Low Testosterone

What is Low Testosterone?

Low testosterone, also called male hypogonadism, is a clinical syndrome in which symptoms of testosterone deficiency occur together with consistently low morning blood levels of the hormone.^[1] The testes make testosterone under the control of signals from the pituitary gland and hypothalamus in the brain, and a problem at any of these points can lower it.^[1]

Low testosterone is a medical diagnosis, and a low number alone is not enough to make it.^[2]

Common symptoms

The most common signs are decreased sex drive, fewer spontaneous erections and small testes.^[1] Other changes that men and their doctors often link to low testosterone include tiredness, low mood, loss of muscle, more body fat and poorer concentration. These are less specific and overlap with many other conditions, which is why a blood test and an examination are needed.^[3]

Causes and risk factors

Primary hypogonadism starts in the testes. The most common cause is Klinefelter syndrome, a chromosome condition that is often undiagnosed.^[1] Secondary hypogonadism starts in the pituitary or hypothalamus, for example after head injury or radiation to the head and neck.^[1]

Some causes can be reversible. These include obesity, severe illness, and medicines such as opioids and corticosteroids.^[1] Ageing is also linked to lower testosterone, and some men with symptoms have low levels with no clear disease of the testes or pituitary, sometimes called functional hypogonadism.^[4]

How it is diagnosed and treated conventionally

Guidelines advise testing only men who have symptoms, and confirming the result with at least two fasting morning blood samples.^{[1, 2]} Further blood tests, including luteinizing hormone and follicle-stimulating hormone, help separate testicular from pituitary causes.^[1]

Treatment depends on the cause. For obesity-related low testosterone, the recommended first step is weight loss.^[1] Testosterone therapy is advised for men with permanent hypogonadism, and the decision for other men is more debated.^{[1, 4]} Guidelines recommend against starting it in men planning to have children soon or with prostate or breast cancer, and advise regular monitoring.^[2]

Large trials suggest testosterone therapy gives modest improvements in sexual function without raising heart attack or stroke rates over the short to medium term.^{[4, 5]} One large trial in 5,246 men did find more atrial fibrillation, kidney injury and pulmonary embolism with testosterone gel than with placebo.^[5]

Why Low Testosterone calls for a whole-person approach

Testosterone levels are shaped by more than the testes. Body weight, sleep, other illnesses and medicines all feed into the hormone system, so the cause often involves several factors at once.^[1]

This is why the first steps in conventional care often involve health habits as well as hormones. Supportive care can reasonably address the same areas, working beside your physician.

Body fat and metabolic health

Excess body fat can lower testosterone. Fat tissue converts testosterone to estrogen, changes signals to the brain, and low testosterone can in turn promote more fat gain, creating a cycle.^[6] A meta-analysis of 24 studies found that weight loss from diet or bariatric surgery raised testosterone levels, and the more weight men lost, the greater the rise.^[7]

Sleep

Short or disrupted sleep is linked to lower testosterone. A review of epidemiological and interventional studies found that sleep loss is associated with lower morning, afternoon and 24-hour testosterone, and sleep apnea is also associated with lower levels.^[8]

Other illness and medicines

Severe illness, opioids and corticosteroids can lower testosterone, so reviewing the whole medical picture matters.^[1] This is work for your physician, and we do not change or advise changes to prescribed medicines.

Acupuncture as supportive care in Low Testosterone

What the research shows

We found no clinical trials of acupuncture in men diagnosed with low testosterone, so there is no direct evidence that it raises testosterone or treats the condition. Most research is in related symptoms, mainly erectile dysfunction.

A 2026 meta-analysis of 21 randomized trials in erectile dysfunction found better erectile function scores with acupuncture, and a small rise in serum testosterone was also reported. The authors rated the certainty of the evidence as very low to moderate and said it was too weak for firm conclusions.^[9] A review of 13 studies of acupuncture for sexual dysfunction in men and women reported improvements in desire and erectile function, but concluded that high-quality evidence is lacking.^[10]

How acupuncture may work

How acupuncture might affect testosterone or sexual function has not been established, and we do not have a mechanism study in men with low testosterone to cite. The meta-analysis above reported lower anxiety and depression scores alongside the sexual outcomes, which suggests stress and mood may be part of any benefit.^[9] This is a hypothesis, not a proven pathway.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the body, usually left in place for about 20 to 40 minutes. A course is typically several visits, and we reassess progress along the way.

