{"id":9402,"date":"2026-04-28T20:00:00","date_gmt":"2026-04-28T13:00:00","guid":{"rendered":"https:\/\/drsoaraweeurology.com\/?p=9402"},"modified":"2026-08-29T04:48:14","modified_gmt":"2026-08-28T21:48:14","slug":"%e1%9e%80%e1%9e%b6%e1%9e%9a%e1%9e%8e%e1%9f%82%e1%9e%93%e1%9e%b6%e1%9f%86%e1%9e%a2%e1%9f%86%e1%9e%96%e1%9e%b8%e1%9e%8f%e1%9f%81%e1%9e%9f%e1%9f%92%e1%9e%8f%e1%9e%bc%e1%9e%9f%e1%9f%92%e1%9e%8f%e1%9f%81","status":"publish","type":"post","link":"https:\/\/drsoaraweeurology.com\/km\/2026\/04\/28\/low-testosterone-2024-guide\/","title":{"rendered":"Low Testosterone in Men: What the Evidence Actually Supports"},"content":{"rendered":"\n<div class=\"wp-block-columns coblocks-author-columns has-background is-layout-flex wp-container-core-columns-is-layout-52275889 wp-block-columns-is-layout-flex\" style=\"background-color:#8C8C971A;padding-top:2.5rem;padding-right:2.5rem;padding-bottom:2.5rem;padding-left:2.5rem\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:25%\">\n<figure class=\"wp-block-image size-full is-style-rounded\"><img data-recalc-dims=\"1\" fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"800\" data-attachment-id=\"7037\" data-permalink=\"https:\/\/drsoaraweeurology.com\/km\/new-photo-2024\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" data-orig-size=\"800,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=800%2C800&#038;ssl=1\" alt=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" class=\"wp-image-7037\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?w=800&amp;ssl=1 800w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=300%2C300&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=150%2C150&amp;ssl=1 150w, 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12 12 12 12-5.372 12-12S18.628 0 12 0zM7.369 4.378c.525 0 .947.431.947.947 0 .525-.422.947-.947.947-.525 0-.946-.422-.946-.947 0-.525.421-.947.946-.947zm-.722 3.038h1.444v10.041H6.647V7.416zm3.562 0h3.9c3.712 0 5.344 2.653 5.344 5.025 0 2.578-2.016 5.025-5.325 5.025h-3.919V7.416zm1.444 1.303v7.444h2.297c3.272 0 4.022-2.484 4.022-3.722 0-2.016-1.284-3.722-4.097-3.722h-2.222z\"\/>\n    <\/svg>\n  <\/a>\n  \n  <a href=\"https:\/\/scholar.google.com\/citations?user=lTgsRMUAAAAJ&#038;hl=en\" \n     target=\"_blank\" \n     rel=\"noopener\"\n     title=\"Google Scholar\"\n     aria-label=\"View Google Scholar Profile\"\n     style=\"text-decoration: none; color: #4285F4; transition: transform 0.2s; display: inline-block;\"\n     onmouseover=\"this.style.transform='scale(1.15)'\"\n     onmouseout=\"this.style.transform='scale(1)'\">\n    <svg width=\"28\" height=\"28\" viewBox=\"0 0 24 24\" fill=\"currentColor\">\n      <path d=\"M5.242 13.769L0.5 9.5 12 1l11.5 8.5-4.742 4.269C17.548 11.249 14.978 9.5 12 9.5c-2.977 0-5.548 1.748-6.758 4.269zM12 10a7 7 0 1 0 0 14 7 7 0 0 0 0-14z\"\/>\n    <\/svg>\n  <\/a>\n  \n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Few areas of men\u2019s health attract as much confusion \u2014 and as much aggressive marketing \u2014 as low testosterone, or male hypogonadism. My training in this area is an Andrology Fellowship at Chang Gung Memorial Hospital Kaohsiung, Taiwan (2019), under Professor Po-Hui Chiang, and male hormonal health has been a large part of my clinic ever since. I am currently a Research Scholar and Clinical Observer at the Scott Department of Urology, Baylor College of Medicine \u2014 a research and observer appointment rather than a clinical fellowship, carrying no licence to practise in the United States. My practice is in Thailand.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In 2024 <em><a href=\"https:\/\/www.thelancet.com\/journals\/landia\/article\/PIIS2213-8587(24)00199-2\/abstract\" target=\"_blank\" rel=\"noreferrer noopener\">The Lancet Diabetes &amp; Endocrinology<\/a><\/em> published a review of the pathogenesis, diagnosis and management of male hypogonadism, drawing together the large clinical trials of the previous decade including TRAVERSE. Its conclusions are considerably more modest than the advertising, and considerably more useful. This article sets out what they mean for a man who suspects his testosterone is low.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"600\" data-attachment-id=\"10004\" data-permalink=\"https:\/\/drsoaraweeurology.com\/km\/low-testosterone-2024-6-things-to-know\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/low-testosterone-2024-6-things-to-know.webp?fit=800%2C600&amp;ssl=1\" data-orig-size=\"800,600\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Low Testosterone 2024 &amp;#8211; 6 Things to Know\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/low-testosterone-2024-6-things-to-know.webp?fit=800%2C600&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/low-testosterone-2024-6-things-to-know.webp?resize=800%2C600&#038;ssl=1\" alt=\"Six evidence-based points about low testosterone in men \u2014 organic versus functional hypogonadism, correct testing, and what testosterone therapy does and does not deliver\" class=\"wp-image-10004\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/low-testosterone-2024-6-things-to-know.webp?w=800&amp;ssl=1 800w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/low-testosterone-2024-6-things-to-know.webp?resize=300%2C225&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/low-testosterone-2024-6-things-to-know.webp?resize=768%2C576&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/low-testosterone-2024-6-things-to-know.webp?resize=16%2C12&amp;ssl=1 16w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Six things worth knowing before deciding whether testosterone therapy is the right answer for you.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Before Anything Else: Symptoms That Need Urgent Assessment<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most low testosterone is investigated calmly over weeks. Two situations are not.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>If you are already taking testosterone<\/strong>, go to an emergency department the same day for chest pain or chest tightness, breathlessness at a level of exertion that never used to trouble you, pain or swelling in one calf, sudden sharp chest pain that is worse on breathing in, a rapid or irregular heartbeat, or any stroke symptom \u2014 face drooping, arm weakness, difficulty speaking \u2014 even if it settles within minutes. In Thailand, call <strong>1669<\/strong>. These are ordinary emergency symptoms that anyone should act on; listing them here is prudence, not a claim that testosterone caused them.