Low testosterone (Low T or male hypogonadism) is a condition where the body does not produce a sufficient amount of the hormone testosterone. This deficiency can lead to a variety of physical and emotional changes, prompting individuals to seek medical guidance. Deciding which medical professional to consult can be confusing, as the condition involves both the endocrine system and reproductive health. Understanding the roles of different practitioners makes navigating the healthcare system for this diagnosis and subsequent management straightforward.
The First Step: Primary Care Providers
The journey to address low testosterone begins with a Primary Care Provider (PCP) or General Practitioner. This doctor serves as the necessary first point of contact for an initial assessment of symptoms and overall health status. The PCP will conduct a thorough review of your medical history, including any medications you are taking, which may sometimes influence hormone levels.
A PCP’s initial role involves ordering the first round of diagnostic blood work, which typically includes a total testosterone level test. This test must be performed in the morning, ideally between 8 a.m. and 10 a.m., because testosterone levels naturally peak early in the day. The PCP also works to rule out other common medical conditions, such as thyroid disorders or sleep apnea, which can present with similar symptoms like fatigue and low energy.
If the initial blood test shows a result below the established threshold, generally less than 300 nanograms per deciliter (ng/dL), the PCP will often order a second confirmatory test on a different day. The results of these initial tests, combined with a physical examination, will determine whether the case is mild enough for the PCP to manage or if a referral to a specialist is required.
Specialist Options: Endocrinologists and Urologists
When a low testosterone diagnosis is confirmed and requires specialized evaluation, two main types of specialists are typically involved: endocrinologists and urologists. The choice between them depends on where the issue is believed to originate within the body’s complex hormonal pathways.
An endocrinologist specializes in the endocrine system, which is the network of glands that produce hormones, including the pituitary and hypothalamus in the brain. They are the preferred specialist if the low testosterone is suspected to be secondary hypogonadism, meaning the issue lies with the brain not signaling the testes correctly. This specialist is best equipped to diagnose and manage complex systemic or glandular issues, such as pituitary dysfunction or other related hormonal disorders.
A urologist, conversely, specializes in the male reproductive system and the urinary tract. They are the appropriate choice when the cause is suspected to be primary hypogonadism, which means the testes themselves are not producing enough testosterone, often due to injury, infection, or anatomical defects. Urologists are well-suited to manage cases where fertility preservation is a concern.
Confirming the Diagnosis: Necessary Medical Tests
A definitive diagnosis of low testosterone requires precise laboratory testing, which relies on more than just a single total testosterone measurement. Doctors often require two separate morning measurements to confirm a persistently low level before any treatment is considered.
Beyond the total testosterone test, doctors also frequently measure free testosterone, which is the unbound portion of the hormone that is biologically active and available for the body’s tissues to use. This free level can sometimes provide a more accurate picture of a patient’s functional hormone status than the total level alone.
Other important secondary blood tests include measuring Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH). Checking LH and FSH levels helps determine whether the cause of the low testosterone is originating from the pituitary gland (secondary hypogonadism) or the testes (primary hypogonadism). A doctor may also check prolactin levels, as high values can indicate a pituitary issue that suppresses testosterone production.
Understanding Treatment Options
Once a diagnosis of low testosterone is confirmed, the doctor will discuss various therapeutic interventions, most commonly Testosterone Replacement Therapy (TRT). TRT is administered in several forms, including intramuscular injections, topical gels or creams, and subdermal pellets. The doctor will select the best option based on the patient’s lifestyle, preference, and how their body responds to the initial therapy.
Forms of Testosterone Replacement Therapy
- Intramuscular injections are often given weekly or biweekly and are one of the most cost-effective methods, although they can cause peaks and troughs in hormone levels.
- Topical gels and creams are applied daily to the skin, offering a more consistent level of testosterone throughout the day, but they require caution to prevent transference to others.
- Subdermal pellets can be implanted under the skin every few months, providing a slow and steady release of the hormone.
Regardless of the form chosen, TRT is a long-term commitment that requires diligent medical monitoring. Follow-up blood work is typically performed every three to six months to measure testosterone levels and adjust the dosage. Doctors also screen for potential side effects by monitoring hematocrit (a measure of red blood cell concentration) and Prostate-Specific Antigen (PSA) levels.