Androgen deficiency means your body produces too little of the hormones, primarily testosterone, that drive muscle growth, bone density, sex drive, energy levels, and mood. In men, a total testosterone level below 8 nmol/L (about 230 ng/dL) strongly supports a diagnosis, while levels above 12 nmol/L are generally considered normal. The condition affects roughly 5.6% of men between ages 30 and 79, climbing to 18.4% in men over 70. Women can also develop androgen deficiency, though it’s harder to measure and less well understood.
What Androgens Actually Do
Androgens are a family of hormones. Testosterone is the most well known, but the group also includes a more potent form that plays a key role in skin, hair, and prostate tissue. These hormones work by binding to androgen receptors found in cells throughout the body, switching certain genes on or off. That signaling system controls a surprisingly wide range of functions: building and maintaining muscle, keeping bones strong, regulating fat distribution, producing red blood cells, and fueling sexual desire.
In men, androgens are essential for the development of male sex organs during fetal life, the changes of puberty (voice deepening, facial hair, muscle growth), and ongoing reproductive health in adulthood. In women, androgens are produced in smaller amounts by the ovaries and adrenal glands. They contribute to libido, energy, and bone health. Research using genetic mouse models has confirmed that androgen receptor function matters for female reproduction as well, not just male physiology.
Symptoms in Men
The signs of androgen deficiency depend heavily on when it starts. If testosterone is very low during fetal development, a baby with male chromosomes may be born with incompletely developed or ambiguous genitals. If the deficiency begins before puberty, it can delay or prevent typical development: the voice may not deepen, facial and body hair may not grow, and muscle mass may remain low. The arms and legs may grow disproportionately long relative to the torso, and breast tissue can develop.
Most people searching this term, though, are dealing with adult-onset deficiency. The early symptoms tend to be vague enough to blame on stress or aging: lower sex drive, less energy, and depressed mood. Over time, more specific problems emerge. Erectile dysfunction, difficulty concentrating, hot flashes, loss of muscle mass, and increased body fat are all common. Because these symptoms overlap with so many other conditions, blood testing is necessary to confirm the diagnosis.
Symptoms in Women
Androgen deficiency in women typically shows up as persistent low libido, fatigue, and a general decline in well-being, particularly when estrogen levels are otherwise normal. The Princeton Consensus Statement defined female androgen insufficiency as a pattern of clinical symptoms combined with decreased bioavailable testosterone and normal estrogen status. One complication is that current lab tests aren’t very reliable at measuring the low testosterone levels typical in women, so diagnosis often depends on clinical judgment as much as bloodwork.
Common Causes and Risk Factors
Androgen deficiency falls into two broad categories based on where the problem originates. Primary hypogonadism means the testes (or ovaries) themselves aren’t producing enough hormone. This can result from genetic conditions, injury, infection, or certain cancer treatments. Blood tests in primary hypogonadism show low testosterone alongside elevated levels of the pituitary hormones that normally stimulate hormone production, because the brain is essentially shouting at glands that can’t respond.
Secondary hypogonadism means the problem is upstream, in the pituitary gland or hypothalamus. These brain structures aren’t sending the right signals, so the testes or ovaries never get the instruction to ramp up production. Tumors, head injuries, and certain medications can cause this. In secondary hypogonadism, both testosterone and the signaling hormones from the pituitary are low or inappropriately normal.
Beyond these two categories, several everyday health factors significantly raise the risk. Obesity roughly doubles the odds of androgen deficiency. Diabetes, high blood pressure, and high cholesterol are all independently associated with lower testosterone, and the relationship likely runs in both directions: low testosterone promotes metabolic problems, and metabolic problems suppress testosterone. Chronic opioid use is another major contributor. Research comparing different opioids found that some carry dramatically higher risk than others, but daily use of any opioid is a well-established cause of clinically low testosterone, with consequences including bone loss, depression, and sexual dysfunction. Age over 50, combined with two or more of those metabolic conditions, further increases risk.
How Testing Works
Testosterone levels fluctuate throughout the day, peaking in the early morning and dropping as the day goes on. For an accurate reading, blood should be drawn before 10:00 AM or within three hours of waking, ideally in a fasting state. Testing should happen when your sleep schedule is stable (not during jet lag or shift changes) and when you’re generally healthy, since acute illness or hospitalization can temporarily tank levels.
Even under ideal conditions, testosterone levels naturally vary by 10 to 15% from day to day, meaning two successive tests on the same person can differ by up to 30%. That’s why guidelines call for at least two separate morning blood draws before making a diagnosis. A result in the gray zone between 8 and 12 nmol/L typically requires additional testing of free or bioavailable testosterone to clarify the picture. For women with regular menstrual cycles, blood should be drawn between days 4 and 10 of the cycle for the most reliable result.
Treatment Options
The most common forms of testosterone replacement are topical gels and intramuscular injections. Gels are generally the preferred starting point because they’re convenient, produce relatively stable hormone levels throughout the day, and tend to be well covered by insurance. You apply the gel daily to the skin, typically on the shoulders or upper arms.
Injections are given every one to two weeks and are effective but produce more pronounced peaks and valleys in hormone levels. Some people notice a surge of energy and mood improvement in the days after an injection, followed by a dip before the next one. Skin patches are another option, applied daily and rotated to different body sites. For people who want less frequent dosing, small testosterone pellets can be implanted under the skin of the buttocks, abdomen, or thigh every three to six months. Oral and buccal (cheek) formulations also exist, though they’re used less often.
For women, androgen replacement is available in several forms, but none has been specifically approved for treating sexual dysfunction or other symptoms of female androgen insufficiency. Treatment in women remains more individualized and is typically guided by symptom response.
Once on stable replacement therapy, men are generally monitored with annual blood tests. The goal is symptom improvement alongside testosterone levels in the normal range, not maximum levels.
Who Should Not Use Testosterone Replacement
Testosterone replacement is contraindicated in men with untreated prostate cancer or breast cancer. Men at elevated risk for prostate cancer, including those with a first-degree relative who had it and African American men with elevated PSA levels, need careful evaluation before starting. Sleep apnea is a relative concern as well: testosterone can worsen symptoms in people who already have it, and anyone starting treatment should be aware of that possibility. The distinction between primary and secondary hypogonadism also matters for treatment planning, since certain medications that stimulate the body’s own testosterone production only work when the testes are still functional. If the problem is testicular failure, those options won’t help.