("brain fog")
✓ Reduced morning or spontaneous erections
✓ Sparse body and facial hair
✓ Hot flushes in severe cases (male menopause equivalent)

Risk Factors

When to Seek Help

SoonThree or more of the listed symptoms, especially fatigue + low libido + reduced morning erections in a man over 35 — book a morning testosterone blood test
SoonInfertility with low sperm count on semen analysis — testosterone panel to distinguish testicular failure from pituitary problem
RoutineAnnual testosterone check for men over 50 with diabetes, obesity, or metabolic syndrome — these groups have high rates of undiagnosed hypogonadism

Tests & Diagnosis

🧪 Morning Total Testosterone (7–10 am)
The essential first test. Testosterone peaks between 6–10 am and can be 20–30% lower in the afternoon — always test in the morning for an accurate reading. Collect on two separate mornings before accepting a low result as definitive. Normal in adult men: above 10–12 nmol/L (300 ng/dL). Symptomatic hypogonadism: below 8 nmol/L (230 ng/dL) on two occasions.
🧪 LH and FSH (Pituitary Hormones)
Essential for distinguishing causes: High LH/FSH + low testosterone = primary hypogonadism (testicular failure — e.g., Klinefelter, orchitis, chemotherapy). Low or normal LH/FSH + low testosterone = secondary/hypogonadotrophic hypogonadism (pituitary or hypothalamic problem — e.g., prolactinoma, haemochromatosis, obesity). These two categories have different treatments.
🧪 Prolactin
A pituitary hormone that, when elevated, suppresses LH/FSH and testosterone. Elevated prolactin (hyperprolactinaemia) is caused by prolactinomas (benign pituitary tumours), stress, antipsychotic medications, or chronic kidney disease. Treat the prolactin problem, and testosterone often normalises.
🧪 SHBG (Sex Hormone Binding Globulin)
Testosterone circulates bound to SHBG — only "free" testosterone is biologically active. Men with high SHBG (elderly, thin men, liver disease) may have normal total testosterone but low free testosterone, explaining symptoms. Obese men have low SHBG and may have normal free testosterone despite low total testosterone.

Treatment Options

1
Lifestyle first — especially for obese or inactive men
Weight loss of 10–15% of body weight significantly raises testosterone — in some obese men it normalises levels without medication. Regular resistance training (weights, bodyweight exercise) raises testosterone acutely and chronically. Adequate sleep (7–9 hours) is essential — growth hormone and testosterone are predominantly secreted during deep sleep. Reduce alcohol and chronic stress.
2
Testosterone Replacement Therapy (TRT)
For confirmed hypogonadism with two low morning testosterones and appropriate symptoms. Options: injectable testosterone (testosterone undecanoate every 12 weeks, or testosterone enanthate every 2–4 weeks) — most reliable; testosterone gel (applied daily to shoulders or abdomen) — mimics natural daily rhythm; testosterone implants (pellets under the skin every 3–6 months). TRT improves energy, libido, muscle mass, mood, and metabolic profile within 3–6 months.
3
Gonadotrophin therapy (if fertility is desired)
TRT suppresses sperm production. Men with hypogonadism who want to father children should use hCG injections (which mimic LH) instead — they stimulate testicular testosterone and sperm production simultaneously. Discuss with a fertility or endocrinology specialist.
4
Treat the underlying cause if identified
Prolactinoma → cabergoline (medication) reduces prolactin and often restores testosterone without direct testosterone replacement. Haemochromatosis → phlebotomy (blood removal) and iron chelation. Obesity → weight loss programme as primary treatment.

Frequently Asked Questions

Will testosterone replacement make me infertile?
Yes — exogenous testosterone suppresses FSH and LH, which shuts down sperm production. Men on TRT typically have zero or near-zero sperm counts. This is reversible on stopping TRT, but recovery takes 6–18 months and is not guaranteed after long-term use. If you want children now or in the future, discuss alternatives (hCG, clomiphene) with your doctor before starting TRT.
Is low testosterone the same as "male menopause"?
Partly. "Andropause" or "male menopause" is a colloquial term for the gradual age-related testosterone decline in men — distinct from the abrupt oestrogen drop of female menopause. Not all men experience significant symptoms; those who do have a real, measurable condition (late-onset hypogonadism) that responds to treatment. The term "menopause" is imprecise — male testosterone decline is gradual and partial, not complete and sudden.
Can herbal supplements boost testosterone?
Some herbal supplements (ashwagandha, fenugreek, tongkat ali, zinc, vitamin D) have modest evidence for small improvements in testosterone in mildly deficient men. None have been shown to restore testosterone to normal in clinical hypogonadism, and none are regulated as medicines. For mildly low testosterone with borderline symptoms, trying a reputable supplement alongside lifestyle change for 3 months is reasonable — but should not replace medical investigation or proven treatment in confirmed hypogonadism.
Does high testosterone cause aggression?
The relationship between testosterone and aggression is far more nuanced than popular belief. Normal physiological testosterone levels are not associated with pathological aggression. Supraphysiological testosterone (from anabolic steroid abuse — levels 5–10× normal) does cause mood instability in susceptible individuals. Restoring clinically low testosterone to the normal physiological range typically improves mood, reduces irritability, and has a calming rather than aggression-promoting effect.

Related Pages

Erectile DysfunctionMale Fertility and Semen AnalysisType 1 vs Type 2 Diabetes

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