Testosterone deficiency in men: symptoms, testing and treatment

Testosterone levels in men decline by approximately 1–2% per year after age 30. For many, this is gradual — but for about 25% of men over 40, it leads to clinical testosterone deficiency with noticeable symptoms affecting quality of life, health and performance.

Common symptoms of testosterone deficiency

• Chronic fatigue and lack of energy
• Decreased muscle mass and increased abdominal fat
• Low libido and erectile difficulties
• Concentration problems and 'brain fog'
• Low mood and irritability
• Poor sleep
• Reduced endurance and physical performance

How is testosterone deficiency diagnosed?

Diagnosis is based on blood tests taken fasting in the morning, measuring total testosterone, free testosterone, SHBG, LH and FSH. The assessment is always based on the combination of blood work and symptoms — both carry significant weight. Exact reference ranges are age-dependent, and free testosterone is considered more clinically significant than total testosterone as it reflects the biologically active fraction.

Our health check includes comprehensive blood work with over 70 biomarkers, including a complete hormone profile, metabolic markers and inflammation markers — all analyzed by specialist physicians.

Treatment — TRT (testosterone replacement therapy)

With confirmed testosterone deficiency, testosterone replacement therapy (TRT) can be prescribed. The treatment aims to restore testosterone levels to the upper normal range. There are several administration methods: gel (daily application), long-acting injections (e.g. Nebido, every 10–14 weeks) and short-acting injections with testosterone enanthate, which requires a license from Läkemedelsverket (the Swedish Medical Products Agency). Revi offers testosterone enanthate to patients where gel or Nebido do not provide adequate results, or where these treatments produce variable outcomes and/or side effects. The advantage of weekly or more frequent injections is more stable hormone levels, resulting in better treatment efficacy and lower risk of side effects.

What can you expect?

• Increased energy and reduced fatigue
• Improved body composition (more muscle, less fat)
• Better libido and sexual function
• Improved cognitive sharpness and mood
• Increased motivation and physical performance
• Peak effects of TRT are typically achieved after approximately six months

Risks and side effects

TRT shuts down the body's own testosterone production for the duration of treatment. It may also reduce or completely shut down fertility.

If not monitored correctly, there is a risk of erythrocytosis (elevated red blood cell count, increasing the risk of blood clots) and aromatization — the biochemical process in which the enzyme aromatase catalyzes the conversion of testosterone into estradiol. Other side effects include acne, fluid retention, breast tenderness and sleep apnea.

Weekly or more frequent injections with testosterone enanthate provide more stable serum levels and reduce the risk of these side effects compared to long-acting injections with large dosing intervals.

After discontinuing TRT, it is not guaranteed that the body's own production will restart. However, there are protocols to actively attempt to restart endogenous production.

Next steps

The first step is a health check with blood tests and DEXA scan to map your hormonal profile and body composition. Based on the results, our specialist physician makes an assessment and creates an individual treatment plan.