Symptom
Low energy and low libido in men.
Reduced drive, poor energy, low mood, weight gain around the middle and loss of strength can be related to hormonal, metabolic, sleep, medication, psychological or relationship factors.
In short
Low libido and low energy in men are commonly caused by low testosterone, insulin resistance and excess visceral fat, poor sleep or sleep apnoea, chronic stress and overtraining, thyroid disease, raised prolactin, nutrient deficiency, depression, alcohol and certain medicines. Testosterone should be measured on a morning sample, ideally twice, alongside SHBG, LH, FSH, prolactin and metabolic markers. Treatment depends on the cause, and is not automatically testosterone replacement.
Medically reviewed by Dr Arnav Kapur, MBBCh Cum Laude
The approach
Understand first. Then treat.
Symptoms rarely have a single cause. Low testosterone often coexists with visceral fat, poor sleep and high stress load, and each one worsens the others.
We assess the full picture, correct what is reversible, and consider hormone treatment where it is clinically justified and properly monitored.
What we measure
- Total and free testosterone on a morning sample, with SHBG
- LH, FSH, prolactin and oestradiol to distinguish the cause
- Thyroid function, ferritin, vitamin D and vitamin B12
- Glucose, insulin, HbA1c and lipid profile
- Body composition, including visceral fat and lean mass
- Sleep apnoea risk, stress load, alcohol, training volume and medicines
Testing done correctly
Testosterone varies through the day and between days. Morning sampling, repeat confirmation and SHBG measurement matter, because a single mid afternoon total testosterone result frequently misleads in both directions.
Reversible causes come first
Visceral fat, untreated sleep apnoea, heavy alcohol use, excessive training with inadequate fuelling, nutrient deficiency and some medicines all suppress testosterone. Addressing these sometimes restores levels without replacement therapy.
When replacement is appropriate
Where deficiency is confirmed on appropriate testing and symptoms fit, testosterone therapy may improve libido and sexual symptoms. Effects on energy, mood, cognition and body composition are less consistent and are not seen in every man. Treatment requires baseline assessment, a fertility discussion and ongoing monitoring of haematocrit, PSA and lipids.
Metabolic health is part of the same problem
Insulin resistance and low testosterone reinforce each other. Treating the metabolic side improves hormonal health, and improving hormonal health makes metabolic change easier to achieve.
Common questions
Answers before you book.
Is low libido always low testosterone?
No. Sleep, stress, mood, relationship factors, medicines, alcohol, thyroid disease and raised prolactin all contribute. Testing distinguishes them.
Will testosterone therapy affect fertility?
Testosterone replacement can suppress sperm production. If fertility matters now or later, this must be discussed before starting, and alternative approaches considered.
At what age does testosterone decline?
Levels decline gradually from roughly the fourth decade, but symptomatic deficiency at any age deserves assessment rather than being dismissed as normal ageing.
This page is general health information and is not medical advice. Testosterone therapy is prescription treatment that follows individual clinical assessment and requires monitoring.
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Centre of Advanced Medicine, 13 Scott St, Waverley, Johannesburg
Monday to Friday, 07:40 to 17:00
011 440 8721