Low Testosterone

Low testosterone, medically termed as hypogonadism, refers to a condition where the testes produce insufficient amounts of the hormone testosterone. This hormone plays a pivotal role in male growth, development, and overall health, influencing muscle mass, bone density, and mood.

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Causes of Low Testosterone

Natural ageing process: Testosterone levels naturally decline as men age, typically starting from the age of 30.
Medical conditions: Certain medical conditions, such as pituitary gland disorders, infections, or genetic disorders, can lead to reduced testosterone production.
Medications and treatments: Some medications, including opioids and steroids, can adversely affect testosterone levels.
Lifestyle factors: Obesity, excessive alcohol consumption, and chronic stress can contribute to decreased testosterone levels.

Symptoms and Diagnosis

Physical symptoms: These include fatigue, reduced muscle mass, increased body fat, and diminished bone density.
Psychological symptoms: Low testosterone can lead to mood disturbances, decreased motivation, and memory problems.
Diagnostic tests and procedures: Diagnosis involves blood tests to measure testosterone levels. Additional tests may be conducted to determine the underlying cause.

Treatment Options

Testosterone Replacement Therapy (TRT)

Testosterone Replacement Therapy (TRT) is the most common form of treatment for low testosterone. It involves supplementing the body with external testosterone to restore its levels.


  • Gel: Testosterone gels are applied directly to the skin, allowing the hormone to be absorbed into the bloodstream. Avoid skin-to-skin contact with others for a few hours after application to prevent transferring the medication.
  • Injection: Testosterone can be injected directly into the muscles or under the skin. The frequency of injections can vary, and the effects might fluctuate between doses.
  • Patch: Testosterone patches are applied to the skin, usually on the thighs or torso. They release testosterone gradually into the bloodstream.
  • Gum and Cheek (Buccal Cavity): This method involves placing a small putty-like substance in the buccal cavity, where it sticks to the gumline and allows testosterone to be absorbed.
  • Nasal: A testosterone gel can be pumped into the nostrils, reducing the risk of transferring the medication through skin contact.

Lifestyle Changes

Diet and Nutrition: Consuming a balanced diet rich in zinc, vitamin D, and omega-3 fatty acids can help boost testosterone levels.
Exercise: Regular physical activity, especially resistance training, can increase testosterone levels and improve symptoms.
Stress Management: Chronic stress can elevate cortisol levels, which can suppress testosterone production. Techniques like meditation, deep breathing exercises, and adequate sleep can help manage stress.

Alternative Treatments

Herbal Supplements: Some herbs, such as fenugreek, tongkat ali, and ashwagandha, are believed to boost testosterone levels. However, the efficacy of these herbs is still under research, and one should consult a urologist before using them.
Acupuncture: Some studies suggest that acupuncture can help improve testosterone levels and alleviate symptoms of low testosterone.
DHEA Supplements: Dehydroepiandrosterone (DHEA) is a hormone that can be converted into testosterone. Some men take DHEA supplements to boost their testosterone levels, but its effectiveness is still debated.

Risks and Side Effects of Treatment

Potential Side Effects of Testosterone Replacement Therapy (TRT)

Skin Reactions: Topical testosterone gels and patches can cause skin reactions, including itching, blistering, or redness at the application site.

Mood Fluctuations: Some men may experience mood swings, increased aggression, or even depression after starting TRT.

Sleep Apnea: TRT can exacerbate or cause sleep apnea, a condition where breathing stops and starts repeatedly during sleep.

Fluid Retention: Some men may experience swelling in the ankles or feet due to fluid retention.

Breast Enlargement: TRT can lead to gynecomastia, which is the enlargement of breast tissue in men.

Testicular Shrinkage: The testicles may become smaller and softer due to decreased natural testosterone production.

Increased Red Blood Cell Count: TRT can lead to an increase in the number of red blood cells, which can increase the risk of blood clots.

