Even as a doctor, I didn’t realise I was suffering low testosterone

There’s a growing buzz around testosterone and testosterone replacement therapy (TRT) – and much debate. What was once a rarely discussed hormone is now headline material, appearing everywhere from medical journals to social media feeds. As a doctor who needed TRT to reclaim his own health, I am naturally a strong advocate for appropriate, carefully monitored treatment. It transformed my energy, mood and quality of life. But I can see how the conversation has become distorted.

Testosterone is often either attacked as dangerous and reckless, or sold as a faddish miracle cure for almost every ailment affecting men over the age 40. The truth, as ever in medicine, lies somewhere between the two extremes. I was 29 when my journey with testosterone began. I was a newly qualified GP, and my wife and I were expecting our first baby, then I was diagnosed with testicular cancer. My left testicle was surgically removed, and I was placed under regular hospital follow-ups to monitor for signs of recurrence.

The diagnosis was a shock, but it wasn’t the hardest part of this journey. After surgery, and with some hindsight, I did perhaps experience some subtle changes: less energy, and some mild anxiety. At first, I put it down to stress and life with a newborn. But two years later, after a hospital admission with viral meningitis, everything changed far more dramatically.

From that point, I didn’t feel like myself for several years. I lived with a constant hum of anxiety and felt easily overwhelmed. I woke each morning exhausted and moved through the day in a fog. My mood was flat – motivation was a struggle. Beneath it was a persistent sense of defeat. I tried everything I could think of. I exercised regularly. I prioritised sleep, took regular naps and experimented with supplements, meditation and dietary changes.

Medically, I did what any responsible GP would advise: cognitive behavioural therapy (CBT), antidepressants, routine blood tests to check for the cause. I saw multiple GPs, a therapist and a psychiatrist. But I didn’t meaningfully improve. It was by far the most difficult time of my life.

During a cancer follow-up appointment, I mentioned the fatigue again and we agreed to check my testosterone. The result came back low, sitting beneath the reference range the lab provides. Because the NHS waiting time to see an endocrinologist was close to a year, I sought a private consultation. After further testing, I was started on TRT.

The results were incredible but also rather frustrating. Incredible because within weeks my energy and mental clarity began to return. And within months, my anxiety had eased and my mood lifted beyond anything I had experienced in years. Frustrating because I was a doctor, surrounded by doctors, and yet low testosterone had not been properly considered, despite the clear risk factors and symptoms.

TRT did not turn me into a different person. It allowed me to feel like myself again. Within a year, after immersing myself in the science of testosterone and men’s health, I knew this was the field I wanted to dedicate much of my career to: helping other men who may be struggling.

I’ve now been on TRT for five years. During this time, my wife and I have welcomed our third child, something we were able to achieve using a fertility protocol to support my sperm count. Professionally, I left general practice to focus full-time on hormone and health optimisation.

Why testosterone matters

When most people think of testosterone, they picture a bodybuilder, or associate it with sex. In reality, testosterone is a foundational hormone with receptors throughout the body. Its role goes far beyond libido, sexual function or muscle mass. It works in the brain and influences mood and cognitive function. It affects men physically, having a role with energy, bone density, red blood cell production, and metabolic health.

It regulates processes that affect daily life, resilience, and wellbeing. Understanding testosterone in this broader context explains why a deficiency can profoundly change how a man feels and functions, as well as his long-term health.

Average testosterone levels in men have declined significantly over recent decades. Contributing factors include obesity, poor sleep, chronic stress, sedentary lifestyles and environmental exposures. The result is more men experiencing issues at younger ages. Many men with low testosterone do not have obvious risk factors (such as testicular cancer or injury), making awareness and testing more important.

How to recognise low testosterone

Symptoms vary between men, but often more than one aspect of life is affected. While sexual symptoms such as low libido, reduced morning erections, or erectile difficulties, are the most commonly recognised, deficiency has other physical and psychological effects. Physical signs include fatigue, aches, proneness to injury and illness, increased fat and reduced muscle. Psychological effects can include brain fog, impaired memory, anxiety and low mood.

Beyond symptoms, low testosterone has been demonstrated to increase the risk of many health issues over time, including metabolic syndrome, type 2 diabetes, cardiovascular disease, osteoporosis, and even increased all-cause mortality. Low testosterone doesn’t just cause symptoms but also affects long-term health outcomes.

If you recognise any of these symptoms, speak to a GP or private physician who understands this hormone.

How it’s diagnosed

Blood tests are the first step. Assessing testosterone properly requires more than a single measurement and looks at more than only testosterone levels. A thorough evaluation considers overall health markers, organ function, and the wider hormonal system to understand the full picture. The goal is not just to identify a low level, but to determine why it is low and whether it can be corrected naturally or TRT is necessary.

It is also essential to rule out other potential causes. Remember, even classic symptoms of low testosterone may not actually result from testosterone deficiency. For example, an underactive thyroid can present very similarly.

What’s the treatment?

If you have a confirmed deficiency, the key question is to work out if TRT is the next best step. The basic aims of TRT are to correct the deficiency and address the symptoms and mitigate or prevent poor health outcomes over the longer term.

If this is via the NHS, you will often be offered either an injection or a gel. The injection is done roughly every quarter (about every 10 weeks), although some tweaks can be made depending on findings. Gel is applied daily, and the dose is adjusted based on the response and blood results. For any topical formula, it is important to avoid transference to others!

In my private clinic, I offer either micro-dosing of injections or a daily cream. The idea behind these methods is to achieve steady levels of hormones, rather than big peaks and troughs. Many of my patients administer their testosterone injections subcutaneously (into the fatty tissue layer between the skin and muscle), while others prefer the more traditional intramuscular (IM) route (deep into muscle tissue).

There are potential side effects, as with any medication. Some can be managed with changing the treatment protocol, others, such as the effect on fertility, must be carefully considered. Fertility issues arise from the fact that when you use TRT, the body down-regulates how much the testicles produce so a man’s sperm count will likely decline.

It’s NOT a lifestyle trend

TRT is not a quick fix, cosmetic trend or licence to ignore diet, sleep and lifestyle. While optimising testosterone can be transformative, it demands careful assessment, ongoing monitoring and an understanding of the wider context. After witnessing the volume of misinformation around men’s health, I felt compelled to write Testosterone Decoded. It unpacks why testosterone matters, how to assess it, dismantles the myths and clarifies the clinical considerations behind effective treatment.

Can it affect women?

Women produce testosterone as well, though in much smaller amounts. It plays a recognised role in sexual desire, energy and overall wellbeing. During perimenopause and menopause, testosterone levels decline alongside oestrogen, and some women experience reduced libido, fatigue and a loss of vitality as a result.

In the UK, testosterone is most commonly prescribed for women with persistent low sexual desire after appropriate HRT. Treatment differs significantly from men, using much lower doses and careful monitoring. The key point is that testosterone is not exclusively a “male hormone”. It is a human hormone, important in different amounts and contexts for both sexes.

• Testosterone Decoded: Understanding Testosterone, TRT and Male Hormone Health, by Dr Maxim Draper (Hammersmith Health Books, £18.99) is out now