Testosterone falls slowly with age, but genuine deficiency is less common than the adverts suggest. What counts as normal, when to see your GP, and NHS versus private TRT.
Reviewed, edited and approved by Editor-in-chief Daniel Sköld · Updated 23 October 2026
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Somewhere between your first reading glasses and your first conversation about prostate exams, someone will tell you that your testosterone is “falling off a cliff”. Usually it’s an advert. Sometimes it’s a man down the pub who now injects himself every Tuesday and wants to talk about it.
Here’s the less exciting truth. Your testosterone probably is lower than it was at 25, and for most men that’s not a problem. For a minority it really is a problem, though, and it’s worth finding out which group you’re in before you spend money on it.
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Does testosterone really drop after 50?
Yes, but slowly. In most men testosterone starts falling gently from about 30 or 40, by a small percentage each year. That’s a slow slope, not a cliff. The NHS is fairly blunt about it: this gradual drop alone is unlikely to cause problems, and the popular phrase “male menopause” is misleading. Unlike the menopause, men don’t have a sudden hormonal shutdown.
The things that push testosterone down further tend to be things you already know about. Carrying weight around your middle is a big one, and so are type 2 diabetes, poor sleep (especially untreated sleep apnoea), heavy drinking, long-term stress and some medicines, including opioid painkillers. So a 50-year-old who weighs 17 stone (108kg) and sleeps five hours a night may well have low testosterone. The question is which came first.
Doctors call a genuine deficiency hypogonadism, and if it appears later in life, late-onset hypogonadism. It’s a real medical condition. It’s just much rarer than the marketing suggests.
What is a normal testosterone level for a man over 50?
Testosterone is measured in nanomoles per litre (nmol/L). Every lab sets its own reference range, so don’t get too attached to one number. As a rough guide, UK specialist guidance from the British Society for Sexual Medicine says:
Below about 8 nmol/L, men with symptoms usually benefit from treatment. Between about 8 and 12 nmol/L is a grey zone where a trial of treatment may be considered if your symptoms fit. Above about 12 nmol/L, testosterone is unlikely to be causing your problems.
Two practical points matter more than the numbers. Testosterone peaks in the morning, so the test should be done early, ideally before 11am. Levels also bounce around, so one low result means nothing until it’s been repeated. Your GP may also check related hormones, such as SHBG (the protein that carries testosterone in the blood) and LH, which help show whether the problem is in the testes or the pituitary gland.
The free NHS Health Check, offered every five years to adults aged 40 to 74 in England, doesn’t include a testosterone test. Scotland, Wales and Northern Ireland don’t have an identical scheme. Wherever you live, you need to ask your GP.
A low number without symptoms isn’t a diagnosis, and symptoms without a low number aren’t a testosterone problem.
The symptoms worth taking to your GP
Classic signs of deficiency include low sex drive, erectile problems, fewer morning erections, tiredness that sleep doesn’t fix, loss of muscle and strength, more body fat, low mood and poor concentration. Hot flushes and loss of body hair can also happen.
The catch is that almost every one of those symptoms could also come from depression, an underactive thyroid, diabetes, heart disease, sleep apnoea, too much alcohol or the joys of a demanding job and teenage children. Erection problems in particular can be an early warning of heart and circulation trouble. That alone is a good reason to see a GP instead of ordering a hormone kit online.
A sensible GP appointment covers your symptoms, your medicines, your weight and blood pressure, and blood tests that include a properly timed testosterone check. If deficiency is confirmed, you may be treated in primary care or referred to an endocrinologist or urologist, depending on where you live and what’s causing it.
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NHS or private TRT: what’s the difference?
On the NHS, testosterone replacement therapy (TRT) is prescribed when there’s a confirmed deficiency and symptoms to match. It usually comes as a daily gel or as injections every few weeks or every few months. You’ll have regular monitoring, including blood tests for testosterone levels, red blood cell count (testosterone can thicken the blood) and, in older men, prostate checks. In England you pay the standard prescription charge for each item, and a prepayment certificate can cut the cost if you take regular medicines. Prescriptions are free in Scotland, Wales and Northern Ireland.
The common complaint is that the NHS is cautious and inconsistent. Some GPs are confident treating testosterone deficiency and others refer everything on. A 2025 consensus of UK clinicians published in the Journal of Sexual Medicine said recognition and management across the NHS needed to improve. So if you feel fobbed off, you’re not imagining it.
Private clinics fill that gap, at a price. Expect to pay for the first consultation, the blood tests, the medicine and ongoing monitoring, usually through a monthly plan. Costs vary widely, so ask for the full yearly figure before you sign up. Some clinics are excellent. Some treat men whose levels are normal, aiming for an “optimal” number that isn’t backed by solid evidence.
If you go private, check the clinic is registered with the regulator for your nation: the Care Quality Commission in England, Healthcare Improvement Scotland, Healthcare Inspectorate Wales or the RQIA in Northern Ireland. Make sure they test properly before prescribing, monitor you afterwards and share results with your GP. And never buy testosterone without a prescription. In the UK it’s a Class C controlled drug, and unregulated products can be contaminated, wrongly dosed or simply not what the label says.
Is testosterone therapy safe for men over 50?
For men with a genuine deficiency, the evidence is more reassuring than it used to be. The large TRAVERSE trial, published in the New England Journal of Medicine in 2023, followed men aged 45 to 80 with low testosterone and a raised risk of heart disease. It found no rise in heart attacks or strokes compared with placebo. It did find more cases of atrial fibrillation, blood clots in the lungs and acute kidney injury, so treatment isn’t risk-free.
The benefits are clearest for sex drive and sexual function. The effects on mood, energy, bone and muscle are smaller and less consistent. If you don’t actually have a deficiency, TRT isn’t a proven way to slow ageing.
Two more things to know. TRT suppresses sperm production and can cause infertility, which matters if you might still want children. And it’s usually a long-term commitment, because your own production may stay suppressed after you stop. Discuss both with your doctor first, and don’t start or stop treatment on your own.
The free alternatives are dull but they work. Losing weight if you carry too much, doing strength training two or more days a week, getting proper sleep, getting snoring checked for sleep apnoea and drinking within the 14-units-a-week guideline can all help raise testosterone naturally. They also help your heart, which is the organ most likely to cause you trouble.
In short
Testosterone falls slowly after 30 or 40, and for most men over 50 that’s normal and harmless. True deficiency means repeated low morning blood tests (roughly below 8 to 12 nmol/L) plus symptoms, and it should be confirmed by a GP before anyone prescribes anything. NHS treatment is cautious but properly monitored. Private TRT is faster but costs more, and only makes sense from a regulated clinic that tests first and keeps your GP informed.
Adrian Irving writes about health for men 45 and over who would rather do something than worry. Training, weight loss, sleep, cholesterol and blood tests, heart health, testosterone, the prostate, mental health and your sex life – what the evidence says, what's worth trying, and when it's time to see your GP.
One of Midcent's writers. Spotted something? Write to adrian@midcent.uk.
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