Low Testosterone in Men: 10 Signs You Shouldn’t Ignore

Ashley Harwyn, PA-C  |  ABAAHP Diplomate  |  Updated August 31, 2026  |  11 min read

A man walks into our Mount Pleasant office with a printout he found online in Charleston. Ten symptoms, seven of them checked, and a conclusion already formed. Sometimes he is right. Often he is not, and the difference matters more than either of us would like.

The symptoms of low testosterone are real. The problem is that a checklist cannot tell you whether you have it, and the standard that can is more specific than most clinics will admit. What that standard involves, and what testosterone therapy at this practice actually looks like, is the rest of this piece.

The ten signs, and what they are actually good for

Low libido. Reduced erection quality. Fatigue that sleep does not fix. Loss of muscle despite training. Weight gain around the middle. Low mood. Flat motivation. Poor concentration. Reduced body hair. Disturbed sleep.

Those are the ten, and they are worth taking seriously. Four of them, low libido, erection quality, fatigue and muscle loss, are the ones most consistently associated with genuine testosterone deficiency. The rest are what clinicians call non-specific, which is a polite way of saying they show up in men with normal testosterone just as often.

So the honest use of a checklist is as a reason to get tested, not as a result. If someone hands you one and a prescription pad in the same visit, you have learned something about that clinic.

What the diagnostic standard actually requires

Three things, and all three have to be present.

The morning requirement is not a formality. Testosterone follows a daily rhythm and is highest early. An afternoon draw can read low in a man whose morning level is entirely normal, and that is one of the more common routes onto therapy a man did not need.

If your number came from a convenient afternoon appointment, it is worth repeating properly before anyone makes a decision from it.

The question nobody asks first

Whether you want children.

The AUA is direct about this: exogenous testosterone therapy should not be prescribed to men who are currently trying to conceive, and the long-term impact on sperm production should be discussed with any man interested in future fertility [1]. Both carry their strongest recommendation grade.

Testosterone from outside the body suppresses the signal that tells the testes to produce sperm. For some men that reverses when therapy stops. For some it does not, or takes a long time. There are treatment approaches that raise testosterone without shutting that down, and they need to be on the table before you start, not after.

A clinic that does not ask this question in the first visit is not running a full assessment.

What changed at the FDA in 2025

The labels, and the change is more nuanced than the headlines suggested.

In February 2025 the FDA announced class-wide labeling changes for all testosterone products, removing the boxed warning about increased cardiovascular risk [2]. That followed the TRAVERSE trial, which randomized 5,246 men aged 45 to 80 with testosterone below 300 ng/dL and either established cardiovascular disease or elevated risk, and found testosterone non-inferior to placebo for major adverse cardiac events [3].

Three pieces of precision the headlines dropped. The same FDA action added a new warning about increased blood pressure [2]. TRAVERSE itself recorded higher rates of pulmonary embolism and atrial fibrillation in the testosterone group [3]. And the limitation of use for age-related hypogonadism was retained [2].

Removing a warning is not the same as demonstrating a benefit. The AUA's own position remains that before starting treatment, patients should be counseled that it cannot be stated definitively whether testosterone therapy increases or decreases cardiovascular risk [1]. That is still the honest summary.

When the symptoms are real and the level is normal

This is the outcome men are least prepared for, and it is common.

Fatigue, low mood, weight gain, poor concentration and reduced libido have a long list of causes that have nothing to do with testosterone. Untreated sleep apnea produces all of them and can lower testosterone directly. Thyroid dysfunction, iron deficiency, poorly controlled blood sugar, medication effects and depression all belong on the list.

A clinic that measures only testosterone can only ever find a testosterone problem. That is not a diagnostic process, it is a sales funnel with a blood draw attached.

The Endocrine Society reaches the same place from a different direction, recommending against routine screening of the general population and advising that treatment be reserved for men with unequivocally low levels and consistent symptoms [4]. Two major bodies, one conclusion: measure properly, or do not treat.

Getting assessed properly in Charleston or Mount Pleasant

Charleston has no shortage of clinics that will move from a checklist to a prescription inside one visit, and the Mount Pleasant stretch of Highway 17 has several. Greater Charleston is a busy market for testosterone, which is exactly why the diagnostic standard matters here. If you get as far as a consultation, the six questions to ask a Charleston men's clinic before you start testosterone will separate a real evaluation from a fast one. If you want the full picture, our men's health evaluation guide covers a complete workup.

Solcara Health sees patients at two locations. The Mount Pleasant office is at 496 Bramson Ct, Ste 120, convenient to Old Village, I'On, Park West and Daniel Island. The downtown practice is at The Longevity Club, 163 Rutledge Ave, Ste 202, in the medical district near MUSC and easy to reach from Harleston Village, West Ashley, Sullivan's Island and Isle of Palms.

Ashley Harwyn, PA-C is a Diplomate of the American Board of Anti-Aging Health Practitioners (ABAAHP) through A4M. Testosterone is assessed here against the diagnostic standard rather than a questionnaire, which sometimes means the answer is that your testosterone is fine and something else is going on. That is a less profitable answer than a Charleston prescription, and it is more often the correct one.

What a first visit involves

A conversation about which symptoms you actually have and how long they have been there, your sleep including whether anyone has told you that you stop breathing, your training and what has changed, your medications, and whether children are in your plans. Laboratory work follows from that conversation, and the first draw is scheduled early morning because an afternoon result cannot be interpreted.

Questions men actually ask

Ashley Harwyn, PA-C ABAAHP Diplomate · Founder, Solcara Health Online

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About the author

Ashley Harwyn, PA-C

Founder, Solcara Health · Diplomate of the American Board of Anti-Aging Health Practitioners (ABAAHP) through A4M

Ashley has practiced medicine for more than fifteen years. Her path into it began at home, with a family member born with a congenital heart defect and a childhood spent watching how much the quality of a clinician's attention could change the shape of a life. She has since practiced across a range of settings, including medical mission work in Uganda, before founding Solcara to build the kind of practice she kept wishing existed, one that treats women as whole people and tells them the truth about what the evidence does and does not support.

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