Real Diagnosis, Real Treatment
Low Testosterone
Low testosterone is real, measurable, and treatable — and it is also widely overdiagnosed by clinics that sell treatment without proper evaluation. At Texas Regional Urology, our board-certified urologists diagnose it properly and manage it safely at our offices in The Woodlands, Tomball, and Kingwood.
What is low testosterone?
Understanding Low Testosterone
Testosterone is the primary male sex hormone, produced mainly in the testicles under signals from the brain, and it governs sex drive, erectile function, sperm production, muscle mass, bone density, red blood cell production, energy, and mood. Levels decline gradually with age, but a meaningful drop below the normal range — hypogonadism — produces symptoms that affect daily life. The cause may be in the testicles themselves, from injury, infection, chemotherapy, or genetic conditions, or in the pituitary signaling that drives them. Obesity, type 2 diabetes, sleep apnea, chronic opioid use, and certain medications all suppress testosterone, and treating those underlying causes sometimes resolves the problem without hormone therapy at all.
How would I know if I had low testosterone?
Symptoms of Low Testosterone
The most specific symptoms are reduced sex drive, erectile difficulty, and decreased spontaneous erections. Less specific but common symptoms include persistent fatigue, loss of muscle mass and strength, increased body fat, low mood or irritability, poor concentration, reduced body hair, and disrupted sleep. Over time, untreated low testosterone can reduce bone density and increase fracture risk. The difficulty is that fatigue, low mood, and weight gain have many causes, which is why symptoms alone never establish the diagnosis — confirmed blood testing does.
How is low testosterone diagnosed?
How We Diagnose Low Testosterone
Diagnosis requires at least two morning blood draws, since testosterone peaks in the early hours and a single afternoon sample routinely produces falsely low results. We measure total testosterone and, when indicated, free testosterone, along with LH and FSH to determine whether the problem originates in the testicles or the pituitary. Prolactin, thyroid function, and a complete blood count round out the workup, and we screen for the conditions that commonly suppress testosterone, particularly sleep apnea and metabolic syndrome. Baseline PSA and hematocrit are obtained before any treatment begins, because both must be monitored during therapy. If fertility is a consideration, we discuss it before starting, since standard testosterone therapy suppresses sperm production.
Why Choose Texas Regional Urology for Low T Care?
Why Patients Choose TRU
Here is what we can do
Low Testosterone Treatment Options at Texas Regional Urology
Treatment begins with addressing reversible causes — weight loss, treating sleep apnea, reviewing medications — which alone raises testosterone meaningfully in some men. When replacement therapy is warranted, several delivery methods exist and the right one depends on your preferences, tolerance, and how often you want to think about it. All forms require ongoing monitoring; testosterone is not a prescription to start and forget.
Testosterone Pellet Implantation
Small pellets are placed under the skin in a brief office procedure and release testosterone steadily over several months. This suits men who want consistent levels without daily or weekly administration.
Injections
Intramuscular or subcutaneous injections are given weekly or every two weeks and are the most affordable option. Levels fluctuate between doses, which some men notice as a cycle in energy and mood.
Topical Gels
Daily gels applied to the skin maintain steady levels and are easy to adjust. They require care to avoid transferring testosterone to a partner or child through skin contact.
Fertility-Sparing Alternatives
For men who want to preserve fertility, medications such as clomiphene or hCG can raise the body's own testosterone production rather than replacing it. Standard testosterone therapy suppresses sperm production and is not appropriate for men currently trying to conceive.
Answers to your Low Testosterone Questions
Frequently Asked Questions
Levels vary, and timing matters greatly.
Testosterone peaks in the morning and fluctuates day to day, so a single sample — especially an afternoon one — frequently misleads in both directions. Guidelines call for two separate morning measurements before diagnosing.
Yes — it suppresses sperm production.
Replacement therapy signals the body to stop making its own testosterone and sperm, and that suppression can persist after stopping. Tell your urologist before starting if children are a possibility.
Current evidence does not support that.
Research has not shown that replacement therapy causes prostate cancer, though it can accelerate growth of an existing one. We check PSA before starting and monitor it throughout treatment.
Weeks for some effects, months for others.
Sex drive and mood often improve within three to six weeks, while changes in muscle mass, body composition, and bone density take several months. If nothing has changed after a few months at appropriate levels, testosterone likely was not the cause.
Usually, if it's genuinely needed.
Symptoms typically return when treatment stops, since the underlying deficiency remains. Men whose low testosterone stems from a reversible cause may improve enough to come off therapy.
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