In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000.^[11] Tell the practitioner first if you have a bleeding disorder, take blood thinners, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine as supportive care in Low Testosterone

The Ayurvedic view

In Ayurveda, reduced sexual vitality and stamina are described under terms such as Klaibya, and are linked to weakened reproductive tissue (Shukra dhatu), poor digestion and depleted strength. These are traditional categories, not biomedical diagnoses, and they do not equal a low blood testosterone level.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine, including regular meals and consistent sleep hours
• Stress-reducing practices such as breathing exercises and gentle yoga
• Warm oil massage
• Herbs traditionally used for vitality, such as ashwagandha (Withania somnifera) and shilajit
• In selected, otherwise healthy men, Panchakarma cleansing procedures

Panchakarma is not appropriate during acute illness, frailty, or before a medical evaluation is complete. Transdermal medication therapy, meaning an herbal preparation applied to the skin, may also be used, but we make no claim that it affects testosterone.

What the research shows

Ayurvedic treatment of diagnosed low testosterone has not been tested in clinical trials that we could find. The evidence that exists concerns individual herbs, mostly in healthy men.

A randomized, placebo-controlled trial in healthy men aged 45 to 55 found that 90 days of purified shilajit increased total and free testosterone compared with placebo.^[12] In a trial of 60 stressed adults, ashwagandha lowered cortisol, but the rise in testosterone seen in men was not significantly different from placebo.^[13]

Herbal medicine as supportive care in Low Testosterone

Herbs and formulas that have been studied

Herbs studied for testosterone in men include fenugreek seed extract, ashwagandha, shilajit, Asian red ginseng and forskolin from coleus root.^[14] Tribulus terrestris and Eurycoma longifolia (tongkat ali) are also sold as "testosterone boosters."^[15] In traditional Chinese medicine, low vitality and libido are often treated with formulas for the kidney, chosen individually by the practitioner. We did not find trials of these formulas in men with low testosterone.

What the research shows

The evidence is limited and mostly in men without a diagnosis of low testosterone. A systematic review of 32 randomized trials of 13 herbs found that fenugreek and ashwagandha extracts had positive effects on testosterone, but only 9 of 32 studies showed a significant increase, only 6 had low risk of bias, and half enrolled men under 40.^[14]

A 12-week trial in 120 healthy men aged 43 to 70 found that a fenugreek seed extract improved symptom scores, sexual function and testosterone compared with placebo.^[16] A separate systematic review of 52 studies of "testosterone boosters" found that most did not raise total testosterone. Eurycoma longifolia and shilajit extract were considered possibly effective in men with late-onset hypogonadism.^[15] Tribulus terrestris was among the products that did not reliably raise total testosterone.^[15]

Safety and herb-drug interactions

Herbs can cause harm. A case series described liver injury with jaundice in five people taking ashwagandha supplements, which resolved over one to five months.^[17] Herbal and dietary supplements account for about 20% of drug-induced liver injury in the United States, and many products are multi-ingredient with unknown active components.^[18] About one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[19]

Herb-drug interactions are documented, including bleeding with blood thinners and altered levels of other medicines.^[20] Tell us about all medicines, including any testosterone therapy. Because guidelines advise against testosterone therapy in men with prostate cancer, anything intended to raise testosterone should be discussed with your physician first.^[2] Tell us if you have liver or kidney disease, or are planning to have children. Herbs should come from tested sources and be prescribed individually.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine often describes low libido and fatigue in men as deficiency of kidney yang or essence. Ayurveda describes weakened Shukra dhatu and Ojas. Researchers would look at related ideas in the hormone axis between brain and testes, body fat and metabolism, sleep, and the stress hormone cortisol.^{[6, 8, 13]}

No study has shown that a TCM pattern or a dosha corresponds to a particular testosterone level or a specific biological process.

How this care fits with your medical care

Low testosterone needs evaluation and ongoing care from a physician, such as a primary care doctor, endocrinologist or urologist, and our care is supportive only. We do not diagnose low testosterone, order hormone tests, prescribe or adjust testosterone, or change any medicine. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

Please bring your diagnosis, recent blood test results including morning testosterone, a full list of medicines and supplements, and the details of any testosterone treatment. Do not stop or change testosterone therapy or any other prescribed treatment without your prescriber.

When to seek urgent medical care

Some symptoms need prompt medical attention, whether or not you have low testosterone or take testosterone therapy.

• Chest pain, pressure or shortness of breath
• Sudden weakness, facial droop, trouble speaking or vision loss
• A swollen, painful or red leg, or sudden breathlessness, which can signal a blood clot
• A severe new headache with vision changes, which can signal a pituitary problem
• A painful erection lasting more than four hours
• Yellow skin or eyes, dark urine or severe itching, especially while taking herbs or supplements

If any of these occur, call 911 or go to the nearest emergency department.