Testosterone testing has become a major focus in men’s health conversations, as the hormone is linked to strength, energy, body composition, sexual health, cognitive health, and aspects of physical performance.
It's true that low testosterone, sometimes referred to as “low T,” can contribute to symptoms that affect quality of life. At the same time, many symptoms commonly attributed to testosterone deficiency may also reflect poor sleep, chronic stress, metabolic dysfunction, excess body fat, overtraining, depression, or underlying medical conditions, which is why testosterone testing should be a part of a bigger blood panel and comprehensive screening.
For many men, the symptoms develop gradually. Energy decreases. Recovery slows. Muscle mass and strength become harder to maintain. Libido changes. Sleep worsens. Focus declines. Weight piles on more easily over time.
Sometimes aging is part of the story, but sometimes these symptoms are signals that there’s more to the story. Men’s Health Month offers an important reminder that preventive care is not only about identifying disease; it’s also about understanding the physiologic changes that may affect long-term health, performance, and quality of life before more advanced disease develops.
At Biograph, testosterone testing is approached within a larger preventive health framework, one that evaluates hormones alongside metabolic health, cardiovascular fitness, body composition, sleep quality, recovery, and lifestyle factors to better understand what’s driving symptoms.
What is testosterone and why does it matter for men’s health?
Testosterone is the primary male sex hormone produced in the testes and regulated through signaling pathways involving the brain and pituitary gland. Beyond libido and sexual performance, testosterone also plays key roles in:
Testosterone levels naturally change throughout your life. Beginning around age 40, testosterone levels tend to decline gradually by roughly 1-2% per year. [1] It’s estimated that more than one-third of men over age 45 may have testosterone levels below the normal range for their age. [2]
Age is only part of the equation. Lifestyle habits and metabolic health can also contribute to declining testosterone levels.
What are the symptoms of low testosterone?
Symptoms associated with testosterone deficiency can vary widely from person to person. Some are more specific, while others overlap with common issues like sleep deprivation, burnout, stress, or poor metabolic health.
More specific symptoms may include:
Other symptoms are less specific and may include:
Many of these symptoms are not exclusive to testosterone deficiency. Low energy levels, for example, could reflect hormonal changes, but they could also result from chronic sleep restriction, sleep apnea, depression, overtraining, poor nutrition, insulin resistance, or cardiovascular disease.
When should a man get testosterone testing?
There’s no universal age when men should begin testosterone testing. However, establishing a baseline and understanding trends may provide a foundation for interpreting changes in quality of life, physical performance, recovery, mood, or sexual health.
Men with obesity, poor sleep, metabolic dysfunction, or chronic medical conditions may be at higher risk for testosterone deficiency. Research suggests that testosterone deficiency is more common in men with higher BMI and or those in older age [3].
How do you test for testosterone deficiency?
A testosterone blood test typically measures total testosterone, which reflects both protein-bound and free circulating testosterone in the bloodstream.
In many cases, clinicians will also evaluate:
When you take the test matters, too. Testosterone levels naturally fluctuate throughout the day and are usually highest in the morning. For this reason, testosterone testing is generally performed early in the day under standardized conditions.
One important misconception is that a single low testosterone result automatically confirms a deficiency. Keep in mind that hormones are highly sensitive to the following factors:
A more complete picture often comes from repeat testing and evaluating testosterone in the context of symptoms, lifestyle, metabolic health, and other biomarkers.
What’s the difference between total and free testosterone?
Most testosterone circulating in the blood is attached to proteins, primarily SHBG and albumin. This is referred to as bound testosterone.
Free testosterone refers to the smaller proportion that isn’t protein-bound and is biologically available to tissues.
You can have:
Normal total testosterone but low free testosterone
Low total testosterone but adequate free testosterone
Changes in SHBG affecting interpretation
What can cause low testosterone besides aging?
Metabolic dysfunction and several lifestyle factors are important drivers of hormonal changes.
Obesity and metabolic health
Research consistently shows that obesity is strongly associated with lower testosterone levels. [4] In many men, excess body fat, particularly metabolically active visceral fat, can disrupt normal hormonal signaling pathways. [5]
In many cases, reducing your stress levels and increasing physical activity, which in part, can help improve your body composition, may all help improve testosterone levels naturally.
