Tired all the time? Do not blame testosterone just yet
Fatigue, a low sex drive and a thickening middle can point to low testosterone. They can also point to a dozen other things. Here’s how to tell, and what to do.
Reviewed, edited and approved by Editor-in-chief Daniel Sköld · Updated 30 October 2026
Contents
You wake up tired, you flag by mid-afternoon and the sofa has started to feel like a lifestyle choice. Somewhere online, an advert with a man in his fifties and suspiciously good arms is telling you it’s your testosterone.
It might be. Most of the time it isn’t, or not only that. Low testosterone is real, it’s treatable and it’s under-diagnosed in some men. It’s also blamed for a lot of things it didn’t do. Here’s how to work out which camp you’re in without spending a fortune at a private clinic.
AD
Is it normal for testosterone to drop after 40?
Yes, a bit. Testosterone falls gently from your thirties or forties onwards, and the NHS describes the decline as slow and steady rather than a cliff edge. On its own, that gradual drop isn’t usually enough to cause problems.
This is why doctors aren’t keen on the phrase male menopause. Women go through a fairly sudden hormonal shift. Most men don’t. What some men do get is a genuine deficiency, often called late-onset hypogonadism, where levels fall low enough to cause symptoms. That’s a medical condition, not an inevitable part of turning 50.
The more common story is that something else, such as weight, sleep, stress, drink or a long-term illness, is pushing testosterone down. Fix the cause and the hormone often recovers on its own.
What are the symptoms of low testosterone in men?
The classic list includes a reduced sex drive, erection problems, fewer morning erections, tiredness, low mood, irritability, poor concentration, loss of muscle and strength, and more fat around the middle. Some men notice hot flushes or sweats, and over time bones can thin.
Spot the problem? Almost every one of those is also a symptom of something else. Depression causes fatigue and a low libido. So do poor sleep and heavy drinking. Erection problems can be an early warning sign of heart disease or type 2 diabetes, because the blood vessels involved are small and show damage early. An underactive thyroid, anaemia and the side effects of some medicines can produce much the same picture.
So the symptoms are a reason to get checked, not a diagnosis. The sexual symptoms, particularly a lost sex drive and fewer morning erections, tend to be the most telling.
The usual suspects behind a flagging hormone
If your testosterone does turn out to be low, the next question is why. A few culprits come up again and again.
Weight is the big one. Fat tissue, especially around the belly, converts testosterone into oestrogen, and carrying extra weight is closely linked with lower levels. The good news is that this works in reverse: losing weight tends to bring testosterone back up. Even losing a stone (about 6.4kg) is a sensible place to start.
Type 2 diabetes and obesity often travel together with low testosterone, which is why a GP may check your blood sugar at the same time.
Sleep matters too. Most of your daily testosterone is produced while you sleep, so short nights, shift work and obstructive sleep apnoea, the snoring-and-gasping condition your partner may have mentioned, can all drag it down.
Alcohol, long-term use of opioid painkillers or steroid tablets, and anabolic steroids from the gym can all suppress your own production. Chronic stress and illness do the same.
Low testosterone is often a symptom of how you are living, not the root cause of how you feel.
AD
How do I get my testosterone checked on the NHS?
Start with your GP. Tell them plainly what’s going on, sexual symptoms included. They’ve heard it all before, and the detail helps them decide what to test.
Testosterone is checked with a simple blood test. Levels are highest in the morning, so the sample is usually taken early in the day, and a low result is normally repeated before anyone draws conclusions, because levels bounce around. Your GP may also check other hormones, blood sugar, cholesterol, thyroid function and a full blood count to rule out other causes. If results are borderline or unusual, you may be referred to a specialist.
If you’re aged 40 to 74 in England and haven’t had a free NHS Health Check in the last five years, it’s worth booking one. It won’t test your testosterone, but it does look at blood pressure, cholesterol, weight and your risk of heart disease, stroke and type 2 diabetes, which are the very things that often sit behind low levels. Scotland, Wales and Northern Ireland don’t run the same programme, so ask your GP practice what checks are available where you live.
A word on private home testing kits. They can tell you a number, but a single finger-prick result taken at the wrong time of day, without a doctor looking at the whole picture, can mislead you in either direction.
Does testosterone replacement actually work?
For men with a confirmed deficiency and clear symptoms, testosterone replacement therapy (TRT) can help. It’s usually given as a gel rubbed into the skin or as injections. Men often report improvements in sex drive, mood and energy, and it can help with muscle and bone strength.
It isn’t a general-purpose midlife tonic, though. Mayo Clinic notes that the benefits for men whose low levels are simply down to ageing are much less clear. Treatment needs regular blood tests to monitor your red blood cell count and prostate, it can make sleep apnoea worse, and it shuts down sperm production, so it’s a poor choice if you’re still hoping to have children. Whether it’s right for you is a conversation for your GP or specialist, not something to buy online.
As for testosterone booster supplements, the evidence that over-the-counter herbal blends raise testosterone in a meaningful way is weak. Correcting a genuine zinc or vitamin D deficiency may help if you have one. Otherwise, save your money.
What reliably helps is the dull stuff. Lose weight if you’re carrying extra. Do resistance training two or three times a week. Aim for seven to nine hours of sleep, and get snoring checked. Keep within the UK guideline of 14 units of alcohol a week, spread over several days. None of it will appear in an advert, but all of it is backed by better evidence than the shiny pills.
If you have chest pain, sudden breathlessness or symptoms that worry you, don’t sit on them: call NHS 111 for urgent advice, or 999 in an emergency.
In short
Testosterone falls slowly with age, but a gradual drop rarely explains feeling tired all the time on its own. Fatigue, a low sex drive and a thickening waist can mean low testosterone, but they also point to poor sleep, weight, depression, diabetes or heart problems. See your GP for a proper morning blood test and a wider check-up before thinking about treatment or supplements. Losing weight, sleeping better, lifting weights and drinking less are the best-evidenced first steps.
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.
Feeling flat, tired and short-tempered in your fifties? Low testosterone is one possible cause, but often not the main one. Here’s how to tell, and how to get tested on the NHS.
Feeling tired, short-tempered and low on energy is easy to put down to age. Sometimes there’s a fixable cause, and a GP blood test will tell you more than a shelf of supplements.
Tired, flat and off sex? Low testosterone is possible, but it’s rarer than the adverts suggest. Here’s how to get tested properly and what actually helps.
Low vitamin D is common in UK winters and is often blamed for tiredness in midlife. Here’s what the NHS recommends, what the evidence says and when to see your GP.
