Low testosterone
Low testosterone needs symptoms and confirmed labs rather than one number, and many cases turn out to be reversible rather than needing lifelong therapy.
Testosterone therapy is effective and appropriate for genuine hypogonadism. But a meaningful proportion of low readings are secondary and reversible: visceral adiposity, untreated sleep apnea, opioids, chronic underfueling, overtraining, or a pituitary problem that needs identifying. Prescribing before establishing which is a shortcut with consequences, including suppression of your own production.
Visceral adiposity, which increases aromatization of testosterone to estradiol. Untreated sleep apnea and chronic sleep restriction. Opioids, glucocorticoids and other medications. Insulin resistance. Excessive training volume with inadequate fueling. Primary testicular failure. And pituitary causes including hyperprolactinemia, which must be excluded before therapy.
Reversible causes first: sleep apnea treatment, visceral fat reduction, medication review, training and nutrition correction. These alone restore adequate levels in a meaningful share of men. Where therapy is genuinely indicated, Brianna Cole, DNP, APRN prescribes and monitors it — with hematocrit, PSA, estradiol and symptom review, and a fertility conversation before starting.
Total testosterone on two separate early-morning fasting samples, since a single reading is not diagnostic. Free testosterone and SHBG. LH and FSH, which distinguish primary from secondary. Prolactin. Estradiol. Complete thyroid function. Hematocrit, PSA and lipids as baselines. Fasting insulin. And sleep apnea screening, the most commonly missed cause.
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