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>If you have not started treatment<\/strong>, low testosterone accompanied by new persistent headaches, a change in vision \u2014 particularly loss of the outer edges of your visual field \u2014 or milky discharge from the nipples is not the ordinary picture. Those features point towards the pituitary gland rather than the testes, and they need investigating rather than treating with testosterone. Loss of body hair with shrinking testicles is also worth prompt assessment.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">The Two Faces of Low Testosterone: Organic and Functional<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Not all testosterone deficiencies are the same problem, and the distinction decides whether the answer is hormonal or metabolic.<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Organic (classical) hypogonadism<\/strong> \u2014 an intrinsic and usually irreversible problem somewhere in the hypothalamic\u2013pituitary\u2013testicular axis. Klinefelter syndrome, previous testicular surgery, chemotherapy or radiotherapy, and pituitary disease all belong here. Testosterone replacement is the appropriate treatment.<\/li>\n\n\n<li><strong>Functional (late-onset) hypogonadism<\/strong> \u2014 testosterone suppressed by factors outside the reproductive axis, chiefly obesity, type 2 diabetes and accumulated illness, with no permanent structural damage. This is the form driving the global surge in testosterone prescriptions.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">The crucial difference is that <strong>functional hypogonadism is frequently reversible<\/strong> when the underlying factors are corrected. That is why weight and metabolic health come before the prescription pad, and why the Lancet review names health optimisation as the gold-standard management strategy rather than a preliminary courtesy. Losing at least 5% to 10% of body weight raises testosterone measurably \u2014 on pooled data, by around 70 ng\/dL with dietary weight loss and around 200 ng\/dL after bariatric surgery, in proportion to the weight lost. The causal case is discussed in more detail in <a href=\"https:\/\/drsoaraweeurology.com\/2026\/05\/26\/obesity-low-testosterone-weight-loss-mendelian-randomization\/\">why your doctor recommends the gym before the pharmacy<\/a>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What Are the Real Symptoms?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Many men arrive at the clinic attributing general fatigue or low mood to low testosterone. Those can be part of it, but the evidence is clear that <strong>sexual symptoms are the most specific indicators<\/strong>.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>The most specific:<\/strong> a definite fall in libido, loss of spontaneous morning erections, and erectile dysfunction.<\/li>\n\n\n<li><strong>Supporting but non-specific:<\/strong> reduced muscle mass, increased central fat, unexplained anaemia, low mood and chronic fatigue. Each of these is caused far more often by something else \u2014 sleep apnoea, diabetes, thyroid disease, depression, poor sleep \u2014 than by testosterone.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">This matters practically. A man treated with testosterone for fatigue that was actually caused by untreated sleep apnoea has been given a drug that can make sleep apnoea worse, while the real problem goes on unaddressed.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large is-resized\"><img data-recalc-dims=\"1\" decoding=\"async\" data-attachment-id=\"10003\" data-permalink=\"https:\/\/drsoaraweeurology.com\/km\/old-man-tired\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/old-man-tired.webp?fit=800%2C1067&amp;ssl=1\" data-orig-size=\"800,1067\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Older Man Fatigue Low Testosterone\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/old-man-tired.webp?fit=768%2C1024&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/old-man-tired.webp?w=500&#038;ssl=1\" alt=\"Older man appearing fatigued \u2014 a common but non-specific symptom that is more often caused by sleep apnoea, diabetes or depression than by low testosterone\" class=\"wp-image-10003\"  srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/old-man-tired.webp?w=800&amp;ssl=1 800w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/old-man-tired.webp?resize=225%2C300&amp;ssl=1 225w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/old-man-tired.webp?resize=768%2C1024&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/old-man-tired.webp?resize=9%2C12&amp;ssl=1 9w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Fatigue is common in men with low testosterone \u2014 and commoner still in men whose testosterone is normal.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">How the Test Should Be Done<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">One of the commonest problems I see is a diagnosis built on a badly taken sample.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Timing and fasting.<\/strong> Blood should be drawn in the morning, ideally between 7:00 and 10:00, because testosterone peaks after sleep. Fasting matters too, as concentrations fall after a meal.<\/li>\n\n\n<li><strong>Two samples, not one.<\/strong> Day-to-day variation is substantial, so a single low reading should always be confirmed on a separate day before anyone talks about treatment.<\/li>\n\n\n<li><strong>Not during acute illness.<\/strong> Infection, injury, surgery and severe stress all suppress testosterone temporarily. A level taken in hospital or in the week after an illness can be low in a man whose axis is entirely normal.<\/li>\n\n\n<li><strong>Total, and sometimes free.<\/strong> Total serum testosterone is the principal test. In older men and in obesity, the binding protein SHBG shifts, which can make the total figure misleading in either direction; a calculated free testosterone helps in those situations.<\/li>\n\n\n<li><strong>LH and FSH.<\/strong> These separate a testicular problem from a pituitary one, and they change the plan. They are also what determines whether an alternative such as hCG could work at all \u2014 it does nothing when the testes themselves have failed, as explained in the article on <a href=\"https:\/\/drsoaraweeurology.com\/2023\/03\/22\/hcg-male-hypogonadism\/\">hCG for low testosterone<\/a>.