Doc, il mio livello di testosterone è normale — allora perché sono ancora così stanco?

Ultimo aggiornamento: 2 settembre 2026

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If there is one sentence I hear almost every day in clinic, it is this: my energy is gone, I cannot focus, my sex drive has crashed, things are not working in the bedroom — can we please just try some testosterone? It is a completely understandable request. Testosterone is marketed as an elixir of youth, so when a man feels exhausted to his bones, it is natural to blame the most famous male hormone.

But here is the puzzle. What happens when the blood test comes back perfectly normal — and the man sitting across from me is genuinely suffering from deep fatigue and erectile dysfunction? This is one of the most interesting problems in men’s health: how do you help a man who feels terrible but whose testosterone is completely healthy?

A Talk in Washington That Crystallised the Answer

This exact question took centre stage during my trip to Washington, DC in May 2026, where I attended the Assemblea annuale dell'American Urological Association (AUA) 2026 shadowing Professor Mohit Khera of Baylor College of Medicine.

The highlight was a forum hosted by the American Society for Men’s Health, where Dr. Martin Miner of Brown University gave a talk titled, almost word for word, what my patients say to me: Doc, my testosterone is 600 — why am I still tired and having ED? Here is what the evidence actually supports.

Why a Normal Level Does Not Guarantee Energy

When a man shows up with clear symptoms — profound fatigue, low drive, ED — but his testosterone is solidly normal, many commercial hormone clinics will hand him testosterone anyway and call it optimisation. That is not supported by the science.

All the major, high-quality studies we rely on to show that testosterone therapy works had one thing in common: they enrolled only men who genuinely had low testosterone. In those men, restoring the hormone delivers real benefits — better sexual function, improved mood, correction of anaemia, stronger bones.

But there is no good evidence that adding testosterone to a man who already has healthy levels gives him any meaningful, lasting benefit. The tank is already full. Adding fuel to a full tank does not make the engine run better; it creates overflow and risk.

What About Clomiphene?

When men hear that testosterone injections can shut down their own production, they often ask about tablets such as clomiphene, which coax the body into making more of its own testosterone. These have a genuine role — but only in men who truly start out with low testosterone. In men who already have normal levels, there is no evidence these drugs relieve symptoms. They may push the number higher on paper, and a higher number on paper is not the same as feeling better.

Hunting for the Real Culprit

If a man has a normal testosterone level and feels drained, the useful conclusion is that something other than the fuel tank is disrupting the engine. Giving testosterone to a man with normal levels is a distraction that leaves the true cause unaddressed. So we go hunting. Here are the usual suspects.

1. Obstructive sleep apnea

This is one of the biggest hidden offenders in men with chronic fatigue and ED. If you repeatedly stop breathing through the night, your body spends the night oxygen-starved and in a state of stress. You will wake exhausted no matter how good your testosterone is. Treating sleep apnea often changes how a man feels far more than any hormone would. Loud snoring, waking unrefreshed, or a partner reporting pauses in breathing are all reasons to ask for a sleep study.

2. Depression, anxiety, and stress

Mental health and sexual function are closely tied, and the relationship runs both ways. At the main AUA congress, Professor Khera presented data showing that successfully resolving a man’s erectile problems is associated with substantially lower levels of depression and psychological distress. The reverse is also true: unmanaged burnout, anxiety, depression, or relationship strain shows up physically as low libido, exhaustion, and ED.

This deserves saying plainly rather than in passing: if you have lost interest in things you used to enjoy, or you have felt persistently low for weeks rather than days, that is worth raising with a doctor in its own right. It is a common, treatable condition, and it is a far more likely explanation for exhaustion than a testosterone level that is already normal. And if things have gone further than that — if you have had thoughts of harming yourself, or feel you cannot go on — please do not wait for an appointment. Speak to someone today: the Department of Mental Health helpline in Thailand is 1323, and in an emergency call 1669 or go to the nearest emergency department. This is outside my own specialty, and it matters more than anything else on this page.

3. Metabolic and lifestyle factors

Obesity, poorly controlled blood sugar, physical inactivity, and an underactive thyroid are powerful drivers of physical exhaustion. They also quietly damage the small blood vessels that erections depend on. Addressing them is not only about energy — it directly affects erectile health.

4. Medication side effects

We always review the full medication list. Some antidepressants, strong painkillers, and certain blood pressure drugs are well known for causing fatigue, reducing libido, and triggering ED. Sometimes the answer is an adjustment to an existing prescription rather than a new one. Never stop a prescribed medicine on your own on the strength of an article — that conversation belongs with the doctor who prescribed it.

5. Everything else that causes fatigue

It is worth remembering that fatigue is one of the least specific symptoms in medicine. Anaemia, iron deficiency, thyroid disease, kidney or liver problems, chronic infection and, occasionally, something more serious can all present exactly this way. A proper assessment includes basic blood work looking for these, which is precisely the step that gets skipped when a clinic reaches straight for a hormone.

Proven Ways to Treat ED When Testosterone Is Normal

If your testosterone is normal but you are still struggling with ED, forcing the hormone level higher is not the answer. Instead we turn to therapies that address the blood vessels, nerves and psychology behind an erection:

• First-line ED tablets — sildenafil, or daily low-dose tadalafil, have gold-standard evidence for treating ED in men with normal hormones. They improve blood flow directly, independent of testosterone. They are not suitable for men taking nitrates. See how erectile dysfunction assessment and treatment is structured in practice.
• Weight, exercise and sleep — structured exercise, weight reduction and better sleep have good evidence for improving both erectile function and energy, and they treat the vascular problem rather than masking it. Newer weight-loss injections are changing this field internationally; they are prescribed by endocrinology or weight-management services rather than in my urology clinic, and I am happy to point you in the right direction.
• Targeted mental health care — if the assessment uncovers depression or a chronic sleep disorder, treating that directly with the right specialist is the treatment, not an afterthought.
• Sex therapy — for performance anxiety, high stress, or difficulty with a partner, specialised couples or sex therapy is genuinely effective at rebuilding confidence and intimacy.