Risks Associated with Long-Term Use

Cardiovascular Risks: Some studies suggest that long-term use of TRT can increase the risk of heart attacks or strokes, especially in older men.

Prostate Health: TRT can lead to an increase in the size of the prostate gland. There’s also a concern about the potential risk of prostate cancer, although the evidence is inconclusive.

Infertility: Long-term use of TRT can reduce sperm production, leading to infertility. Men who wish to father children should discuss this risk with their urologist.

Liver Toxicity: Oral testosterone treatments (not commonly prescribed due to this risk) can have adverse effects on liver function.

Bone Density: While TRT can increase bone density initially, very high levels of testosterone can decrease bone density over time.


Low testosterone is a condition that can significantly impact an individual’s quality of life. While treatments are available, consult with a urologist to determine the most appropriate course of action and to be aware of potential risks.

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Dr Lee is a urologist and kidney transplant surgeon with a broad-based expertise of all urological disorders

He has subspecialty focus on men’s health and male infertility, and special interest in minimally invasive prostate enlargement therapy and kidney stone treatment. Dr Lee has received numerous awards for service excellence such as the Service With A Heart Award (2006-2008, 2011) and the Singapore Health Quality Service Award (2016).

  • Bachelor of Medicine and Bachelor of Surgery (Singapore)
  • Membership of The Royal College of Surgeons (Edin)
  • Master of Medicine (Surgery) (Singapore)
  • Fellowship of the Academy of Medicine (Urology)
  • Clinical fellowship at Oxford Transplant Centre in the UK

Prior to entering private practice, Dr Lee served in the public sector for 16 years at SGH, where he initiated dedicated clinics evaluating and treating patients with complex men’s health and fertility issues. He also led the Renal Transplant Program and laparoscopic donor nephrectomy service as Surgical Director.

Apart from clinical work, Dr Lee is active in academia and believes in the importance of grooming the next generation of doctor. He was Senior Clinical Lecturer at NUS’ Yong Loo Lin School of Medicine and currently, Adjunct Assistant Professor at the Duke-NUS Medical School. Dr Lee is also regularly invited to share his experiences locally and regionally through lectures, workshops and surgical demonstrations.

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    Frequently Asked Questions

    How does low testosterone affect women?

    While testosterone is often associated with men, women also produce this hormone, albeit in smaller amounts. In women, low testosterone can lead to reduced libido, fatigue, and mood disturbances. Testosterone levels in women can be influenced by various factors, including menopause and ovarian conditions.

    Are there any natural foods or diets recommended to boost testosterone levels?

    Yes, certain foods such as tuna, egg yolks, fortified cereals, oysters, and beef can help boost testosterone levels. Additionally, maintaining a balanced diet, rich in zinc and vitamin D, can support healthy testosterone production.

    How often should one undergo testosterone level testing after starting TRT?

    Typically, it’s recommended to test testosterone levels 3 to 6 months after starting TRT and then annually. However, the frequency can vary based on individual needs and the specific treatment regimen.

    What is the difference between 'free' testosterone and 'total' testosterone in blood tests?

    Total testosterone measures the overall amount of testosterone in the blood, including that bound to proteins. Free testosterone, on the other hand, measures the testosterone available in the bloodstream not bound to proteins. Both values are importantl in assessing testosterone health.

    Can low testosterone levels affect cognitive functions or memory?

    Some studies suggest that low testosterone can impact cognitive functions, including memory. However, the relationship is complex, and other factors, such as age and overall health, can also influence cognitive abilities.

    How does alcohol consumption impact testosterone levels?

    Excessive alcohol consumption can lead to decreased testosterone production. It’s advisable to consume alcohol in moderation and be aware of its potential impact on hormonal health.

    Are there any age-specific considerations or risks when treating older adults with TRT?

    Yes, older adults may be at a higher risk for certain side effects of TRT, such as cardiovascular issues. Have a thorough assessment and regular monitoring when considering TRT for older individuals.