Most men who ask us about testosterone don’t open with the word. They say they’re tired by two in the afternoon, that the gym stopped paying off, that their wife has noticed they snap more than they used to. Then, a little quieter, that sex has become something they could take or leave.
That cluster is worth taking seriously. It is also worth checking properly before anyone hands you a prescription.
This article is general information, not medical advice.
What are the first signs of low testosterone at 45?
Testosterone drifts down slowly with age, and for many men the change is gradual enough that they blame work, kids or getting older. The signs men describe to us most often are:
- Less interest in sex, and fewer morning erections
- Tiredness that a weekend of sleep doesn’t fix
- Losing muscle even though the workouts haven’t changed
- More fat around the middle
- A flatter mood, less patience, less drive
- Trouble concentrating in the afternoon
Low libido with fewer morning erections is the most specific of these. Fatigue and low mood on their own are much less specific, because a dozen other things cause them.
Could it be something other than testosterone?
Often, yes, and this is where a quick online questionnaire lets people down.
Poor sleep is the big one. Untreated sleep apnea can lower testosterone and also leaves you exhausted, so treating the apnea sometimes fixes both. Thyroid problems, depression, heavy drinking, a lot of extra weight and some medications, opioids in particular, can all produce the same tired, low-libido picture. So can plain overwork.
Your testosterone could still be low as well, so the result has to be read next to the rest of your health. If you snore, wake up unrefreshed, or your partner has seen you stop breathing at night, say so at your visit. It changes what gets looked at.
How do you actually find out?
With blood work, done in a way that gives a fair reading.
Testosterone runs highest in the morning and varies from day to day. Mainstream guidance is to test early in the morning and to confirm a low result with a second test before calling it low. A single afternoon draw that comes back borderline doesn’t tell you much.
At our office in Towaco, hormone therapy starts with a consultation in person. You tell us what has changed, we take a full health history, and lab work comes before anything is prescribed. Dr. Donna D’Alessio oversees every plan. If the labs and your symptoms point to low testosterone, treatment is either an injection or a topical cream or gel, depending on what fits your week. Then we recheck your levels and adjust the dose on the numbers.
Two things are worth knowing before you start.
If you still want children, tell us on day one. Testosterone from outside the body tells your own system to slow down, and that includes sperm production. For a man planning a family in the next few years, that can change the whole plan.
Treatment also means follow-up. Testosterone can raise your red blood cell count, and men on it should have blood counts and prostate screening checked on a schedule. A program that ships you a vial and never draws blood again is skipping the part that keeps this safe. The goal is a normal range where you feel like yourself. Chasing the highest reading we can get would only add side effects.
Some men come in sure it’s testosterone and leave with a sleep study referral instead. That is a good outcome too. You wanted to know why you feel the way you do, and now you know where to look.
If this sounds like the last year or two of your life, the hormone replacement therapy page explains how our program works, and you can book a consultation at our Montville office whenever you’re ready.
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