More Than Muscle: Testosterone and Hormone Health

The hormone testosterone plays a central role in men’s health, influencing energy, mood, body composition, and sexual function. While it’s normal for levels to decline with age, more men are seeking treatment for what they suspect is “low T,” without the full context of the hormone’s function.

Scott Selinger, MD, FACP, a board-certified internal medicine specialist and the Primary Care Clinic Lead for UT Health Austin’s Primary Care Clinic, has witnessed this sharp increase in patients asking about testosterone. His research shows a dramatic rise in testosterone prescriptions, particularly among younger men, many of whom may not actually need the treatment.

For men navigating symptoms or wondering what’s normal, the conversation starts with understanding how testosterone works and when therapy makes sense. Here, Dr. Selinger explains the role that testosterone plays in the male body and when hormone therapies are beneficial.

What is Testosterone?

Testosterone is a hormone made primarily in the testicles. It helps regulate everything from muscle mass and fat distribution to red blood cell production and sexual function. It also plays a role in mood and overall well-being.

“Its role is far-reaching,” Dr. Selinger says. “Testosterone levels contribute to how men look, feel, and show up in the world.”

Why Testosterone Levels Change

Testosterone levels, like many hormone levels, naturally decline with age, but lifestyle and environment have a strong influence too. Increased body fat, chronic stress, lack of exercise, alcohol, and poor sleep all contribute to lower levels. Mental health conditions, like depression or anxiety, can also impact hormone production.

Even environmental exposures, such as heat or microplastics, are suspected to disrupt hormonal balance.

“These shifts didn’t happen overnight,” says Dr. Selinger. “But we’re living in a world that makes it harder to maintain healthy levels.”

Signs and Symptoms of Low Testosterone

The signs of low testosterone aren’t always obvious. In fact, they can overlap with other health conditions like thyroid dysfunction, sleep apnea, or depression. However, if you are noticing these patterns, it can be a sign that you should get tested.

Common symptoms of low testosterone include:

• Low energy or chronic fatigue
• Decreased libido or sex drive
• Erectile difficulties
• Weight gain, especially around the midsection
• Loss of muscle mass
• Depressed mood or increased irritability
• Trouble concentrating or brain fog

“It’s not always clear whether low testosterone is the cause or the effect,” says Dr. Selinger. “That’s why we want to look at the full picture in our patients.”

And while a normal testosterone range is typically between 300 to 900 ng/dL, what’s “normal” isn’t the same as what’s ideal for every person. Some men feel fine with lower levels, while others may experience symptoms even within that range. This is why it is important to talk to your doctor about what is normal for you, not for the general population.

When to Get Tested

If symptoms are affecting your quality of life, talk to your primary care provider. A simple morning blood test can check your testosterone level. If results are low, they’re usually repeated to confirm accuracy.

Dr. Selinger emphasizes the importance of context. “We don’t routinely screen for low testosterone unless someone has symptoms,” he explains. “But if something feels off, it’s worth getting checked out by someone who can interpret the full story, not just a number.”

Testosterone Replacement Therapy

For men with consistently low testosterone and symptoms that interfere with daily life, testosterone replacement therapy (TRT) may be an option. It’s not a quick fix, but it can help improve mood, energy, libido, and strength when prescribed appropriately.

Still, therapy shouldn’t be the first step for most patients. “Many men can significantly increase their testosterone levels through lifestyle changes,” says Dr. Selinger. “Weight loss, better sleep, and mental health support can raise testosterone naturally and improve long-term health, before turning to TRT.”

When treatment is appropriate, options include:

• Topical gels or oral medications: Mimic the body’s natural hormone rhythm and are generally well-tolerated
• Injectable testosterone: Common due to insurance coverage, but may carry higher risks for heart issues if not closely monitored

Risks and Side Effects of TRT

Testosterone therapy can be safe when managed carefully. However, it does come with risks, particularly for younger men.

Potential side effects of TRT include:

• Reduced fertility or sperm production (especially in younger patients)
• Increased red blood cell count, raising the risk of blood clots
• Heart rhythm changes or cardiovascular concerns
• Fluid retention or swelling
• Acne or oily skin
• Sleep disturbances

TRT also shuts down the body’s own testosterone production, which can make stopping therapy challenging. Ongoing follow-up with a healthcare professional is essential.

Understanding the Rise in Testosterone Clinics

Since 2020, testosterone prescriptions have increased dramatically, especially among men under 45. Some of this shift relates to pandemic-era lifestyle changes, including more time indoors, rising stress, delayed care, and growing focus on personal health.

In many cases, though, men are self-diagnosing with low testosterone based on what they read online and turning to independent telehealth clinics that promise fast fixes. Dr. Selinger’s research found that thousands of patients were prescribed testosterone by a single provider, far beyond the few patients most primary care doctors treat per year.

These clinics often skip key evaluations, such as repeat testing or screening for underlying conditions. That can lead to overprescription for people who don’t need it.

“When testosterone therapy is handed out too freely or without good follow-up, it can do more harm than good,” Dr. Selinger says.

Seeing the Bigger Health Picture

For many men, the real issue isn’t low testosterone — it’s the accumulation of stress, poor sleep, burnout, or lifestyle factors that haven’t been addressed. Focusing only on hormone levels can cause men to overlook what’s truly affecting their overall health.

Read more about conditions impacting men’s health that should not be ignored.

“We’ve narrowed the conversation around men’s health so much that we risk missing what actually matters,” Dr. Selinger says. “Most men aren’t just looking for a higher number on a lab test. They want to feel better, stay active, and take control of their health long term.”

If you’re experiencing symptoms or just want a clearer picture of your health, make an appointment with your primary care provider. A conversation can be the first step toward lasting improvement.

For more information about UT Health Austin’s Primary Care Clinic or to schedule an appointment, call 1-833-UT-CARES (1-833-882-2737) or visit here.