For nearly two years, Abdul (name changed), a 42-year-old corporate executive, struggled with severe tiredness, weight gain and brain fog that made it difficult for him to focus at work.
He thought the problem was workplace burnout. He was also treated for depression, but his symptoms did not improve.
Further tests later showed that he had low morning testosterone and undiagnosed sleep apnoea. Once the sleep disorder was treated, his hormonal balance improved.
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In another case, a 38-year-old man believed his persistent headaches and low libido were linked to stress and getting older. Doctors later discovered a small, non-cancerous tumour in his pituitary gland.
Medication restored his testosterone levels, stopped his headaches and meant that he did not need testosterone replacement therapy.
Doctors said such cases show why men should not ignore persistent tiredness, weight gain, low libido or poor concentration. But they also warned that these symptoms do not always mean testosterone is low.
More men getting tested
Interest in testosterone testing appears to be rising. Metabolic recorded a 44 per cent year-on-year increase in patients undergoing total testosterone tests in 2024. This rose by 165 per cent in 2025, when the clinic carried out 2,383 tests.
Dr Ismail Arslan, endocrinologist at Metabolic, said many men live with symptoms for months or even years because they assume these are simply part of getting older or working long hours.
“The most common reason for their visit is some noticeable change in their sexual health, for example a decrease in libido, having fewer morning erections, or suffering from erectile dysfunction,” he said.
Other common complaints include constant tiredness, loss of muscle mass, weight gain around the abdomen, brain fog, poor concentration and lack of motivation.
It may not be testosterone
The problem is that many of these symptoms can also be caused by other conditions.
Poor sleep, obesity, diabetes, thyroid problems and depression can all leave a person feeling tired, low in mood or unable to concentrate.
Dr Arslan said doctors therefore look at the full picture before making a diagnosis.
“For example, severe snoring or sleep apnoea can disturb the deep sleep during which testosterone is naturally produced. Obesity can also affect hormone levels, and testosterone may improve after a patient loses weight.”
More specific signs, such as fewer morning erections, sexual dysfunction or changes in body hair, may point more strongly towards a hormonal problem.
Not every man has ‘andropause’
Testosterone levels usually peak when men are in their mid-20s and gradually begin to fall after the age of 30. However, Dr Arslan said men do not experience the same sudden hormonal change that women experience during menopause.
Age alone does not mean that every man in his 40s or 50s will develop low testosterone. Men who remain healthy and manage conditions such as obesity or diabetes may continue to have normal testosterone levels well into their 60s and 70s, he said.
One test is not enough
Doctors also warned against diagnosing low testosterone from a single blood test. Dr Arslan said a patient should have clear and persistent symptoms along with at least two separate low testosterone readings taken in the morning.
Testosterone levels are usually highest between 7am and 10am and fall later in the day.
Even a poor night’s sleep, severe stress, a viral infection or a heavy high-carbohydrate breakfast before testing can temporarily lower testosterone levels, he said.
Repeating the test helps doctors understand whether the reading reflects a real deficiency or only a temporary change.
When is TRT needed?
Testosterone replacement therapy, or TRT, may be considered for selected men who are diagnosed with hypogonadism.
Dr Ahmad Allam, specialist in urology and andrology at Trust Fertility Clinic, said the aim of treatment is to bring testosterone levels back into the normal range.
When medically required, TRT may help improve sexual health, mood and physical performance. “Doctors must first rule out other causes and complete the required tests before treatment begins,” said Dr Allam.
There is also an important fertility concern. External testosterone can reduce sperm production and, in some men, may stop it completely.
Dr Allam said: “TRT is not the preferred treatment for men who want children now or in the future. Such patients should discuss fertility with their doctor before starting treatment and may need a semen analysis.”
Doctors said men who continue to experience tiredness, low libido, weight gain or brain fog should seek medical advice rather than dismissing the symptoms as ageing or turning directly to testosterone treatment.
Source: Khaleej Times