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large is-resized\"><img data-recalc-dims=\"1\" decoding=\"async\" data-attachment-id=\"10002\" data-permalink=\"https:\/\/drsoaraweeurology.com\/km\/asian-male-tired\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/Asian-male-tired.webp?fit=800%2C1067&amp;ssl=1\" data-orig-size=\"800,1067\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Asian Man Brain Fog Low Testosterone\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/Asian-male-tired.webp?fit=768%2C1024&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/Asian-male-tired.webp?w=500&#038;ssl=1\" alt=\"Man with low mood and poor concentration \u2014 supporting symptoms of low testosterone that require confirmation with a correctly timed morning blood test\" class=\"wp-image-10002\"  srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/Asian-male-tired.webp?w=800&amp;ssl=1 800w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/Asian-male-tired.webp?resize=225%2C300&amp;ssl=1 225w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/Asian-male-tired.webp?resize=768%2C1024&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/Asian-male-tired.webp?resize=9%2C12&amp;ssl=1 9w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Mood and concentration changes are worth mentioning, but they are not enough on their own to make the diagnosis.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">What Treatment Delivers, and What It Does Not<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">For functional, obesity-related hypogonadism, weight loss and treatment of the underlying conditions remain the best management. When that is not enough, or when the deficiency is organic, testosterone therapy is a reasonable option \u2014 but it is worth being precise about the size of the benefit.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The pooled trial evidence describes improvements in sexual function that are <strong>statistically significant and modest<\/strong>. Desire responds fairly dependably. Erections respond far less reliably, because most erectile dysfunction is a blood-vessel problem rather than a hormonal one, and normalising a hormone does not repair an artery. Energy and mood improve for some men and not for others. Testosterone is not a tonic for ageing, and higher levels are not better than adequate ones.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">An earlier version of this article described testosterone therapy as a highly effective treatment for sexual symptoms. That was stronger than the evidence it cited, and it has been corrected.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What Testosterone Therapy Asks of You in Return<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This is the section that was missing from the original version of this article, and it is the part of the conversation that should happen before the first dose rather than after it.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Fertility.<\/strong> Testosterone given from outside switches off the body\u2019s own signal to the testes, and sperm production falls with it \u2014 frequently to zero. For a man who may want children, this is the single most important fact about the treatment. Recovery usually takes months and sometimes a couple of years, and it is not guaranteed. If fertility matters to you, say so before starting: a semen analysis beforehand is sensible, and there are alternatives that raise testosterone while preserving sperm production, including clomiphene citrate, hCG and an aromatase inhibitor.<\/li>\n\n\n<li><strong>Erythrocytosis.<\/strong> Testosterone thickens the blood by raising the red cell count. <strong>This was by a wide margin the clearest adverse effect in the TRAVERSE trial<\/strong> \u2014 a difference of a completely different order from the signals discussed below. Haematocrit is the monitoring result that most often forces a dose reduction, a change of preparation or a pause. It is checked before starting and regularly for as long as you remain on treatment.<\/li>\n\n\n<li><strong>PSA.<\/strong> Prostate assessment and a PSA before starting, then monitoring, are standard \u2014 not because testosterone is thought to cause prostate cancer, but because treatment should not be started blind in a man over 40.<\/li>\n\n\n<li><strong>Sleep apnoea.<\/strong> Testosterone can worsen untreated obstructive sleep apnoea, which is common in exactly the men who present with low testosterone. It should be looked for first, not afterwards.<\/li>\n\n\n<li><strong>Transfer from gels.<\/strong> Testosterone gel transfers by skin contact and can cause early virilisation in a child or unwanted effects in a partner. Cover the site, wash your hands, and keep the area away from others until it is absorbed.<\/li>\n\n\n<li><strong>Commitment.<\/strong> For organic hypogonadism this is usually lifelong. Stopping abruptly, having suppressed your own production, generally feels worse than never starting.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Safety: What TRAVERSE Actually Found<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">TRAVERSE was the large cardiovascular safety trial the field had waited decades for. It randomised <strong>5,246 men aged 45 to 80<\/strong> with confirmed low testosterone who already had cardiovascular disease or carried multiple risk factors, and followed them for a mean of 33 months. It is usually quoted in half \u2014 and, as this page previously demonstrated, it is easy to quote the wrong half in either direction.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">The main result<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Testosterone did not increase heart attack, stroke or cardiovascular death.<\/strong> It met the criterion for non-inferiority to placebo on that combined endpoint. This is the finding that is quoted everywhere, and it is genuinely reassuring \u2014 particularly given the trial deliberately enrolled the men most likely to be harmed if testosterone were harmful.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">What reached statistical significance<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Erythrocytosis<\/strong> \u2014 a rise in red cell count, several times more frequent on testosterone than on placebo. This was the clearest adverse effect in the trial, and it is why haematocrit is monitored for as long as treatment continues.