Sleep
Sleep plays an important role in hormonal regulation, including testosterone production. Research suggests that sleep restriction, poor sleep quality, and certain sleep disorders may negatively affect testosterone levels and broader hormonal health. [6]
This is particularly important because many men normalize chronic sleep deprivation while simultaneously wondering why energy, mood, recovery, and libido decline.
Stress
Chronic stress elevates cortisol, which can interfere with normal testosterone production and recovery, especially in those with type 2 diabetes. [7]
Exercise imbalance
Exercise plays an important role in metabolic health, body composition, cardiovascular fitness, recovery, and overall hormonal health. However, the relationship between exercise and resting testosterone levels is more nuanced than many people assume.
A systematic review examining exercise training in insufficiently active men found that exercise alone had minimal impact on resting testosterone levels in otherwise healthy participants. [8] At the same time, regular physical activity remains strongly associated with improvements in insulin sensitivity, visceral fat reduction, cardiovascular fitness, and overall physiologic health, all of which can indirectly influence hormonal function.
In practice, exercise is less about “boosting testosterone” in isolation and more about supporting the broader physiologic systems that influence long-term health, recovery, performance, and hormonal regulation.
Can testosterone levels improve naturally?
In some men, yes. But improving testosterone naturally is usually less about “optimizing” one hormone and more about improving the broader physiologic systems that affect your overall health.
For men with low testosterone related to lifestyle or metabolic factors, several interventions may help support healthier hormone levels over time:
Prioritize sleep quality
Sleep is one of several factors that may influence testosterone levels. Chronic sleep restriction, inconsistent schedules, and untreated sleep apnea can all negatively affect hormonal recovery and testosterone production. [9]
Improve body composition—not just body weight
Excess visceral fat is strongly associated with lower testosterone levels and poorer metabolic health. Reducing visceral fat through sustainable lifestyle changes such as eating balanced meals, resistance training, cardiovascular exercise, and improved sleep may positively influence testosterone levels over time.
Build and maintain lean muscle mass
You can begin to lose muscle mass as early as age 30, especially if you don’t stay consistent with a strength training routine. [10] Strength training supports metabolic health and healthy aging, but recovery, nutrition, and sleep are equally important to maintaining muscle and hormonal health.
Support your cardiovascular fitness and metabolic health
Hormonal health is closely tied to metabolic and cardiovascular health. Improving cardiovascular fitness through aerobic exercises such as running, swimming, and cycling may help support energy, recovery, insulin sensitivity, and long-term metabolic function.
Pay attention to your nutrition and alcohol intake
Bad eating habits, inadequate protein intake, chronic caloric restriction, and excess alcohol intake may all negatively affect your hormonal health over time. Adopting sustainable nutrition patterns that support recovery, muscle maintenance, and metabolic health. Consider working with a nutrition expert, such as a registered dietitian, who can suggest dietary swaps that fit your unique health needs.
How can preventive health testing identify root causes of symptoms?
One of the biggest mistakes in modern men’s health is assuming low testosterone is the main cause for the above symptoms before understanding what else could be at play. At Biograph, hormone testing is integrated into a broader preventive health framework designed to uncover upstream contributors to symptoms.
For men, this may include:
Comprehensive hormone panels
Cardiovascular fitness testing (VO2 max)
DEXA body composition analysis
Sleep assessments
Movement and musculoskeletal evaluation
Metabolic and inflammatory biomarkers
Cognitive and functional assessments
Together, these provide a more complete picture of why someone feels the way they do.
The bottom line
Testosterone matters, but no hormone exists in isolation.
Low energy, declining strength, poor recovery, reduced libido, and body composition changes are not simply things men should ignore or normalize indefinitely. At the same time, these symptoms are rarely explained by one lab value alone.
Thoughtful testosterone testing, combined with broader preventive health screening, can uncover upstream contributors affecting long-term health, performance, and quality of life years before more serious disease develops.
