Low testosterone: signs, testing and treatment options

Signs of low testosterone in men can include:

• A low sex drive
• Trouble getting or keeping an erection
• Low energy or feeling tired
• Low mood, feeling cranky, or trouble focusing
• Less face or body hair
• Breasts that get bigger
• Thin bones

These signs are common, and other health problems can cause them too. That is why a blood test is needed.

Some medicines can lower testosterone, such as opioid pain medicines and steroid pills.

A blood test measures your total testosterone. Levels are highest in the morning and change from day to day, and eating can lower them for a while. So the test is done in the morning before you eat, and it is done twice, on two different days.

A doctor should only call it low testosterone when you have symptoms and both results are low.

Wait to test if you are sick or getting over an illness, or if you are taking opioid pain medicine for a short time. These can lower testosterone for a while.

Other blood tests help find the cause. LH and FSH show whether the problem starts in the testicles or in the signals from the brain. A doctor may also check prolactin and iron.

Testosterone itself can be given as a gel, a shot or a patch. It is a controlled drug. It also lowers the body's own sperm production, so it is not a good choice for men who want to have a baby soon.

Clomiphene is a pill that tells your body to make more of its own testosterone. It is not testosterone, and it is not a controlled drug. The FDA approved it to help women get pregnant. Using it for low testosterone in men is called off-label use. It is not expected to stop sperm production.

In a study that looked back at 400 men who took clomiphene, most reached a normal testosterone level. But this kind of study is weaker than a controlled trial, and large, long-term trials are still missing.

Stop the pill and get care today, without waiting for a reply from us, for any change in your vision, very bad belly pain, a very bad headache, or yellow skin or eyes. Do not drive until your vision is checked.

Call 911 or go to the emergency room for chest pain, trouble breathing, coughing up blood, a swollen painful leg, sudden vision loss, weakness on one side, trouble speaking, a drooping face, or sudden or very bad pain in a testicle.

Tell your doctor if your breasts get bigger or sore while you take it.

Go to the emergency room now for sudden or very bad pain in a testicle, or testicle pain with nausea, throwing up or belly pain. It can be a twisted testicle, which needs care right away.

See a doctor in person for:

• A lump or swelling in a testicle
• A new kind of headache, headaches with changes in your vision, or milky fluid from a nipple. These can be signs of a problem with the pituitary, a small gland under the brain that helps control testosterone.

If you are in Virginia or West Virginia, you can start a visit online at any time. It is for men 18 to 64 with symptoms of low testosterone and two low testosterone tests from the last 6 months, each taken before 10 in the morning on a different day.

You bring your lab reports. For this plan, we do not order your lab tests. Your own doctor can order them, or you can buy them from a lab that sells tests to the public. Tests you order yourself can cost a few hundred dollars, paid to the lab. Each report must show your name, the lab's name, and the date and time the blood was drawn. Besides the two testosterone tests, the plan needs LH, FSH, prolactin, iron tests, estradiol, a blood count, liver tests, and cholesterol with triglycerides, plus a PSA test if you are 40 or older.

A board-certified physician reads every report. If clomiphene is right for you, the doctor can send it to your pharmacy. Testosterone itself is never prescribed through QuickVisitMD.

It is not the right fit if you:

• Want testosterone itself
• Are 65 or older
• Are trying to have a baby now (a fertility doctor should lead)
• Have had a blood clot, or have a clotting disorder
• Have liver disease, a pituitary problem, seizures, prostate or breast cancer, or a lump in a testicle
• Have high LH and FSH with low testosterone (a hormone specialist should lead)
• Compete in a sport that tests for drugs (clomiphene is banned at all times)
• Have any of the warning signs above

Your first visit starts at $59. Your first check-in after you start is free, and each later check-in is $39. You pay the lab for tests and the pharmacy for the medicine. You do not need insurance.