<\/li>\n\n\n<li><strong>Fractures<\/strong> \u2014 the fracture subtrial found a <strong>statistically significant increase of roughly 43%<\/strong> in clinical fractures on testosterone, around 3.5% of men versus 2.5% on placebo, with the curves separating within the first few months. Ribs, wrist and ankle were the commonest sites. Contrary to the older belief that testosterone protects bone, it should not be prescribed to prevent fractures.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">What was numerically higher but not statistically significant<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Atrial fibrillation, pulmonary embolism and acute kidney injury<\/strong> each occurred somewhat more often in the testosterone group. <strong>None of those differences reached statistical significance.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">An earlier version of this page listed these three as findings the trial recorded, without that qualification. That reads as though they were established harms, and they are not. Describing a difference the trial could not distinguish from chance as a demonstrated risk is a real error \u2014 and it is the same error, pointed the other way, as calling a significant 43% rise in fractures merely slight.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That is not a reason to dismiss them. These are serious events, the numbers moved in the same direction, and a trial this size failing to reach significance is not proof of no effect. It is reasonable to mention a previous blood clot, a clotting disorder or a known arrhythmia before starting, so it can be weighed. It is not reasonable to refuse treatment to a man who needs it on the strength of them.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">What the trial looked for and did not find<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Diabetes.<\/strong> Smaller earlier studies suggested testosterone might stop prediabetes progressing. The <strong>prespecified TRAVERSE diabetes substudy found no significant difference<\/strong> in progression, and no difference in glucose or HbA1c. The American Diabetes Association does not recommend testosterone for diabetes prevention. It is not a treatment for diabetes and not a substitute for weight loss.<\/li>\n\n\n<li><strong>Prostate.<\/strong> No increase in prostate cancer was seen. The important qualification is that <strong>TRAVERSE, like the earlier T-Trials, excluded men with a history of prostate cancer<\/strong> \u2014 so it does not answer the question that men already treated for prostate cancer most want answered.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">That last gap is one our group has contributed to directly. A single-centre cohort of 46 hypogonadal men aged 80 and over starting testosterone therapy, published in <em>The Journal of Sexual Medicine<\/em> in 2026, found that 39% had a history of prostate cancer and that no biopsy-confirmed recurrence occurred during follow-up. The limits deserve as much weight as the finding: the median follow-up was around 21 months rather than the full three years, only about a third of the men were followed for the whole 36 months, and there was no untreated comparison group, so the study cannot measure relative risk. It is a contribution to the evidence rather than an answer to it \u2014 and the shift in thinking it belongs to is set out in <a href=\"https:\/\/drsoaraweeurology.com\/2026\/05\/19\/testosterone-prostate-cancer-saturation-model\/\">testosterone and prostate cancer: the saturation model<\/a> and in <a href=\"https:\/\/drsoaraweeurology.com\/2021\/11\/26\/testosterone-replacement-therapy\/\">the honest balance of benefits and risks<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A safety trial that finds no increase in the feared harm has shown the absence of that harm. It has not shown a benefit. Those are different results and they are often reported as the same one. The fuller account of the cardiovascular question is in <a href=\"https:\/\/drsoaraweeurology.com\/2026\/09\/23\/testosterone-therapy-heart-safety-traverse\/\">testosterone and the heart<\/a>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What Is Available Here<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">At Bangkok Hospital Headquarters I provide testosterone as <strong>gels and injections<\/strong>. Pellets are common in the United States and are almost never used in Thailand; oral testosterone products vary by country and are not part of my practice. Where preserving fertility is the priority, clomiphene citrate, hCG or an aromatase inhibitor may be more appropriate than testosterone itself. Practical technique for the injectable route is covered in <a href=\"https:\/\/drsoaraweeurology.com\/2026\/06\/09\/subcutaneous-testosterone-injection-how-to-do-it-yourself\/\">the guide to subcutaneous self-injection<\/a>, and the wider metabolic picture in <a href=\"https:\/\/drsoaraweeurology.com\/2026\/08\/04\/beyond-the-needle-and-the-gel-testosterone-weight-loss-and-mens-metabolic-health\/\">testosterone, weight loss and men\u2019s metabolic health<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Testosterone bought online or from a gym is a different proposition altogether. The contents are not guaranteed, the dose is often far above replacement, and nobody is monitoring your haematocrit.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">The Bottom Line<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">If you are over 40 with a genuine fall in sexual desire, loss of morning erections and fatigue, that is worth investigating properly rather than self-treating. The investigation is a correctly taken morning test repeated on a second day, with LH, FSH and a look for the conditions that suppress testosterone in the first place. Distinguishing organic from functional hypogonadism is what determines whether the answer is hormonal or metabolic, and that distinction is the starting point of the <a href=\"https:\/\/drsoaraweeurology.com\/services\/testosterone-replacement-therapy\/\">low testosterone evaluation and treatment<\/a> pathway. A fuller discussion of fertility, prostate and heart questions is in <a href=\"https:\/\/drsoaraweeurology.com\/2026\/06\/23\/testosterone-therapy-today-fertility-prostate-cancer-heart-health-explained\/\">testosterone therapy today<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Appointments.