An increasing number of men are turning to male hormone supplements, but medical experts caution against assuming that a low sex drive, chronic fatigue, or erectile dysfunction are automatically caused by low testosterone.
The New York Post recently highlighted this issue in a report featuring Dr. Justin Dubin, a urology specialist and director of Men’s Sexual Health at the Herbert Wertheim Cancer Institute under Baptist Health South Florida. The report explored symptoms frequently mistaken for low testosterone and examined the true health conditions that may be driving them.
With the rise of telehealth services offering online consultations and easy prescriptions, trying testosterone replacement therapy (TRT) has become simpler than ever. However, clinical data reveals a significant gap between perception and reality: one study found that among men who received testosterone prescriptions, only 12% actually had low blood testosterone levels.
The Overlap Between Low Testosterone and Mental Health
Dr. Dubin noted that while low libido, exhaustion, and erectile dysfunction are hallmark symptoms of low testosterone, they are also common manifestations of various other medical issues. For example, a drop in sex drive is a classic sign of hormonal deficiency, but mental health struggles such as depression or anxiety can produce the exact same effect. When an individual's mood sinks or motivation fades, their interest in sex frequently declines alongside it.
Furthermore, a variety of widely prescribed medications—including high blood pressure drugs, antidepressants such as selective serotonin reuptake inhibitors (SSRIs), and anticonvulsants—can heavily suppress libido. Because problems with sexual function can serve as an early warning sign for systemic health issues, patients should thoroughly evaluate their overall health rather than focusing solely on hormone panels.
Chronic Fatigue, Sleep Disorders, and Metabolic Links
Feeling easily exhausted and lacking energy can stem from low testosterone, but the underlying causes are incredibly wide-ranging. Fatigue can be driven by simple sleep deprivation, sleep apnea, hypothyroidism, anemia, mental health disorders, or poor lifestyle factors. Sleep apnea—a condition where breathing repeatedly stops and starts during sleep, often characterized by severe snoring or gasping for air—can drastically increase the risk of dangerous cardiovascular events, including stroke and heart failure, if left untreated.
Endocrine and blood disorders also play a compounding role. Hypothyroidism can actively suppress the body's natural testosterone production. Additionally, because testosterone is directly involved in stimulating red blood cell production, a severe hormonal deficiency can cause anemia. Dr. Dubin emphasized that it is not uncommon for men to experience multiple overlapping conditions simultaneously.
Erectile Dysfunction as a Vascular Warning Sign
While erectile dysfunction can point to low testosterone, it is more famously recognized as an early clinical indicator of cardiovascular and vascular disease. When general blood vessel function begins to decline, the robust blood supply required to achieve and maintain an erection cannot flow smoothly.
Diabetes stands as another major contributor to vascular dysfunction. Approximately 75% of men with diabetes experience erectile dysfunction, as prolonged high blood sugar progressively damages the delicate blood vessels and nerves responsible for erectile function. Beyond diabetes, vascular damage caused by smoking, as well as radiation therapy or pelvic surgery for prostate cancer treatment, can similarly disrupt these pathways.
Dr. Dubin stressed that while individuals with a history of cancer, chronic illnesses, or obesity face a statistically higher risk of developing low testosterone, their symptoms are not always explained by male hormones alone. In clinical practice, he frequently evaluates young men complaining of low libido and erectile dysfunction who possess perfectly normal testosterone levels, but suffer from reduced sexual function due to underlying stress, relationship issues, or mental health challenges.
"Just because you have symptoms, you shouldn’t conclude it’s low male hormones or immediately start with testosterone treatment," Dr. Dubin advised. "What matters most is identifying the root cause accurately and securing a treatment plan that is properly tailored to you."
