Why testosterone matters

Charis Torrance

When people hear “testosterone”, they often picture extreme fitness or muscle gain. In reality, low testosterone often shows up quietly. Energy drops. Mood shifts. Relationships feel strained. Long-term health takes a knock. Many men dismiss these signs as stress, ageing, or a busy life. That delay costs more than most realise.

According to Dr Zodwa Dire, an endocrinologist at Mediclinic Morningside, symptoms depend on when testosterone levels fall.

“If onset is prior to puberty, symptoms include failure to complete puberty,” she explains. “If onset is after puberty, symptoms can be nonspecific with decreased vigour, low mood, decreased libido, infertility, reduced muscle mass and gynaecomastia among others.”

These symptoms overlap with many common conditions. That overlap explains why low testosterone often goes undiagnosed.

Testing and diagnosis

Diagnosis starts with a simple blood test. Timing matters.

“A fasting morning serum testosterone measurement is a good screening tool,” says Dr Dire. “Two measurements are required to confirm a low testosterone level.”

If symptoms persist, a GP visit is a practical first step. Early testing reduces guesswork and rules out other causes.

Treatment options and risks

For men diagnosed with low testosterone, treatment depends on the cause and severity. Testosterone replacement therapy helps some patients.

“The benefit of TRT is that it restores testosterone levels to normal concentration,” Dr Dire explains.

There are risks. TRT increases haemoglobin levels. Prostate size increases. The risk of blood clots rises. For this reason, treatment requires medical supervision and regular follow-up. TRT suits specific cases. It is not a general wellness fix.

Lifestyle factors still count

Daily habits affect testosterone more than many expect.

• Diets extremely low in fat are linked to lower testosterone
• Regular exercise supports natural production
• Sleep plays a direct role in hormone regulation

“Adequate sleep is necessary for testosterone production,” says Dr Dire.

Ignoring the problem

Untreated low testosterone affects the body over time.

Dr Dire warns of long-term effects, including loss of muscle mass, increased fat mass, reduced bone density and gynaecomastia.

The takeaway

Feeling flat, irritable, or disconnected from yourself is not something to ignore. Symptoms might feel vague, but they carry meaning. Early testing, medical advice, and realistic treatment choices protect long-term health.