Rationale:
Symptoms or signs of testicular failure, such as loss of morning erections, infertility, enlarged breasts, small testicles, reduced body hair, decreased need for shaving, loss of muscle mass and strength, or osteoporosis, should be present before testing testosterone levels.
Complaints like reduced libido, erectile dysfunction, fatigue, low energy, and decreased performance or vitality are common in the general population, even when testosterone production is normal. While testosterone levels gradually decline with age, the reduction is highly individual, and most men maintain levels within the normal range throughout life. Lifestyle factors—especially increasing weight/BMI—seem to have a greater impact on testosterone levels than aging itself. Many symptoms of testicular failure can be difficult to distinguish from those associated with natural aging.
Reference:
- Svartberg JB, Jørgensen AP, Haave EM, et al. Mannlig hypogonadisme. Nasjonal Veileder i Endokrinologi. September 2021.