Testosterone is often mistakenly reduced to its role in sexual function alone. In reality, this hormone is the cornerstone of overall male health . It acts as a true “fuel” for the body, influencing not only libido, but also muscle mass, bone density, mood, cognitive abilities, and fat metabolism.
We often hear about “andropause”. Although this term is inaccurate (because the hormonal decline is not abrupt like menopause), it describes a medical reality: Age-Related Androgen Deficiency (ARAD) or hypogonadism.
This is not inevitable. When this deficiency affects your quality of life, specialized medical care can help you regain energy and balance.
Testosterone deficiency often develops insidiously. These signs should not be attributed to “normal aging.” If you experience several of these symptoms, an evaluation is recommended.
Decreased desire (libido): Less desire, fewer sexual thoughts.
Erectile dysfunction: Erections that are less rigid or difficult to maintain.
Disappearance of morning erections.
Chronic fatigue: A weariness that does not go away with sleep.
Weight gain: Accumulation of fat, particularly in the abdominal area.
Loss of muscle mass: Feeling of physical weakness.
Hot flashes or profuse sweating (less common).
Mood disorders: Irritability, “feeling blue”, lack of motivation.
Sleep disorders.
Decline in intellectual abilities: Difficulty concentrating or remembering.
There are two main mechanisms:
Physiological aging: From the age of 30-40, testosterone levels naturally decline by about 1 to 2% per year. However, in some men, this decline is more abrupt and becomes symptomatic.
Risk factors (Lifestyle): This is the most frequent cause of severe deficiency today.
Obesity and being overweight.
Type 2 diabetes.
A sedentary lifestyle.
Chronic stress and lack of sleep.
Did you know that? Abdominal fat converts testosterone into estrogen (female hormones), which worsens the deficiency. It’s a vicious cycle that we can break.
As a urological and andrological surgeon, my role is to confirm that your symptoms are indeed related to a hormonal problem and not to another pathology.
The diagnosis rests on two inseparable pillars:
Important: The measurement of Total and Bioavailable Testosterone must be carried out in the morning (before 10:00 am) and on an empty stomach , as the level naturally fluctuates during the day.
Treatment is never automatic: it is only offered if the deficiency is confirmed and bothersome. The goal is to bring testosterone levels back to the physiological average to eliminate symptoms.
Before any medication, we address lifestyle. Weight loss and resuming physical activity can, in some cases, be enough to restart natural production.
If necessary, we will prescribe testosterone supplementation. Several dosage forms are available to suit your lifestyle:
Transdermal gel: Daily application to the skin (shoulders or arms). It allows for a stable level, without injection.
Intramuscular injections: Performed on average every month or every 10 to 12 weeks for the delayed form, they offer ease of compliance.
It is advisable to make an appointment if your symptoms (decreased libido, fatigue, erectile dysfunction) have persisted for more than 3 months and are affecting your quality of life. A specific warning sign not to be ignored is the disappearance of morning erections . Don’t wait for these problems to become chronic before seeking medical attention.
This is the most common fear, but current scientific studies are reassuring: testosterone treatment does not cause prostate cancer. However, testosterone can stimulate the growth of an existing cancer. As a urologist, I routinely perform screening before starting treatment, followed by regular monitoring to ensure your safety.
This is not an addiction, but a replacement therapy. If your body can no longer produce enough testosterone due to testicular damage, treatment will likely be long-term. However, if the deficiency is related to obesity or lifestyle, significant weight loss and a return to exercise can sometimes restart the process and allow you to stop treatment. We regularly reassess the appropriateness of continuing therapy.
Testosterone is the hormone of desire , not mechanics . Treatment restores libido, which is the basis of an erection. However, if the blood vessels in the penis are damaged (diabetes, hypertension, smoking), testosterone alone may not be enough. It is often combined with erectile dysfunction medications (like Viagra/Cialis), which it actually makes more effective.
Contrary to popular belief, it’s a lack of testosterone that’s associated with an increased risk of cardiovascular disease (metabolic syndrome). Bringing testosterone levels back to normal is generally beneficial for the heart. The only common side effect to monitor is an increase in hematocrit (the blood becomes slightly thicker). That’s why I prescribe regular blood tests.
Urologist and andrologist surgeon
Specializing in male sexual health, Dr. Davy Benarroche is an expert in the diagnosis and management of testosterone deficiency (hypogonadism).
Dr. Benarroche offers a male-focused approach to care, combining medical and surgical approaches, adapted to the needs of each patient.
