Hormonal Health

Low Testosterone

Most clinics prescribe testosterone. Few protect fertility. Dr. Asanad's approach identifies the cause of low T and builds a treatment plan around your goals — including fertility-preserving strategies that most men aren't told about.

Testosterone is the primary male sex hormone — central to nearly every aspect of a man's physical, sexual, and emotional health. When it drops, the effects show up everywhere: energy, mood, body composition, sexual function, fertility, quality of life. At Asanad MD, we identify the cause first, then build a treatment plan around it — with a particular focus on preserving fertility whenever possible.

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Watch: Dr. Asanad on Testosterone Therapy

What Testosterone Does

Testosterone is produced primarily by the testicles, controlled by the brain's hypothalamic-pituitary-gonadal (HPG) axis. It governs:

  • Sexual desire (libido)
  • Erectile function
  • Energy and stamina
  • Muscle mass and strength
  • Fat metabolism
  • Bone density
  • Mood and motivation
  • Cognitive function
  • Sperm production
  • Overall sense of well-being

Symptoms

Sexual

Decreased sex drive, erectile dysfunction, reduced morning erections, difficulty achieving orgasm, reduced satisfaction.

Physical

Fatigue, loss of muscle mass, increased body fat, reduced exercise performance, decreased strength, reduced endurance.

Cognitive and emotional

Brain fog, difficulty concentrating, reduced motivation, depressed mood, irritability, decreased confidence.

Many men describe feeling "not like themselves" before seeking evaluation.

What Causes Low T

Not all low testosterone is the same. Identifying the cause is critical.

Primary testicular failure (primary hypogonadism)

The testicles can't produce enough testosterone despite proper signaling from the brain. Causes: aging, prior chemotherapy, radiation, Klinefelter syndrome, testicular trauma, prior testicular surgery, severe varicoceles, genetic conditions.

Lab pattern: low testosterone with elevated LH and FSH.

Secondary hypogonadism (hypogonadotropic hypogonadism)

The brain doesn't send enough hormonal signal to the testicles. Causes: pituitary disorders, hypothalamic disorders, obesity, chronic illness, sleep apnea, certain medications, elevated prolactin.

Lab pattern: low testosterone with low or inappropriately normal LH and FSH.

Functional or idiopathic hypogonadism

Low T without a clearly identifiable structural cause. Contributing factors: obesity, poor sleep, chronic stress, metabolic syndrome, aging, lifestyle. Often responds well to combined hormonal optimization and lifestyle change.

Comprehensive Evaluation

Every patient gets thorough workup before any treatment is recommended:

  • Total testosterone
  • Free testosterone
  • LH and FSH
  • Estradiol
  • Prolactin
  • SHBG
  • CBC
  • PSA
  • Comprehensive metabolic panel
  • Thyroid testing when indicated

The goal: determine not just whether testosterone is low, but why it's low.

The fertility conversation

Many men don't know that testosterone replacement therapy can suppress sperm production — sometimes causing temporary azoospermia. For men who want children, are actively trying to conceive, or want to preserve testicular function, fertility-preserving alternatives often make more sense than standard TRT.

Fertility-Preserving Treatment

Unlike many clinics that prescribe testosterone without discussing fertility consequences, we lead with the fertility question.

Clomiphene citrate (Clomid)

Stimulates the brain to increase LH and FSH production — raising natural testosterone, preserving sperm production, and maintaining testicular size. Oral medication. Often excellent for younger men interested in fertility.

Human chorionic gonadotropin (hCG)

Acts like LH, directly stimulating testosterone production within the testicles. Maintains fertility, preserves intratesticular testosterone, prevents testicular atrophy. Often a cornerstone of fertility-preserving hormonal therapy.

Anastrozole (Arimidex)

Some men convert excess testosterone into estrogen. Anastrozole blocks that conversion — improving testosterone, lowering estradiol, balancing the ratio. Useful in select men with elevated estradiol.

Testosterone Replacement Therapy (TRT)

For many men, TRT remains the most effective treatment. It can significantly improve libido, energy, mood, muscle mass, body composition, erectile function, and overall quality of life.

Treatment plans are built around symptoms, lab values, age, fertility goals, and overall health.

Delivery options

  • Injections — reliable absorption, flexible dosing, excellent control, cost-effective
  • Gel — applied daily to the skin, stable hormone levels, no injections
  • Oral — newer formulations offering convenient administration
  • Pellets — implanted under the skin for long-term delivery

Preventing Testicular Atrophy on TRT

Because external testosterone suppresses natural testicular stimulation, some men develop reduced testicular volume, reduced sperm production, and reduced intratesticular testosterone.

TRT + hCG combination therapy preserves testicular size, maintains intratesticular testosterone, supports fertility preservation, and reduces TRT-related atrophy. This is where specialized male fertility expertise creates a real advantage.

Monitoring

Regular follow-up and lab monitoring:

  • Testosterone levels
  • Estradiol levels
  • Hematocrit
  • PSA
  • Liver function testing
  • Symptom assessment

The goal: optimize benefits while maintaining long-term safety.

Frequently Asked Questions

Common questions, answered.

What are the symptoms of low testosterone?
Symptoms include decreased sex drive, erectile dysfunction, reduced morning erections, fatigue, loss of muscle mass, increased body fat, reduced exercise performance, brain fog, depressed mood, irritability, and decreased confidence.
Does testosterone replacement therapy affect fertility?
Yes. Testosterone replacement therapy can significantly reduce sperm production and may cause temporary azoospermia. For men who want children or wish to preserve testicular function, fertility-preserving alternatives such as clomiphene citrate (Clomid), hCG, or anastrozole may be preferable to standard TRT.
What is hCG used for in men?
Human chorionic gonadotropin (hCG) acts similarly to luteinizing hormone (LH) and directly stimulates testosterone production within the testicles. It is often used to preserve fertility, maintain testicular size, and prevent testicular atrophy in men on testosterone replacement therapy.
What is the difference between primary and secondary hypogonadism?
In primary hypogonadism, the testicles cannot produce enough testosterone despite proper signaling from the brain — labs show low testosterone with elevated LH and FSH. In secondary hypogonadism, the brain does not produce sufficient hormonal stimulation — labs show low testosterone with low or inappropriately normal LH and FSH.
Why Asanad MD

Low T treatment isn't one-size-fits-all.

Low testosterone treatment is not one-size-fits-all. As a fellowship-trained male fertility and sexual health specialist, Dr. Asanad provides expertise that extends far beyond prescribing testosterone:

  • Comprehensive hormonal evaluation
  • Expertise in primary and secondary hypogonadism
  • Fertility-preserving treatment strategies
  • Advanced management of Clomid, hCG, and anastrozole
  • TRT optimization
  • Personalized monitoring and long-term follow-up
  • Specialized knowledge of fertility preservation and testicular function
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