Testosterone, Energy and Wellbeing: Making Sense of a Complex Conversation | Rodolico Health
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In recent years, testosterone has become part of a much wider conversation about energy, motivation, mood and ageing. For some people, it has offered real benefits. For others, it has promised more than it can reliably deliver.
In general practice, conversations about testosterone are increasingly common. They are often prompted by persistent fatigue, reduced libido, changes in mood, or a sense of not feeling quite like yourself. These are very real concerns, and they deserve to be taken seriously.
Testosterone now sits within a broader discussion about wellbeing — one that blends genuine medical need, overlapping symptoms, and very real personal experiences.
What Testosterone Actually Does
Testosterone is a hormone that plays a role in sexual function, muscle mass, and certain aspects of mood and energy. While it is often thought of as a “male hormone”, it is present in both men and women, albeit at very different levels.
Testosterone levels naturally change over time and vary widely between individuals. A lower number on a blood test does not automatically mean illness, and symptoms rarely have a single cause.
Testosterone Therapy in Men: When It Helps Most
Based on current evidence, testosterone therapy is most clearly beneficial for men with confirmed hypogonadism — meaning consistently low testosterone levels on blood testing, alongside symptoms that fit with this diagnosis.
In these men, treatment can lead to modest but meaningful improvements in sexual function, particularly libido and sexual activity. These benefits are most evident when testosterone levels are clearly low, rather than borderline or mildly reduced with age.
For those who want to explore this further, the Endocrine Society provides clear, patient-focused information on testosterone therapy and when it is most likely to help
What is important to say — and often comes as a surprise — is that testosterone therapy does not consistently improve energy levels, mood, concentration or overall physical performance for most men. These symptoms are common, but they are usually influenced by multiple factors, many of which are unrelated to testosterone.
Testosterone therapy should always be reviewed. If there is no meaningful improvement in the symptoms being treated — particularly sexual function — continuing treatment is unlikely to be beneficial. Professional bodies such as the American College of Physicians have highlighted the importance of focusing testosterone treatment on clearly defined indications and reviewing benefit over time.
Erectile Dysfunction as a Health Signal
Erectile dysfunction (ED) is often one of the symptoms that prompts men to ask about testosterone, and understandably so. Sexual health is closely tied to wellbeing, confidence and relationships.
It’s also important to recognise that ED can sometimes be an early sign of other underlying health conditions, particularly those affecting blood vessels and circulation. Conditions such as high blood pressure, diabetes, high cholesterol and cardiovascular disease can all affect erectile function, sometimes years before other symptoms appear.
This doesn’t mean ED is always a sign of an underlying medical condition. Stress, anxiety, sleep deprivation, relationship factors and hormonal changes can all play an important role. But it does mean that ED deserves a broader health conversation, rather than being treated in isolation or attributed solely to testosterone levels.
From a GP perspective, assessing ED is often an opportunity to look at overall cardiovascular and metabolic health, review lifestyle factors, and decide whether further investigation is needed — alongside discussing symptom-focused treatments where appropriate.
Risks and Uncertainties
Testosterone therapy is generally safe for appropriately selected men in the short to medium term, but it is not entirely without risk.
Possible side effects include changes in blood thickness, fluid retention, and — in some individuals — a small increase in the risk of blood clots or heart rhythm disturbances. Large studies have not shown a clear increase in heart attacks or prostate cancer over several years of follow-up, but longer-term safety data are still evolving.
This is why testosterone treatment should always involve ongoing monitoring and regular review, rather than being started and forgotten.
How Testosterone Is Taken — and Why It Matters
A common question is whether the way testosterone is taken makes a difference. In practice, several formulations are available, including injections and transdermal preparations such as gels or patches.
When used appropriately, transdermal and injectable preparations are broadly similar in terms of effectiveness. The choice between these is usually an individual discussion, based on symptoms, preferences, practical considerations and monitoring.
Oral testosterone is not currently recommended, and most treatment uses either transdermal or injectable options.
What matters more than the route itself is using an appropriate dose, monitoring response and side effects, and reviewing whether treatment is actually helping.
No formulation removes the need for follow-up, and no route guarantees benefit if testosterone is not the main driver of symptoms.
Testosterone in Women: An Individualised Discussion
In women, testosterone is sometimes discussed in the context of wellbeing, energy and sexual health, particularly around midlife and menopause. As with many hormone-related topics, the evidence base is evolving and does not lend itself to simple, one-size-fits-all conclusions.
Current evidence supports its use most clearly in postmenopausal women with hypoactive sexual desire disorder, following a careful assessment that considers physical, psychological and relationship factors. In this context, low-dose testosterone can lead to modest improvements in sexual desire and related distress.
The potential role of testosterone beyond sexual desire continues to be explored. Some menopause specialists report benefits for certain individuals in areas such as energy, mood or cognitive clarity, while population-level research has not yet demonstrated consistent benefits across these domains. This difference between individual experience and research findings is important to recognise and discuss openly.
It is also acknowledged that some women describe meaningful improvements in how they feel after starting testosterone. Balancing individual experience with the current evidence base is an important part of clinical decision-making.
For now, testosterone is not routinely used as a general treatment for fatigue or low mood in women. Where it is considered, decisions are usually made on a case-by-case basis, following careful discussion with a menopause specialist, alongside ongoing monitoring and regular review to assess whether any benefits are meaningful and sustained.
When prescribed, treatment involves very low, physiological doses, most commonly via transdermal preparations. Possible side effects such as acne or increased hair growth can occur, and treatment is usually stopped if clear benefit is not seen.
Symptoms in Context
Many symptoms that prompt questions about testosterone — such as low energy, reduced motivation or changes in mood — overlap with a wide range of other common issues. These may include sleep problems, chronic stress, menopause-related changes, thyroid dysfunction, mental health concerns, relationship pressures or life-stage transitions. See my previous blog posts on thyroid health and sleep problems.
Because testosterone can be measured and treated, it can sometimes appear to offer a clear explanation for complex symptoms. In some cases, it may play a role. In others, focusing on contributing factors such as sleep, stress, hormonal transitions or overall health is more helpful.
From a primary care perspective, testosterone is most useful when it is considered as part of a broader picture, rather than in isolation.
When Testing Is Reasonable
Testosterone testing may be appropriate when symptoms are specific, persistent and clinically suggestive, particularly where sexual function is a key concern. It is generally less helpful as a broad screening test for non-specific symptoms such as fatigue alone.
Interpreting results requires care. Hormone levels fluctuate, reference ranges are wide, and results are most meaningful when interpreted alongside symptoms, medical history and overall health.
A GP Perspective on Testosterone
Testosterone therapy can be helpful for some people, but it is not a universal solution. For many, symptoms improve more effectively when attention is given to sleep, mental health, physical activity, hormonal transitions or other underlying medical conditions.
Often, the most important part of testosterone care is not the prescription itself, but the conversation that comes before it — clarifying goals, setting expectations and deciding together what feels appropriate to explore, and what may not.
How Rodolico Health Can Help
At Rodolico Health, we help patients make sense of testosterone in context. This includes discussing symptoms, deciding if and when testing is useful, and reaching a shared decision about whether treatment is appropriate.
Where testosterone therapy is used, we support ongoing monitoring and review, and we revisit the plan if benefits are not clear.
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