Should I be tested for 'Low-T?'

Perhaps prompted by all the ads for drugs such as AndroGel 1.62% and Axiron, many men attribute their lagging libido to reduced testosterone levels. But stress, depression, lack of sleep or exercise, work load, or changed feelings about your partner can all have the same negative effect on your sex drive without affecting your testosterone level.

So can some drugs, including antidepressants, antihypertensives, and opioid pain relievers. In addition, diabetes, obesity, and certain other conditions can not only affect sexual function, but can also lower levels of the hormone. All of those problems should be ruled out and addressed before resorting to testosterone testing, let alone use of testosterone drugs.

Testing can make sense if you have symptoms that are more typical of low testosterone levels, or hypogonadism, including loss of body hair or muscle mass, breast enlargement, or testicular shrinkage. But even then you should proceed with caution, since getting accurate results can be difficult, interpreting them can be even more complicated, and treatment may not be warranted even when your levels really are low.

If it seems likely that your symptoms do stem from abnormally low testosterone levels, testing can be appropriate. But to get accurate results, the test should be done in the morning, when testosterone levels are highest. And they should be done more than once, at the same lab, since levels can vary from day to day and from lab to lab.

"The tests are notoriously inaccurate, especially at the lower end of the normal range, and that makes it hard to tell the difference between results that are 'low normal' and those that are abnormally low," says Marvin M. Lipman, M.D., chief medical adviser for Consumer Reports and a specialist in endocrinology, the field of medicine that focuses on hormones such as testosterone.

Even if your doctor is confident that your symptoms stem from testosterone levels that are truly low, the decision to treat demands careful consideration. That's because testosterone poses significant risks, including, blood clots, increased LDL (bad) cholesterol, heart attacks, reduced fertility, sleep apnea, prostate enlargement, and possibly faster-growing prostate cancer. And gel forms of testosterone can be transferred through skin contact, so women and children should avoid touching unwashed and unclothed areas of skin where a man has applied the gel.

If you do take a testosterone drug, contact your doctor immediately if you notice signs of sleep apnea, swelling of your feet and ankles, marked weight gain, mood swings, or enlarged or painful breasts.

Read more about the risks associated with testosterone drugs, and for tips on how to manage erectile dysfunction, see our report Choosing Wisely: Treatment for erection problems.

—Ginger Skinner