Low Testosterone: Symptoms, Tests & TRT – What Men Need to Know

Are men being sold a solution to a problem they don’t have? A recent advertising campaign by Voy, featuring posters across the London Underground, has sparked debate about testosterone deficiency and the growing market for at-home testing kits and testosterone replacement therapy (TRT). The ads, posing questions like “Are your men hormones getting the better of you?” and asserting “It’s not him, it’s his hormones,” tap into anxieties about male vitality while raising concerns about overdiagnosis and unnecessary medical intervention.

The Rise of Direct-to-Consumer Testosterone Testing

Voy is not alone in offering these services. Companies like Numan, Optimale, Balance My Hormones, Alphagenix and Urban TRT all provide similar pathways: an initial blood test to assess testosterone levels (£33.95 with Voy), a confirmatory test, a medical consultation, and then a potential subscription to TRT. This aggressive marketing has led to a significant increase in testosterone blood testing, according to Dr. Rob Stevens, who runs The Men’s Health Clinic in Dorset. The global testosterone industry was valued at $114.3 million in 2025, with blood tests representing the largest segment of the market, according to research firm Future Market Insights.

What Does Testosterone Actually Do?

Testosterone plays a crucial role in many aspects of male health, influencing muscle and hair growth, bone density, fat distribution, mood, red blood cell production, and sexual development. While often associated with men, women too produce testosterone, albeit in much smaller quantities. Generally, testosterone levels decline with age; by age 40, an estimated 10 to 30% of men experience a decrease, explains Professor Suks Minhas, a consultant urologist and andrologist at Imperial College London.

Recognizing Genuine Deficiency: Symptoms and Concerns

However, a decline in testosterone doesn’t automatically equate to a health problem. Dr. Stevens emphasizes that while some men experience debilitating symptoms – including suicidal ideation – due to low testosterone, many others maintain healthy levels well into their 50s and 60s. The most common symptoms of testosterone deficiency include low mood, brain fog, fatigue, and reduced libido. Other potential indicators include increased abdominal fat, erectile dysfunction, and loss of muscle mass. It’s important to remember, though, that these symptoms are non-specific and can be caused by a multitude of factors, from poor sleep to underlying medical conditions like cancer.

The Pitfalls of Isolated Testing

This is where concerns about direct-to-consumer testing arise. Experts caution that a basic testosterone test, offered by many online companies, provides a limited snapshot of a person’s overall health. Dr. Stevens argues that “testing testosterone in isolation provides little or no useful information other than to sell TRT if it’s ‘low’.” He adds that it can also fuel health anxieties without providing meaningful insights. Low testosterone is often linked to other conditions, such as type 2 diabetes and metabolic syndrome, which increase the risk of cardiovascular disease. A comprehensive assessment is vital.

A Holistic Approach to Assessment

The recommended approach, according to Dr. Stevens, is to consult a registered healthcare professional for a comprehensive blood screening. This should include assessments of kidney function, thyroid levels, vitamin D, and zinc – all of which play a role in testosterone production. Lifestyle factors, such as stress management, sleep quality, nutrition, and exercise, should also be addressed before considering TRT. Often, improvements in these areas can naturally restore testosterone levels.

Understanding Testosterone Replacement Therapy (TRT)

TRT, typically administered via injection, works by suppressing the body’s natural testosterone production. As of this, it’s generally a lifelong commitment requiring ongoing monitoring for potential side effects, such as raised blood pressure and cholesterol. It’s a “controlled medicine for a reason,” Dr. Stevens stresses, and unnecessary prescribing without proper medical supervision can lead to long-term harm. TRT can also impact fertility, and patients are often prescribed additional hormones, like human chorionic gonadotropin (hCG), to maintain sperm production.

Cost and Access to Treatment

TRT can be expensive, typically costing upwards of £100 per month on a subscription basis. Access to TRT on the NHS is limited, as it requires ongoing follow-up care, which the health service struggles to provide given other priorities. There’s a lack of dedicated “men’s health specialists” within the NHS, making it difficult to navigate the system.

Addressing Misconceptions and Stigma

Part of the problem, Dr. Stevens suggests, is that testosterone deficiency isn’t adequately taught in medical school, and TRT still carries a stigma associated with bodybuilders. This can lead some doctors to dismiss the condition or view a diagnosis as emasculating, resulting in patients being misdiagnosed with depression and prescribed antidepressants – a similar experience reported by many women experiencing menopause who are not offered hormone replacement therapy (HRT).

The Positive Impact of Increased Awareness

Despite the concerns, the increased awareness generated by companies like Voy may have a positive effect. Dr. Stevens believes that open discussion about testosterone and men’s health is crucial. “There shouldn’t be any stigma,” he says. “After all, it’s just a hormone.”

Ensuring Accurate Testing and Timing

Professor Minhas highlights another critical aspect of accurate testing: timing. Testosterone levels fluctuate throughout the day, peaking in the morning before 10 am. Tests performed at other times may yield inaccurate results, leading to misdiagnosis. He emphasizes that testing must adhere to evidence-based guidelines and cautions against over-prescribing, as TRT also carries potential negative consequences.

the conversation around testosterone deficiency needs to be nuanced. While legitimate cases exist, a rush to medical intervention based on limited testing and aggressive marketing could do more harm than decent. A comprehensive assessment by a qualified healthcare professional, coupled with lifestyle modifications, remains the most sensible approach to addressing concerns about low testosterone.