Knowing When to Stop

Even when a doctor decides to try a carefully monitored, time-limited hormone trial in a genuinely borderline case, there have to be firm boundaries. Testosterone is not a harmless supplement. Expert consensus is that therapy should stop if any of these occur:

• No real improvement. If a man has been treated for several months and the level has risen on paper while the fatigue and ED have not budged, the trial has failed. Continuing exposes him to long-term risk for a benefit that is not there. We stop, and we keep looking for the true cause — rather than concluding it is all in his head.
• Blood becoming too thick. Testosterone can overstimulate red blood cell production. This raises the risk of clots and is a clear signal to stop or reduce treatment.
• A meaningful PSA change. A rapid rise in this prostate marker, or any new sign of prostate cancer, means stopping and arranging urological assessment.
• A cardiovascular event. A new heart problem or a blood clot means therapy halts immediately.

Fuller detail on how testosterone therapy is started and monitored is on the testosterone replacement therapy page.

La linea di fondo

The forum at AUA 2026 reinforced something old rather than something new: treat the patient, not the lab paper.

If your testosterone is normal, you do not have a hormone deficiency. Forcing that number higher with injections, gels, or tablets will not restore your energy or fix erectile difficulties, and as the baseline level rises, the balance of risk and benefit only tips further the wrong way. The route to feeling better runs through your sleep, your mood, your metabolism, your medications, and treatments that work on erections directly.

So if you are battling fatigue or sexual changes despite normal labs, it does not mean nothing is wrong and it does not mean nothing can be done. It means the answer is somewhere the single number cannot show you. Dr. Soarawee Weerasopone offers specialist men’s health consultations at Bangkok Hospital Headquarters. Prenota una consulenza. Sono disponibili anche consultazioni presso l'ospedale Samitivej Sriracha di Chonburi — è possibile contattare la linea interna del reparto al numero 088-022-1445. Questions about the cost of consultation or blood testing should go to the hospital directly — for Bangkok Hospital, by email to bhquro@bdms.co.th.

La telemedicina del Bangkok Hospital è disponibile per i pazienti che non possono presentarsi di persona, compresi i pazienti internazionali: va organizzata in anticipo via email con il reparto di urologia all'indirizzo bhquro@bdms.co.th. This particular problem suits a video consultation unusually well, because most of the work is history: your sleep, your mood, your medication list and the results you already have. Examination and blood tests are done in person. Samitivej Sriracha is in-person only.

Domande frequenti

My testosterone is normal but I still feel exhausted and have ED. Why?

A normal testosterone level means the fuel tank is already full, so adding more will not help. Persistent fatigue and erectile dysfunction usually point to a different underlying cause — most commonly obstructive sleep apnea, depression or chronic stress, metabolic problems such as obesity or diabetes, medication side effects, or general medical causes of tiredness such as anaemia or thyroid disease. The right approach is to investigate and treat those rather than chase a higher hormone number.

Will taking testosterone help if my level is already normal?

The evidence says no. The high-quality trials showing that testosterone therapy works enrolled men who genuinely had low testosterone. In men with normal levels there is no good evidence that extra testosterone improves energy, libido, or erectile function, and pushing the level higher increases risk without delivering benefit. A time-limited trial is occasionally reasonable in a genuinely borderline case, but only with a clear plan to stop if nothing improves.

What about clomiphene to boost a normal testosterone level?

Clomiphene has a genuine role for men who truly have low testosterone, encouraging the body to make more of its own, and it is often preferred for younger men who want to preserve fertility. In men who already have normal levels, however, there is no evidence it relieves symptoms. It can raise the number on a lab report, but that improvement on paper does not translate into feeling better and does not address the real cause.

How can ED be treated if my testosterone is normal?

With therapies that target blood flow and general health rather than hormones. These include first-line ED tablets such as sildenafil or daily low-dose tadalafil, which are not suitable for men taking nitrates; weight reduction, exercise and better sleep; treating any underlying depression or sleep disorder; and sex therapy for performance anxiety or relationship-related difficulty. Which combination fits depends on what the assessment finds.

When should testosterone therapy be stopped?

It should stop if there is no genuine symptom improvement after a fair trial of several months, if the blood becomes too thick and raises the risk of clots, if there is a significant PSA change or any new sign of prostate cancer, or if a cardiovascular event such as a heart problem or blood clot occurs. Testosterone is not a harmless supplement and needs monitoring by a doctor rather than a repeat prescription.

Posso discutere di questo argomento tramite una consultazione video?

Yes, and this problem suits it particularly well. Bangkok Hospital Headquarters offers a Telemedicine service, arranged in advance by emailing the Urology department at bhquro@bdms.co.th. Most of the work here is history-taking — sleep, mood, medications, and the results you already have — which is exactly what a video consultation is good for. Physical examination and blood tests require an in-person visit. Samitivej Sriracha Hospital is in-person only.

Avvertenza: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. Medical advice, diagnosis and prescriptions are not provided through personal messaging channels or social media. Do not stop or change a prescribed medication without speaking to the doctor who prescribed it. Always consult a qualified healthcare professional before starting any medical treatment.