Testosterone is the most important male sex hormone and influences men's lives from before birth through old age. Starting in the womb of his mother, testosterone drives the development of male genitals. During puberty, testosterone helps a teenager build muscles, deepens his voice, develop facial hair and increases the size of his penis and testes. In adulthood, it enables a man to maintain strong muscles and bone and other male attributes, and is a key factor to his sex drive.

Causes and Symptoms of Low Testosterone

The medical term for low testosterone is hypogonadism and is often referred to as andropause (male version of the more commonly known, menopause).  In some cases, hypogonadism is caused by an underlying medical condition in which the body does not produce enough testosterone, such as a dysfunctional testes or a defect in the pituitary gland or hypothalamus which instruct the testes to produce testosterone.  The much more common type of hypgonadism is a natural part of a man's life where his hormones begin to decline around the age of 35 and continue to decrease with age. However, below 300 ng/dL, testosterone is generally considered to be low.

Common symptoms of low testosterone are low sex drive, fatigue, reduced muscle mass and bone density, mood changes and erectile dysfunction.

Testosterone Replacement Therapy (TRT)

Also called Androgen Replacement Therapy (ART)
There are three basic methods to deliver testosterone:  oral, transdermal (through the skin) or sub-dermal (directly into the tissue below the skin).

Oral Testosterone

Traditional oral testosterone is quickly deactivated by the liver and can result in liver toxicity and is generally not used anywhere worldwide. Oral testosterone undecanoate  is a specially formulated oral testosterone tablet that enables testosterone to be absorbed through the small intestine into the lymphatic system, putting less burden on the liver. It is available in many countries but does not have FDA approval and, therefore, not available in the U.S. Two other oral methods, sublingual (under the tongue) and buccal (against the gums), allow the testosterone to slowly absorb directly into the bloodstream and bypass the gastrointestinal system and liver, thus avoiding liver toxicity. These oral methods, however, are very inconvenient for the user and are not popular.

Topical / Transdermal

Testosterone gels, solutions, and patches are applied to the skin daily.


There are two methods of getting testosterone directly into tissue below the skin.

  • Injections - usually in the upper buttock, are typically given every 1-2 weeks. A new 10-week injection therapy was recently approved by the FDA.
  • Pellets - implanted under the skin near the hip by a doctor and replaced as needed, approximately every 3-4 months. This routine procedure can be done in a doctor's office.

If interested in testosterone replacement therapy, see your doctor for the method that will work best for you.

Low Testosterone and Premature Ejaculation

There is no known correlation between low testosterone and premature ejaculation. In a 2008 study publish in the Journal of Sexual Medicine(1), only 12% of 714 patients 25-40 years old with premature ejaculation symptoms had low testosterone.  Although 12% is somewhat higher than the normal population in that age group, this study does not show a  link between LowT and PE.

(1) Reference:   Corona, G. et. al., Different testosterone levels are associated with ejaculatory dysfunction. J  Sex Medicine 2008 Aug;5(8):1991-8

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