Male hormonal problems are under-investigated, partly because the symptoms — tiredness, low mood, reduced drive — are easy to attribute to stress or age.
Assessment
Testosterone must be measured on a morning sample, and a single low reading should always be confirmed. Assessment also covers LH, FSH, prolactin, thyroid function and metabolic factors, since obesity, diabetes and sleep apnoea are common and reversible contributors to low testosterone.
Testosterone therapy
Testosterone replacement is appropriate for genuine, confirmed deficiency with a clear cause — and inappropriate as a general tonic for tiredness or gym performance. It suppresses fertility, requires monitoring of haematocrit and prostate health, and is usually a long-term commitment. Where the underlying cause is obesity or untreated sleep apnoea, addressing that first often restores levels without hormone therapy.
Gynaecomastia
Breast tissue enlargement in men can result from hormonal imbalance, medication, liver or thyroid disease, or occasionally a testicular or adrenal tumour, and warrants evaluation rather than reassurance alone.