<\/strong> Consultations are arranged through the hospitals: <a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Bangkok Hospital Headquarters<\/a>, or Samitivej Sriracha Hospital in Chonburi on <a href=\"tel:0880221445\">088-022-1445<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients \u2014 arrange it in advance by email to the Urology department at <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>. Samitivej Sriracha is in-person only. Enquiries about cost are answered by the hospital rather than through this website; please email the same address.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Frequently Asked Questions About Low Testosterone<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">What are the most common symptoms of low testosterone?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The most specific symptoms are sexual \u2014 a definite fall in libido, loss of spontaneous morning erections, and erectile dysfunction. Fatigue, low mood, reduced muscle mass and increased central fat can accompany it, but each of those is caused far more often by sleep apnoea, diabetes, thyroid disease or depression than by testosterone, so they are not enough on their own to make the diagnosis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">What is the difference between organic and functional hypogonadism?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Organic hypogonadism involves permanent damage somewhere in the hormonal axis and usually needs testosterone replacement. Functional hypogonadism is testosterone suppressed by outside factors such as obesity or type 2 diabetes, with no structural damage, and it is frequently reversible when those factors are corrected.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">How should testosterone be tested correctly?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Blood is drawn in the morning between 7:00 and 10:00 while fasting, and a single low reading is confirmed on a separate day. It should not be measured during an acute illness or shortly after one, because that suppresses the level temporarily. LH and FSH are measured alongside it to separate a testicular cause from a pituitary one.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Does testosterone therapy affect fertility?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Yes, and substantially. Testosterone given from outside suppresses the body\u2019s own signal to the testes and sperm production falls with it, frequently to zero. Recovery after stopping usually takes months and sometimes a couple of years, and it is not guaranteed. If you may want children, raise it before the first dose \u2014 a semen analysis beforehand is sensible, and clomiphene citrate, hCG or an aromatase inhibitor can raise testosterone while preserving sperm production.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Which adverse findings in TRAVERSE were statistically significant?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Two. Erythrocytosis \u2014 a rise in red cell count \u2014 was by far the clearest, which is why haematocrit is monitored throughout treatment. Clinical fractures also rose significantly, by roughly 43%, in the fracture subtrial. Atrial fibrillation, pulmonary embolism and acute kidney injury were each numerically higher on testosterone but did not reach statistical significance, and should not be described as established harms. An earlier version of this page listed those three without that qualification.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Is testosterone therapy safe for the heart and the prostate?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">For the heart, the TRAVERSE trial found no increase in heart attack, stroke or cardiovascular death, meeting the criterion for non-inferiority. For the prostate, no increase in prostate cancer was seen \u2014 but the trial excluded men with a previous prostate cancer, so it does not answer that question. A safety trial showing the absence of a feared harm is not the same as a trial showing benefit.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Can low testosterone be reversed without medication?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">In functional hypogonadism, often yes. Losing at least 5% to 10% of body weight raises testosterone \u2014 on pooled data, by around 70 ng\/dL with dietary weight loss and around 200 ng\/dL after bariatric surgery, in proportion to the weight lost. Treating underlying conditions such as type 2 diabetes and obstructive sleep apnoea helps too, and this remains the best management strategy for that group.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Which forms of testosterone are used in your practice?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Gels and injections. Pellets are common in the United States and almost never used in Thailand, and oral testosterone products vary by country; neither is part of my practice. Where fertility is the priority, clomiphene citrate, hCG or an aromatase inhibitor may be the better route.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">When should I seek urgent medical attention?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">If you are on testosterone therapy: chest pain, breathlessness on less exertion than usual, pain or swelling in one calf, sharp chest pain worse on breathing in, an irregular or racing heartbeat, or any stroke symptom even if it resolves \u2014 same-day emergency department, and 1669 in Thailand. If you have not started treatment: low testosterone with new headaches, loss of peripheral vision, or milky nipple discharge points to the pituitary and needs assessment rather than a testosterone prescription.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">References<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>De Silva NL, Papanikolaou N, Grossmann M, Antonio L, Quinton R, Anawalt BD, Jayasena CN. Male hypogonadism: pathogenesis, diagnosis, and management. <em>Lancet Diabetes Endocrinol<\/em>. 2024;12(10):761\u2013774.<\/li>\n\n\n<li>Lincoff AM, Bhasin S, Flevaris P, et al. Cardiovascular safety of testosterone-replacement therapy (TRAVERSE). <em>N Engl J Med<\/em>. 2023;389(2):107\u2013117.<\/li>\n\n\n<li>Snyder PJ, Bauer DC, Ellenberg SS, et al. Testosterone treatment and fractures in men with hypogonadism. <em>N Engl J Med<\/em>. 2024;390(3):203\u2013211.