At Biograph, the goal isn’t simply to measure hormones. It’s to understand how cardiovascular fitness, metabolic health, sleep, body composition, recovery, and lifestyle interact to shape long-term health outcomes.
Commonly asked questions testosterone testing
What is testosterone testing?
Testosterone testing is a blood test used to evaluate hormone levels related to energy, libido, muscle mass, mood, recovery, and overall men’s health.
What are common signs of low testosterone?
Symptoms may include fatigue, reduced libido, reduced strength, muscle loss, increased body fat, poor recovery, mood changes, and difficulty concentrating.
Is one low testosterone result enough for diagnosis?
No. Testosterone levels fluctuate based on factors like sleep, stress, illness, exercise, and other factors. Proper evaluation often includes repeat testing and broader clinical context.
Can poor sleep lower testosterone?
Research suggests chronic sleep restriction and sleep disorders may interfere with normal testosterone production and hormonal regulation.
Does exercise increase testosterone?
Exercise supports overall metabolic and cardiovascular health, but research suggests exercise alone may not significantly raise resting testosterone levels in healthy men.
What is the difference between total and free testosterone?
Total testosterone reflects all circulating testosterone, while free testosterone refers to the biologically available portion not bound to proteins.
What causes low testosterone besides aging?
Potential contributors include obesity, poor sleep, metabolic dysfunction, chronic stress, illness, overtraining, and certain medications or medical conditions.
How can men improve testosterone naturally?
Improving sleep quality, reducing excess body fat, maintaining lean muscle mass, improving cardiovascular fitness, managing stress, and optimizing metabolic health may all support healthier testosterone levels over time.
Dr. Michael Doney is Biograph’s Executive Medical Director, with over 20 years of experience leading clinical care and advancing a more proactive, data-driven approach to medicine.
Clinical references
Accetta M. How Aging Affects Testosterone and Muscle Mass in Men. Hospital for Special Surgery. Published June 5, 2023. https://www.hss.edu/health-library/move-better/muscle-mass-testosterone
Endocrine Society. Hypogonadism in Men. www.endocrine.org. Published January 24, 2022. https://www.endocrine.org/patient-engagement/endocrine-library/hypogonadism
Liu N, Feng Y, Ma X, Ma F. Prevalence of testosterone deficiency among US adult males. The Aging Male. 2022;25(1):278-280. doi:10.1080/13685538.2022.2130236
Muir CA, Wittert GA, Handelsman DJ. Approach to the patient: Low testosterone concentrations in men with obesity. The Journal of Clinical Endocrinology & Metabolism. Published online March 7, 2025. doi:10.1210/clinem/dgaf137
Okobi OE, Khoury P, De RJ, et al. Impact of Weight Loss on Testosterone Levels: A Review of BMI and Testosterone. Cureus. Published online December 21, 2024. doi:10.7759/cureus.76139
Wittert G. The relationship between sleep disorders and testosterone in men. Asian Journal of Andrology. 2014;16(2):262. doi:10.4103/1008-682x.122586
Khan SU, Jannat S, Shaukat H, et al. Stress Induced Cortisol Release Depresses The Secretion of Testosterone in Patients With Type 2 Diabetes Mellitus. Clinical Medicine Insights: Endocrinology and Diabetes. 2023;16:117955142211458. doi:10.1177/11795514221145841
Potter NJ, Tomkinson GR, Dufner TJ, Walch TJ, Roemmich JN, Wilson PB, Fitzgerald JS. Effects of Exercise Training on Resting Testosterone Concentrations in Insufficiently Active Men: A Systematic Review and Meta-Analysis. J Strength Cond Res. 2021 Dec 1;35(12):3521-3528. doi: 10.1519/JSC.0000000000004146. PMID: 35134000.
Wittert G. The relationship between sleep disorders and testosterone in men. Asian Journal of Andrology. 2014;16(2):262. doi:10.4103/1008-682x.122586
Keller K, Engelhardt M. Strength and muscle mass loss with aging process. Age and strength loss. Muscles, Ligaments and Tendons Journal. 2014;3(4):346. https://pmc.ncbi.nlm.nih.gov/articles/PMC3940510/
