Low Testosterone Level

Low Testosterone Level


Low Testosterone level (commonly known as ANDROPAUSE or MALE MENOPAUSE) is a condition where there is a relative deficiency in the circulating testosterone hormone.


Testosterone is a hormone produced in the testes and is responsible for the development of male sexual characteristics. As we age, the circulating testosterone level gradually decreases either from decrease in production, increase in binding to carrier protein (rendering it inactive) or both. The decrease in the circulating free testosterone is responsible for the symptoms associated with low testosterone level.


Effects of low testosterone on the body can be summarized by the picture below:


Low Testosterone


In general, the 4 aspects of life affected by low testosterone level will be:

1)      Sexual (the most important symptom men seek help for)

2)      Psychological (characterized by frequent mood swings not unlike menopause in women)

3)      Physical (reduction in muscle mass and bulging abdomen)

4)      Physiological

In addition, the following group of people are more at risk of having low testosterone level:

1)      Diabetes Mellitus

2)      High Cholesterol

3)      High Blood Pressure

4)      Obesity


How do we diagnose low testosterone level?


Listed below is a screening questionnaire (ADAM questionnaire) for low testosterone level:


1. Do you have a decrease in libido (sex drive)?

2. Do you have a lack of energy?

3. Do you have a decrease in strength and/or endurance?

4. Have you lost height?

5. Have you noticed a decreased “enjoyment of life?”

6. Are you sad and/or grumpy?

7. Are your erections less strong?

8. Have you noticed a recent deterioration in your ability to play sports?

9. Are you falling asleep after dinner?

10. Has there been a recent deterioration in your work performance?


If you answer YES in 3/10 of the questions OR YES on question 1 or 7, you may be having low testosterone level.

To confirm, a blood test will need to be done to check on the total testosterone level.

A total testosterone level of < 10 nmol/L confirms the diagnosis of low testosterone level. Levels between 10 – 14 nmol/L falls into the grey zone (if one is symptomatic, he may benefit from trial of testosterone replacement).


Testosterone replacement comes in various modalities including:

1)      Skin gel / patch

2)      Oral tablets

3)      Short acting injection

4)      Long acting injection

The objective of testosterone replacement is to boost the testosterone level circulating in the body (and hence to improve symptoms). Testosterone is generally safe (if use for the correct indication) and being an anabolic steroid, it increases the bone mass, muscle bulk, red blood cells and prostate volume. Hence those on testosterone replacement need to have their bloods tested regularly for blood count, testosterone level and prostate cancer marker.


The biggest question everyone will ask is that: “WILL TESTOSTERONE REPLACEMENT CAUSES PROSTATE CANCER?”


Various studies have shown that testosterone replacement does not increase the risk of prostate cancer. However, men with prostate nodule or with an elevated Prostate Cancer Marker (done as a screening prior to starting testosterone replacement) are not suitable candidates for replacement until prostate cancer has been excluded by urologists.


If you have symptoms suggestive of low testosterone, do make an appointment with Phoenix Medical Group to see if you are indeed suffering from it and if you are a suitable candidate for testosterone replacement. Testosterone replacement is not meant to boost your virility, but it serves to restore a general well-being that comes with a normal testosterone level.

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