<\/li>\n\n\n<li>Bhasin S, Lincoff AM, Nissen SE, et al. Effect of testosterone on progression from prediabetes to diabetes in men with hypogonadism: a substudy of the TRAVERSE randomized clinical trial. <em>JAMA Intern Med<\/em>. 2024;184(4):353\u2013362.<\/li>\n\n\n<li>Coady PJ, Walia A, Oppenheimer A, Hernandez BS, Chidananda R, Hinojosa-Gonzalez DE, Weerasopone S, Kohn T, Khera M. Testosterone replacement therapy in male octogenarians: clinical outcomes and adverse event rates. <em>J Sex Med<\/em>. 2026;23(9):qdag258.<\/li>\n<\/ul>\n\n\n\n<script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@graph\": [\n    {\n      \"@type\": \"MedicalWebPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2026\/04\/28\/low-testosterone-2024-guide\/#webpage\",\n      \"url\": \"https:\/\/drsoaraweeurology.com\/2026\/04\/28\/low-testosterone-2024-guide\/\",\n      \"name\": \"Low Testosterone in Men: What the Evidence Actually Supports\",\n      \"headline\": \"Low Testosterone in Men: What the Evidence Actually Supports\",\n      \"description\": \"How male hypogonadism is diagnosed and treated: organic versus functional deficiency, correct testing, the modest size of the benefit, what treatment costs in fertility, and which of the TRAVERSE adverse findings reached statistical significance.\",\n      \"inLanguage\": \"en\",\n      \"datePublished\": \"2026-04-28\",\n      \"dateModified\": \"2026-08-29\",\n      \"lastReviewed\": \"2026-08-29\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#website\" },\n      \"author\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"reviewedBy\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"publisher\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"about\": [\n        { \"@id\": \"https:\/\/drsoaraweeurology.com\/2026\/04\/28\/low-testosterone-2024-guide\/#hypogonadism\" },\n        { \"@id\": \"https:\/\/drsoaraweeurology.com\/2026\/04\/28\/low-testosterone-2024-guide\/#testosterone-therapy\" }\n      ],\n      \"citation\": [\n        { \"@type\": \"ScholarlyArticle\", \"name\": \"Male hypogonadism: pathogenesis, diagnosis, and management\", \"isPartOf\": { \"@type\": \"Periodical\", \"name\": \"The Lancet Diabetes & Endocrinology\" }, \"datePublished\": \"2024\" },\n        { \"@type\": \"ScholarlyArticle\", \"name\": \"Cardiovascular safety of testosterone-replacement therapy\", \"isPartOf\": { \"@type\": \"Periodical\", \"name\": \"The New England Journal of Medicine\" }, \"datePublished\": \"2023\", \"identifier\": \"10.1056\/NEJMoa2215025\" },\n        { \"@type\": \"ScholarlyArticle\", \"name\": \"Testosterone treatment and fractures in men with hypogonadism\", \"isPartOf\": { \"@type\": \"Periodical\", \"name\": \"The New England Journal of Medicine\" }, \"datePublished\": \"2024\", \"identifier\": \"10.1056\/NEJMoa2308836\" },\n        { \"@type\": \"ScholarlyArticle\", \"name\": \"Effect of testosterone on progression from prediabetes to diabetes in men with hypogonadism\", \"isPartOf\": { \"@type\": \"Periodical\", \"name\": \"JAMA Internal Medicine\" }, \"datePublished\": \"2024\", \"identifier\": \"10.1001\/jamainternmed.2023.7862\" },\n        { \"@type\": \"ScholarlyArticle\", \"name\": \"Testosterone replacement therapy in male octogenarians: clinical outcomes and adverse event rates\", \"isPartOf\": { \"@type\": \"Periodical\", \"name\": \"The Journal of Sexual Medicine\" }, \"datePublished\": \"2026\", \"identifier\": \"10.1093\/jsxmed\/qdag258\" }\n      ],\n      \"disambiguatingDescription\": \"Testosterone therapy at this practice is provided as gels and injections only. Pellets and oral testosterone products are described for completeness but are not offered. Testosterone therapy suppresses sperm production, frequently to azoospermia; clomiphene citrate, hCG and an aromatase inhibitor are the fertility-preserving alternatives used. CORRECTION 29 August 2026: an earlier version of this page listed atrial fibrillation, pulmonary embolism and acute kidney injury as findings TRAVERSE recorded, without stating that none of those differences reached statistical significance, and described the fracture finding as slightly more when it was a statistically significant increase of approximately 43%. Erythrocytosis, the clearest significant adverse effect in the trial, was not identified as such. All three have been corrected. The octogenarian cohort cited on this page is one to which the author contributed as a co-author, not as first author; its follow-up figures were checked against the published paper and the description of its duration corrected.\"\n    },\n    {\n      \"@type\": \"MedicalCondition\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2026\/04\/28\/low-testosterone-2024-guide\/#hypogonadism\",\n      \"name\": \"Male hypogonadism (low testosterone)\",\n      \"alternateName\": \"Testosterone deficiency\",\n      \"description\": \"Impaired testosterone production, divided into organic hypogonadism from irreversible pathology of the hypothalamic-pituitary-testicular axis, and functional hypogonadism driven by obesity, type 2 diabetes and comorbidity, which is frequently reversible.\",\n      \"signOrSymptom\": [\n        { \"@type\": \"MedicalSignOrSymptom\", \"name\": \"Reduced libido\" },\n        { \"@type\": \"MedicalSignOrSymptom\", \"name\": \"Loss of spontaneous morning erections\" },\n        { \"@type\": \"MedicalSignOrSymptom\", \"name\": \"Erectile dysfunction\" },\n        { \"@type\": \"MedicalSignOrSymptom\", \"name\": \"Fatigue, low mood and reduced muscle mass (non-specific)\" }\n      ],\n      \"riskFactor\": [\n        { \"@type\": \"MedicalRiskFactor\", \"name\": \"Obesity\" },\n        { \"@type\": \"MedicalRiskFactor\", \"name\": \"Type 2 diabetes\" },\n        { \"@type\": \"MedicalRiskFactor\", \"name\": \"Obstructive sleep apnoea\" },\n        { \"@type\": \"MedicalRiskFactor\", \"name\": \"Previous testicular surgery, chemotherapy or radiotherapy\" },\n        { \"@type\": \"MedicalRiskFactor\", \"name\": \"Pituitary disease\" }\n      ],\n      \"typicalTest\": {\n        \"@type\": \"MedicalTest\",\n        \"name\": \"Morning fasting total serum testosterone, confirmed on a second day\",\n        \"description\": \"Drawn between 07:00 and 10:00 while fasting and repeated on a separate day, because day-to-day variation is substantial. It should not be measured during or shortly after acute illness, which suppresses the level temporarily. Calculated free testosterone is added where SHBG is shifted by age or obesity. LH and FSH separate a testicular cause from a pituitary one and determine whether hCG could work at all.