Let’s Talk About Testosterone (Yes, It’s Okay to Ask)
“Doc… could it be my testosterone?”
I get that question more often than you’d think—usually from men in their 40s, sometimes younger. They come in complaining of things like low energy, stubborn weight gain, brain fog, or a just-not-feeling-like-myself vibe that’s hard to describe. And they’ve often waited months—or years—to bring it up.
Here’s the thing: low testosterone is common. More common than the textbooks let on, especially here in North Texas where long work hours, chronic stress, and sleep disruption seem to be the norm for a lot of guys.
So let’s unpack this a bit. Why testosterone might be low, what it actually does, how I typically evaluate it in clinic, and—just as importantly—what your options are if yours is low.
Testosterone 101: The Cliff Notes Version
Testosterone is a hormone made mainly in the testicles (and a small amount in the adrenal glands). It plays a big role in:
- Libido (yep, sex drive)
- Muscle mass and strength
- Red blood cell production
- Bone density
- Mood, memory, and motivation
- Fat distribution
Most guys produce the most testosterone in their late teens and 20s. By about age 30, levels start to drift down gradually—roughly 1% per year. But in some men, the drop is faster… or steeper.
Here’s where things get murky. The “normal” range is wide. One guy might feel fine at 350 ng/dL. Another might feel awful at 420. That’s why we don’t just treat numbers—we treat you.
So… Why Might Testosterone Be Low?
Plenty of reasons. And often, it’s not just one.
- Age: Sure, that’s a factor. But I’ve seen low T in 30-year-old night shift workers who never see the sun.
- Sleep apnea: A big one. Poor sleep wrecks testosterone. I can’t count how many guys we’ve sent for sleep studies after a low T finding.
- Obesity and insulin resistance: Visceral fat—especially the kind around your belly—lowers T and raises estrogen.
- Medications: Opioids, steroids, even some antidepressants can suppress testosterone.
- Chronic stress: Cortisol, your stress hormone, is basically testosterone’s arch-nemesis.
- Alcohol and cannabis: Yep, heavy use affects hormone balance.
- Environmental toxins: This is real. BPA and phthalates in plastics, for instance, can act as endocrine disruptors.
Patient Story:
I had a patient recently—45-year-old HVAC tech from Flower Mound. Hardworking guy. Came in exhausted, irritable, gaining weight around the middle. He chalked it up to “just getting old.” Turns out he had untreated sleep apnea, borderline diabetes, and testosterone at 310 ng/dL. Fixing the sleep and glucose made a bigger impact than TRT initially. It was a great reminder that hormone issues are rarely isolated.
What Symptoms Should You Watch For?
These are the kinds of things I hear from my patients:
“I just don’t feel like myself anymore.”
“I’m tired all the time—even after 8 hours of sleep.”
“My sex drive has tanked and I’m embarrassed to talk about it.”
“I used to hit the gym and get results. Now… nothing.”
“Everything annoys me lately. My patience is gone.”
Sometimes it’s subtle—like difficulty concentrating, a drop in motivation, or just feeling emotionally flat. Not depressed, exactly, but not fully present either.
Lewisville-Specific Trend:
What I’ve noticed in our local patient population is that many men here—especially in tech, trucking, or shift-based jobs—present not with classic low libido, but with fatigue and brain fog. Possibly linked to irregular sleep and high summer heat messing with cortisol rhythms. It’s not always the same presentation you’d read in a textbook.
How We Check for It (And Why Timing Matters)
If I suspect low T, here’s my general approach:
- Detailed history and physical exam
- Morning blood draw between 7–10 AM (T levels peak early)
- Check total testosterone, free testosterone, and SHBG
- Evaluate related labs: CBC (for anemia), estradiol, LH/FSH, prolactin, sometimes thyroid and cortisol
We don’t just test and prescribe. If it’s low, we want to understand why. Is it primary (testicles not producing)? Or secondary (brain not signaling correctly)? That distinction changes how we treat it.
What Can You Do About It?
Let’s break it down:
1. Lifestyle Tweaks First
For mild to moderate symptoms, we often start with:
- Weight loss (especially belly fat)
- Strength training (biggest natural T booster out there)
- Sleep optimization (CPAP if needed)
- Cutting back alcohol/cannabis
- Stress management (easier said than done, I know)
In many cases, this is enough to move the needle. Especially if your T is in that “low-normal” 350–450 range.
2. Testosterone Replacement Therapy (TRT)
When lifestyle alone isn’t enough—or symptoms are severe—we may consider TRT. Options include:
- Injections (testosterone cypionate/enanthate) – Usually every 1–2 weeks
- Topical gels or creams – Daily, applied to shoulders or arms
- Pellet implants – Last 3–6 months, inserted under the skin
Each method has pros and cons. I tailor it based on your lifestyle, insurance, and lab trends. For example, injections can cause peaks and crashes if not spaced right. Gels require daily consistency. Pellets are convenient but can be overkill if you’re borderline low.
Teachable Moment:
One of my patients—early 50s, on testosterone injections—came in with a slightly elevated hematocrit. We had to back off the dosing and increase his hydration. It reminded me that more isn’t always better. TRT is powerful medicine—it needs monitoring.
“But Doc… Isn’t Testosterone Dangerous?”
This comes up a lot. There’s been concern over TRT and heart risk. But here’s what recent studies suggest:
- A 2023 meta-analysis in JAMA found no increased cardiovascular risk in men on monitored TRT with appropriate dosing.
- Another trial showed improved metabolic markers—like insulin sensitivity and waist circumference—in treated men.
My Take:
In healthy men with true hypogonadism, properly managed TRT is safe. The danger is from unregulated clinics pushing overly aggressive dosing, or skipping regular labs.
Questions I Hear in the Clinic All the Time:
“Isn’t this just part of aging?”
Not always. Yes, testosterone drops with age—but it shouldn’t tank you. If it’s affecting quality of life, it’s worth evaluating.
“Can I just take a supplement from GNC?”
Most OTC testosterone boosters don’t work. Some are downright risky. I always recommend testing before trying anything.
“Will TRT shrink my testicles?”
It can—because your brain thinks the job is done and stops signaling the testicles. That’s why we sometimes use hCG alongside TRT in men who want to preserve fertility.
“Can I get off TRT once I start?”
Sometimes, yes. If it’s being used temporarily (say, after a stressful illness or medication), we can try a taper. But if your baseline levels are very low, you may need ongoing therapy.
“What does it cost?”
Depends. Some insurance plans cover TRT. In other cases, we work with local pharmacies to keep it affordable—around $50–100/month for most patients.
Final Thoughts from the Clinic
Low testosterone isn’t a “vanity” diagnosis. It’s not just about muscles or libido. It affects how you feel, think, move, and relate to the world. And you’re not alone if you’re struggling with it.
At Health Express Clinics, we take a whole-patient approach. That means not just slapping on a prescription—but looking at the full picture: sleep, stress, diet, meds, labs, and your life goals.
If something feels off, don’t chalk it up to age. Let’s talk. Even if it’s not low T, we’ll figure out what’s going on—and get you back on track.
👨⚕️ Summary & Next Steps
If you’re tired, foggy, low on drive, or just not feeling yourself—it might be your testosterone. Or maybe something else that looks like it. Either way, don’t guess. Get checked.
We’re here to help—judgment-free, data-driven, and focused on your whole health.