Testosterone deficiency
Fatigue, low libido: could it be hormonal?
Fatigue, decreased libido, erectile dysfunction? Everything you need to know about testosterone deficiency – By Dr. Davy Benarroche
Why consult a urologist/andrologist?
3. Diagnosis in the office
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:
- The existence of clinical symptoms (assessed during the interview).
- Biological confirmation (blood test).
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.
Expertise
Testosterone Deficiency (Hypogonadism)
Introduction: Much more than a question of virility
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.
1. Symptoms: When should you consult a doctor?
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.
The sexual sphere (the most frequent signs)
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Decreased desire (libido): Less desire, fewer sexual thoughts.
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Erectile dysfunction: Erections that are less rigid or difficult to maintain.
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Disappearance of morning erections.
The physical and metabolic sphere
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Chronic fatigue: A weariness that does not go away with sleep.
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Weight gain: Accumulation of fat, particularly in the abdominal area.
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Loss of muscle mass: Feeling of physical weakness.
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Hot flashes or profuse sweating (less common).
The psychological sphere
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Mood disorders: Irritability, “feeling blue”, lack of motivation.
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Sleep disorders.
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Decline in intellectual abilities: Difficulty concentrating or remembering.
2. The Causes: Why is my rate dropping?
There are two main mechanisms:
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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.
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Risk factors (Lifestyle): This is the most frequent cause of severe deficiency today.
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Obesity and being overweight.
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Type 2 diabetes.
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A sedentary lifestyle.
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Chronic stress and lack of sleep.
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Did you know? Abdominal fat converts testosterone into estrogen (female hormones), which worsens the deficiency. It’s a vicious cycle we can break.
Treatments: Regaining your vitality
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.
The global approach
Before any medication, we address lifestyle. Weight loss and resuming physical activity can, in some cases, be enough to restart natural production.
Substitute Therapy
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.
Do you suspect a testosterone deficiency?
Needs
Expertise
Experience
Academic background
Dr. Benarroche offers care focused on men’s health , combining a medical and surgical approach, tailored to the needs of each patient.
Dr. Davy Benarroche's expertise
Urologist and andrologist surgeon specializing in male sexual health , Dr. Davy Benarroche is an expert in the diagnosis and management of testosterone deficiency (hypogonadism).
FAQ – Frequently Asked Questions
What are the signs of a lack of testosterone?
Persistent fatigue, decreased libido, erectile dysfunction, muscle loss, abdominal weight gain, sleep and mood disturbances, and difficulty concentrating. These signs, often progressive, are frequently and mistakenly attributed to simple aging.
How is the diagnosis confirmed?
A blood test measuring total (and bioavailable) testosterone, performed in the morning on an empty stomach, is confirmed by a second blood sample. The assessment is completed with other hormone tests (LH, prolactin) to identify the cause of the deficiency.
What are the possible treatments?
Depending on your situation: correction of contributing factors (overweight, sleep apnea), testosterone supplementation (gel or injections), or testicular stimulation if a paternity project exists — exogenous testosterone inhibits fertility.
Is testosterone supplementation risky for the prostate?
Current studies are reassuring: the treatment does not increase the risk of prostate cancer. However, it requires a prior prostate assessment (PSA, digital rectal exam) and regular monitoring, as well as blood counts.
When to consult a doctor?
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.
Does testosterone cause prostate cancer?
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.
Is the treatment lifelong? Will I become "dependent"?
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.
Will this cure my erectile dysfunction?
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.
Are there any cardiovascular risks?
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.
Testosterone deficiency: there are solutions.