\"\n      },\n      \"primaryPrevention\": {\n        \"@type\": \"LifestyleModification\",\n        \"name\": \"Weight loss and treatment of underlying metabolic disease\",\n        \"description\": \"Health optimisation is the gold-standard management strategy for functional hypogonadism. Losing at least 5 to 10 percent of body weight raises testosterone, on pooled data by approximately 70 ng\/dL after dietary weight loss and approximately 200 ng\/dL after bariatric surgery, in proportion to the weight lost.\"\n      }\n    },\n    {\n      \"@type\": \"MedicalTherapy\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2026\/04\/28\/low-testosterone-2024-guide\/#testosterone-therapy\",\n      \"name\": \"Testosterone replacement therapy\",\n      \"description\": \"Replacement of testosterone by gel or injection in men with confirmed deficiency. Pooled trial evidence shows statistically significant but modest improvement in sexual function, with desire responding more reliably than erectile function. It is not a treatment for ageing, diabetes or fracture prevention.\",\n      \"seriousAdverseOutcome\": [\n        { \"@type\": \"MedicalEntity\", \"name\": \"Erythrocytosis\", \"description\": \"The clearest and most statistically robust adverse effect in the TRAVERSE trial, occurring several times more often on testosterone than on placebo. Haematocrit is checked before starting and monitored throughout treatment; it is the commonest reason for dose reduction, change of preparation or a pause.\" },\n        { \"@type\": \"MedicalEntity\", \"name\": \"Clinical fracture\", \"description\": \"Statistically significant increase of approximately 43% in the TRAVERSE fracture subtrial, around 3.5% versus 2.5%, with curves separating within the first months and ribs, wrist and ankle the commonest sites. Testosterone should not be prescribed to protect bone despite improving bone mineral density on imaging.\" }\n      ],\n      \"adverseOutcome\": [\n        { \"@type\": \"MedicalEntity\", \"name\": \"Suppression of sperm production, frequently to azoospermia, with recovery over months to years and not guaranteed\" },\n        { \"@type\": \"MedicalEntity\", \"name\": \"Worsening of untreated obstructive sleep apnoea\" },\n        { \"@type\": \"MedicalEntity\", \"name\": \"Transfer of gel by skin contact, causing virilisation in a child or partner\" },\n        { \"@type\": \"MedicalEntity\", \"name\": \"Atrial fibrillation (numerically higher in TRAVERSE but NOT statistically significant)\" },\n        { \"@type\": \"MedicalEntity\", \"name\": \"Pulmonary embolism (numerically higher in TRAVERSE but NOT statistically significant)\" },\n        { \"@type\": \"MedicalEntity\", \"name\": \"Acute kidney injury (numerically higher in TRAVERSE but NOT statistically significant)\" }\n      ],\n      \"contraindication\": {\n        \"@type\": \"MedicalContraindication\",\n        \"name\": \"Active desire for fertility, untreated obstructive sleep apnoea, and known untreated prostate cancer\"\n      },\n      \"followup\": \"Haematocrit and PSA before starting and regularly afterwards. Semen analysis before starting if fertility may be wanted. Same-day emergency assessment for chest pain, breathlessness on reduced exertion, unilateral calf pain or swelling, pleuritic chest pain, palpitations, or stroke symptoms even if they resolve; the Thai emergency number is 1669.\",\n      \"study\": [\n        {\n          \"@type\": \"MedicalStudy\",\n          \"name\": \"TRAVERSE: Cardiovascular Safety of Testosterone-Replacement Therapy\",\n          \"description\": \"Randomised 5,246 men aged 45 to 80 with hypogonadism and cardiovascular disease or risk factors, mean follow-up 33 months. Testosterone was non-inferior to placebo for major adverse cardiovascular events. Erythrocytosis and, in the fracture subtrial, clinical fractures rose significantly. Atrial fibrillation, pulmonary embolism and acute kidney injury were numerically higher but did not reach statistical significance. The prespecified diabetes substudy found no significant effect on progression from prediabetes to diabetes. Men with a history of prostate cancer were excluded.\"\n        },\n        {\n          \"@type\": \"MedicalStudy\",\n          \"studyDesign\": \"https:\/\/schema.org\/Observational\",\n          \"name\": \"Testosterone replacement therapy in male octogenarians: clinical outcomes and adverse event rates\",\n          \"description\": \"Single-centre retrospective cohort of 46 hypogonadal men aged 80 or older starting testosterone therapy. 39% had a history of prostate cancer and no biopsy-confirmed recurrence occurred during follow-up. Median follow-up was approximately 21 months, with about a third of participants followed to 36 months, and there was no untreated comparator, so relative risk cannot be assessed.\"\n        }\n      ]\n    },\n    {\n      \"@type\": \"FAQPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2026\/04\/28\/low-testosterone-2024-guide\/#faq\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2026\/04\/28\/low-testosterone-2024-guide\/#webpage\" },\n      \"mainEntity\": [\n        {\n          \"@type\": \"Question\",\n          \"name\": \"What are the most common symptoms of low testosterone?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"The most specific symptoms are sexual - a definite fall in libido, loss of spontaneous morning erections, and erectile dysfunction. Fatigue, low mood, reduced muscle mass and increased central fat can accompany it, but each of those is caused far more often by sleep apnoea, diabetes, thyroid disease or depression than by testosterone, so they are not enough on their own to make the diagnosis.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"What is the difference between organic and functional hypogonadism?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Organic hypogonadism involves permanent damage somewhere in the hormonal axis and usually needs testosterone replacement. Functional hypogonadism is testosterone suppressed by outside factors such as obesity or type 2 diabetes, with no structural damage, and it is frequently reversible when those factors are corrected.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"How should testosterone be tested correctly?