Testosterone is a hormone produced mainly in the testicles (and in smaller amounts in ovaries and adrenal glands) that helps regulate muscle growth, energy, sex drive, mood, and overall reproductive health. So it's important.
It's difficult to determine how common low testosterone is because different studies are counting different things in different populations and the definition of "low" varies. Be warned: It's going to get a little technical, but there's a difference between biochemical hypogonadism and clinical hypogonadism. If you're looking at people with both low levels of testosterone in their blood and specific symptoms, estimates range from 2% of men aged 40–79, according to a European cross-sectional study published in the New England Journal of Medicine to 5.6% according to the Massachusetts Male Aging Study (MMAS). If you're strictly looking at testosterone levels in blood in men over 45, with no regard to symptoms, the same MMAS study says that 38.7% have "low testosterone," using MMAS-specific lab cutoffs. These are the kinds of blurry lines that let people claim "nearly 40% of men suffer from low T!" and be telling something like the truth, but not really.
Why your doctor doesn't routinely screen your testosterone levels
As with all conspiracy theories, the truth is much more mundane: You're not routinely screened for low testosterone because the prevalence of hypogonadism in the general population, without clear symptoms, is very low; test results are highly unreliable and prone to false positives unless done under strict conditions; and having low testosterone levels isn't even a medical problem unless you have specific, debilitating symptoms. If you do have symptoms like fatigue, low libido, erectile dysfunction, or loss of muscle mass, and you have low testosterone, it could still be because of other health issues like stress, poor sleep, diabetes, obesity, or sleep apnea.
That "probably" is really the issue, the wedge that makes "low testosterone" the perfect breeding ground for health misinformation. Having less energy and a lower libido are solidly on the "normal human experience" spectrum, but because they could be caused by low testosterone, some people are drawn to that explanation, and the idea of a quick fix for aging and/or general malaise. Others see an opportunity to make some cash.
Historical precedent: snake oil and goat balls
Despite testimony from satisfied customers back in the Jazz Age, goat tissue doesn't actually engraft or function when injected into the testicles, so it doesn't make men more goat-like. Herbs probably don't work either, no matter what that bodybuilder on Instagram says. A review of 32 studies of 13 different herbs meant to raise testosterone concluded that only two (Fenugreek and Ashwagandha) showed any promise, but like many studies on herbal supplements, the research is shaky: The sample sizes are too small, and test subjects didn't have a diagnosed clinical condition so the results may not apply to men who are genuinely deficient. So we have extremely scant evidence that herbs could raise your testosterone, and basically no evidence that raising your testosterone would provide a benefit anyway.
Significant, unexplained decrease in libido
Depression
Unexplained loss of body or facial hair
Infertility
How can you raise testosterone levels?
If you're basically healthy, but you still think there's something to the whole "I need more testosterone, now!" there's good news and bad news. The good news is that it's possible to raise testosterone levels without hormone replacement or taking supplements. The bad news: There is solid scientific research to support the idea that you can raise testosterone levels by losing weight, exercise, and getting enough sleep.
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