There are several treatment options for low testosterone (also known as hypogonadism or low T), which occurs when the testicles don’t make enough of the hormone testosterone. Low testosterone levels can lead to symptoms that interfere with daily life, including low energy, sexual issues, erectile dysfunction, a low sperm count, low mood, and increased body fat, so treatment can be important.
Testosterone replacement therapy (TRT) is the main treatment option. People may also be able to boost or manage testosterone levels with lifestyle changes like losing excess weight and exercising more. When an underlying medical condition is causing or contributing to low T, treating that condition may help restore normal testosterone levels. Always talk to your doctor before starting a treatment or combination of treatments, and work together to decide what’s right for you.
Here’s what to know about the treatment options for low testosterone.
Medication
Testosterone replacement therapy is the standard approach to treat low testosterone that’s due to medical reasons, not typical aging. It comes in a variety of forms, some which may work better for your lifestyle than others.
Testosterone Skin Gels
You apply testosterone gel (AndroGel, Fortesta, Testim) directly to your skin at the same time daily. Clean and dry the skin before applying the gel, and let the area air-dry after use. Then cover it with clothing to make sure that no one else comes into contact with the medication, including pets.
It’s important to avoid other people having skin contact with this medication because of the risk of side effects. For example, people who are pregnant or trying to become pregnant are at risk of birth defects from this medication. If others do come in contact with your medication, have them wash the area with soap and water as soon as possible.
Testosterone Skin Patches
Testosterone skin patches (Androderm, Testoderm) deliver testosterone through the skin. You apply these once daily, at the same time each evening, to the abdomen, back, upper arms, or thighs. Avoid putting a patch in the same place more than once in seven days. These stay attached during showering, sex, and swimming, but sweating too much and intense exercise may cause the patch to come loose or fall off.
Testosterone Injections
Testosterone comes in an injectable form, but you may need to go to a clinic for injections (Andro LA, Aveed, Delatestryl) into your muscle every week or every two weeks. Some testosterone injections are available to self-inject under the skin. Long-acting injections, which last for 10 weeks, are also available.
Testosterone Buccal Systems
Testosterone buccal systems (Striant) are tablet-shaped patches that you apply to the upper gum (just above the left and right incisors) every 12 hours. They don’t completely dissolve, so you’ll need to remove buccal systems when you replace them. You can do normal things like eating, drinking, chewing gum, and brushing your teeth, but the buccal system can fall out, so be sure to check after finishing these activities.
Buccal systems may irritate the gums, leave a bitter taste in your mouth, and make food difficult to taste.
Testosterone Pellets
Testosterone pellets (Testopel) are a newer form of treatment. A medical professional inserts the pellets under the skin every three to six months to provide ongoing, consistent doses of testosterone.
Oral Testosterone
A pill called oral testosterone undecanoate (Andriol, Jatenzo, Tlando) can help restore testosterone levels for people with specific health problems, such as pituitary damage due to tumors and Klinefelter syndrome. You might need to take this medication with food, as fats are sometimes necessary for the bloodstream to absorb the testosterone.
Liver damage is a possible risk of taking testosterone pills.
Testosterone Nasal Gel
Testosterone nasal gel (Natesto) is a gel you put up your nose to supplement testosterone. Be sure to blow your nose before using the gel and wash your hands afterward. Side effects may include a runny, stuffy nose and nosebleeds.
Dehydroepiandrosterone Supplements
Dehydroepiandrosterone (DHEA) is a building block of testosterone. Your body already makes DHEA, but a lab-made version is available as an over-the-counter capsule, tablet, gel, powder, and topical cream.
Some people try these supplements to improve testosterone levels or reduce symptoms like erectile dysfunction, but the U.S. Food and Drug Administration (FDA) doesn’t regulate DHEA supplements in the same way it does medications. The Mayo Clinic suggests avoiding them, finding the quality of most DHEA supplements to be low.
DHEA may also have several side effects, including increasing the risk of hormone-sensitive cancers like prostate, ovarian, and breast cancers. It may make psychiatric disorders worse and cause acne, oily skin, or male-pattern hair growth in women. It may also interact with testosterone if you’re taking other testosterone treatments.
Medication Side Effects, Safety, and Precautions
As of 2018, the FDA advised that using TRT to manage low testosterone due to aging is unsafe, with links to a possible risk of stroke or heart attack.
However, your doctor may still prescribe TRT for off-label use. Several newer studies suggest that TRT is safe and helpful for many men older than 65 who have low testosterone.