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Blood is drawn in the morning between 07:00 and 10:00 while fasting, and a single low reading is confirmed on a separate day. It should not be measured during an acute illness or shortly after one, because that suppresses the level temporarily. LH and FSH are measured alongside it to separate a testicular cause from a pituitary one.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Does testosterone therapy affect fertility?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Yes, and substantially. Testosterone given from outside suppresses the body's own signal to the testes and sperm production falls with it, frequently to zero. Recovery after stopping usually takes months and sometimes a couple of years, and it is not guaranteed. If you may want children, raise it before the first dose - a semen analysis beforehand is sensible, and clomiphene citrate, hCG or an aromatase inhibitor can raise testosterone while preserving sperm production.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Which adverse findings in TRAVERSE were statistically significant?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Two. Erythrocytosis, a rise in red cell count, was by far the clearest, which is why haematocrit is monitored throughout treatment. Clinical fractures also rose significantly, by roughly 43%, in the fracture subtrial. Atrial fibrillation, pulmonary embolism and acute kidney injury were each numerically higher on testosterone but did not reach statistical significance, and should not be described as established harms.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Is testosterone therapy safe for the heart and the prostate?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"For the heart, the TRAVERSE trial found no increase in heart attack, stroke or cardiovascular death, meeting the criterion for non-inferiority. For the prostate, no increase in prostate cancer was seen, but the trial excluded men with a previous prostate cancer, so it does not answer that question. A safety trial showing the absence of a feared harm is not the same as a trial showing benefit.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Can low testosterone be reversed without medication?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"In functional hypogonadism, often yes. Losing at least 5% to 10% of body weight raises testosterone - on pooled data, by around 70 ng\/dL with dietary weight loss and around 200 ng\/dL after bariatric surgery, in proportion to the weight lost. Treating underlying conditions such as type 2 diabetes and obstructive sleep apnoea helps too, and this remains the best management strategy for that group.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Which forms of testosterone are used in your practice?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Gels and injections. Pellets are common in the United States and almost never used in Thailand, and oral testosterone products vary by country; neither is part of my practice. Where fertility is the priority, clomiphene citrate, hCG or an aromatase inhibitor may be the better route.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"When should I seek urgent medical attention?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"If you are on testosterone therapy: chest pain, breathlessness on less exertion than usual, pain or swelling in one calf, sharp chest pain worse on breathing in, an irregular or racing heartbeat, or any stroke symptom even if it resolves - same-day emergency department, and 1669 in Thailand. If you have not started treatment, low testosterone with new headaches, loss of peripheral vision, or milky nipple discharge points to the pituitary and needs assessment rather than a testosterone prescription.\" }\n        }\n      ]\n    }\n  ]\n}\n<\/script>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Disclaimer:<\/strong> This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for general education only and does not constitute medical advice, diagnosis or treatment for any individual. No advice, diagnosis or prescription is given through personal messaging channels or social media, and Dr. Soarawee operates no public social media account. Always consult a qualified doctor about your own symptoms. In an emergency in Thailand, call 1669.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Few areas of men\u2019s health attract as much marketing as low testosterone. What the large trials actually found, how the test should be done, what therapy reliably improves \u2014 and the one thing it costs you that is rarely mentioned before the first dose.<\/p>","protected":false},"author":185281453,"featured_media":9416,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"Low testosterone symptoms, how to test correctly, and what the evidence supports about treatment \u2014 including what testosterone therapy does to fertility, and what TRAVERSE found in full.","jetpack_seo_html_title":"Low Testosterone in Men: Diagnosis and Treatment Evidence | Dr. Soarawee","jetpack_seo_noindex":false,"jetpack_seo_schema_type":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_wpcom_ai_launchpad_first_post":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_wpas_customize_per_network":false,"jetpack_post_was_ever_published":false},"categories":[1363],"tags":[],"class_list":["post-9402","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-mens-health"],"jetpack_publicize_connections":[],"jetpack_likes_enabled":false,"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/pgZdrK-2rE","jetpack_featured_media_url":"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/Low-Testosterone.webp?fit=1200%2C630&ssl=1","_links":{"self":[{"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/posts\/9402","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/users\/185281453"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/comments?post=9402"}],"version-history":[{"count":27,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/posts\/9402\/revisions"}],"predecessor-version":[{"id":11775,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/posts\/9402\/revisions\/11775"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/media\/9416"}],"wp:attachment":[{"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/media?parent=9402"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/categories?post=9402"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/tags?post=9402"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}