You wake up tired, you go to bed tired, and somewhere in between you snapped at a colleague over the printer. Your drive, in every sense, has gone a bit quiet. Type those symptoms into a search engine and within seconds someone is trying to sell you a tub of something with a lion on the label.
Testosterone gets blamed for a great deal in midlife. Sometimes it really is the culprit. More often it isn’t, or it’s only one part of the problem. Here’s how to work out which, without spending a penny on pills you don’t need.
Does testosterone really drop in your 40s and 50s?
It does fall, but slowly. The NHS says levels drop by less than 2% a year from about the age of 30 or 40. That’s a gentle slope, not a cliff, and it doesn’t cause problems for most men.
This is why the NHS is wary of the phrase “male menopause”. The menopause is a sudden, universal hormonal shutdown. Most men get nothing like it. A smaller group do develop genuinely low testosterone later in life, which doctors call late-onset hypogonadism. It’s real and it can be treated, but it’s less common than the marketing would have you believe.
The NHS also points out that the symptoms people blame on hormones are often down to lifestyle or psychological causes: work stress, relationship trouble, money worries, drinking too much, sleeping too little. Which is less exciting than a hormone problem, but a lot easier to fix.
The symptoms that overlap (and why that’s a nuisance)
Low testosterone can cause tiredness, low mood, irritability, poor concentration, a lower sex drive, erection problems, loss of muscle and more fat around the middle. Mayo Clinic also lists reduced bone density and, now and then, hot flushes or sleep problems.
The trouble is that nearly every item on that list has a long queue of other suspects. Depression causes fatigue, low libido and poor concentration. So do an underactive thyroid, anaemia, type 2 diabetes and sleep apnoea. Several common medicines can do it too. So can three glasses of red every night, though nobody likes hearing that.
It works the other way as well. Carrying extra weight, especially round your middle, poorly controlled diabetes and broken sleep can all push testosterone down. So low testosterone is sometimes a result of your other problems rather than the cause of them.
Low testosterone is a diagnosis made from a blood test, not from a bad week and a quiz on a supplement website.
How do I get my testosterone tested on the NHS?
Start with your GP. Be specific: tell them about the tiredness, the mood, the sex drive, any erection problems and how long it has been going on. GPs see this every day, so there’s no need for euphemisms.
If they think a hormone problem is possible, they’ll arrange a blood test. Testosterone levels peak in the morning, so the test is normally done early in the day. Because levels vary, a low result is usually repeated before anyone draws conclusions. Your GP may check other things at the same time, such as thyroid function, blood sugar and a full blood count, because they’re often the real answer.
If you’re in England and aged 40 to 74, you’re also entitled to a free NHS Health Check every five years. It doesn’t test testosterone, but it does look at blood pressure, cholesterol, weight and diabetes risk, which are often tangled up in the same story. Scotland, Wales and Northern Ireland don’t run an identical national programme, so if you live there, ask your GP practice what checks are on offer.
If your symptoms come with a lump in your testicle, breast swelling, or chest pain, get seen promptly. Use NHS 111 for urgent advice and call 999 in an emergency.
What about testosterone boosters and private clinics?
The over-the-counter “testosterone boosters” sold online and in supplement shops usually contain mixes of herbs, zinc, vitamin D and the like. The evidence that they meaningfully raise testosterone in healthy men is weak. If you’re genuinely short of zinc or vitamin D, correcting that makes sense. If you aren’t, you’re mostly buying expensive optimism.
Private men’s health clinics offering testosterone replacement have multiplied. Some are run properly. Others are quick to prescribe after a single test. Testosterone therapy is a proper medical treatment with real benefits for men who are deficient, and it needs monitoring. It can affect red blood cell levels and fertility, and it means regular checks, including of your prostate. Whether it’s right for you is a conversation for a doctor who has your full history, not a decision to make from a slick landing page.
If you’re already on any hormone treatment, don’t stop or change it without speaking to whoever prescribed it.
The free fixes worth trying first
Whatever your blood test says, a handful of unglamorous habits help with energy, mood and, often, testosterone itself.
Lose some belly. The NHS says a waist of 94cm (37in) or more raises a man’s health risks. Losing even a stone (6.4kg) if you’re overweight can make a noticeable difference to how you feel.
Lift something heavy. Strength training two or more days a week is part of NHS activity guidance for adults, and it helps protect the muscle that midlife likes to take away.
Take sleep seriously. Seven or more hours, a regular bedtime, and fewer late-night screens. If your partner says you snore loudly or stop breathing in the night, mention it to your GP, because sleep apnoea drains both energy and testosterone.
Watch the drink. The UK guideline is no more than 14 units a week, spread over several days. Many men feel better on noticeably less.
And look at your head as well as your hormones. If low mood has lasted more than a couple of weeks, your GP can help, and in England you can refer yourself to NHS talking therapies.
In short
Testosterone falls only gradually with age, and most midlife tiredness and low mood come from sleep, weight, stress, alcohol or other health conditions rather than hormones alone. Genuinely low testosterone does exist, and the only way to know is a GP assessment with morning blood tests, usually repeated. Skip the shop-bought boosters, sort out the basics, and if you’re still running on empty, book that GP appointment.
Sources
Midcent Health
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.