Before you start TRT, your doctor will do several blood tests to check for potential low T causes to help avoid risks. While you are receiving TRT, you will get follow-up blood tests for the doctor to monitor you.
Side effects of TRT are similar regardless of which form you use. These are some of the possibilities:
Acne
Altered performance or drive during sex
Irritated skin at the site of application
Unexpected breast tissue growth
More serious side effects are sometimes possible. Immediately tell a doctor if you notice these signs:
Blood clot
Heart attack
Liver injury
Stroke
Increased blood pressure
Sleep apnea
Limb swelling
Allergic reactions
Extreme mood changes
Constant, painful erection
Let a doctor know if you have certain medical conditions, like cancer, diabetes, or diseases of the heart, kidney, liver, lungs, or prostate, as well as any allergies, or if a partner is currently pregnant or trying to conceive, as this medication can cause complications with a pregnancy.
Lifestyle Approaches
Certain lifestyle changes may help you account for some effects of low T and improve your levels.
Keep a Healthy Weight
Excess belly fat might have strong links to low T. Getting enough exercise and eating a diet with vegetables, fruits, whole-grain carbs, healthy fats, and lean protein may support a healthy body weight and boost testosterone levels.
Exercise
Regular exercise, including cardio but especially strength training, may improve testosterone levels. Talk to your doctor if you’re interested in starting a new physical activity routine.
Sleep
Get at least seven to nine hours of sleep per night. Sleep can directly affect testosterone levels, as most testosterone releases overnight. Sleep apnea may also decrease testosterone, so be sure to address it with your doctor if you have trouble breathing during sleep or have other symptoms of sleep apnea.
Manage Stress
Constant stress (and high levels of the stress hormone cortisol) can decrease your testosterone levels. It can also make some low T symptoms worse by distracting from your enjoyment of sex. Try to manage stress, even if that’s as simple as making time for an enjoyable daily activity.
Mental Health Treatment
Low T can cause anxiety and may share several symptoms with depression:
If you notice these symptoms, along with the physical symptoms of low T, like weight gain, sexual problems, reduced muscle mass, or an increase in breast tissue, speak to a doctor about testing your testosterone. TRT may reverse some or all of these symptoms.
You may also consider mental health therapy. It might help you identify problems with stress, work, family, relationships, or the side effects of other medications and start to talk about or treat any issues.
The Takeaway
Low testosterone can bring on symptoms like low energy and increased body fat, but there are options to help. For many people, testosterone replacement therapy can help manage some symptoms, as can lifestyle adjustments like regular exercise and stress management. If you live with low T symptoms, speak to a doctor about testing your levels and whether treatment may be right for you.
Christopher Wolter, MD, is an assistant professor in urology at Mayo Clinic in Phoenix, Arizona. He has been in practice since 2008, specializing in the areas of urinary incontinence, pelvic organ prolapse, urologic reconstruction, urologic prosthetics, post prostate cancer survivorship, erectile dysfunction, neurourology and neuromodulation, and overall functional considerations of urogenital health.
Dr. Wolter has been heavily involved in urologic education. He spent the last 12 years heavily involved in resident education and leadership for his department, including the last eight years as urology residency program director. He currently serves as the director of urologic education for the preclinical and clinical rotations for the Mayo Clinic Alix School of Medicine Phoenix, Arizona, campus.
Wolter completed his undergraduate and medical education at the University of Illinois. He then completed his urology residency at Tulane University in New Orleans, followed by a fellowship in female pelvic medicine and reconstructive urology at Vanderbilt University in Nashville, Tennessee.
Adam is a freelance writer and editor based in Sussex, England. He loves creating content that helps people and animals feel better. His credits include Medical News Today, Greatist, ZOE, MyLifeforce, and Rover, and he also spent a stint as senior updates editor for Screen Rant.
As a hearing aid user and hearing loss advocate, Adam greatly values content that illuminates invisible disabilities. (He's also a music producer and loves the opportunity to explore the junction at which hearing loss and music collide head-on.)
In his spare time, Adam enjoys running along Worthing seafront, hanging out with his rescue dog, Maggie, and performing loop artistry for disgruntled-looking rooms of 10 people or less.
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Resources
Low Testosterone (Male Hypogonadism). Cleveland Clinic. September 2, 2022.
FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use. U.S. Food and Drug Administration. February 26, 2018.
Testosterone Buccal. MedlinePlus. October 15, 2018.
Campbell K et al. Safety Aspects and Rational Use of Testosterone Undecanoate in the Treatment of Testosterone Deficiency: Clinical Insights. Drug, Healthcare and Patient Safety. March 31, 2023.
