Why did you feel it was necessary to publish articles on this topic?

Countless articles and treatises on the internet address the effects of testosterone, testosterone replacement therapy, and the symptoms of testosterone deficiency; it is not uncommon to find lengthy and exhaustive details on websites promoting men’s health, sports, and bodybuilding, blogs, often involving self-proclaimed "experts" in the discussion. Given this, it’s no wonder that numerous misconceptions and false information circulate online, misleading both young and older men alike in our fast-paced world as they pursue a healthy lifestyle, desired sexual performance, and their ideal physique.

Why has discussing testosterone become such a hot topic among the general public these days?

One rarely emphasized and little-studied aspect of social media is the growing number of men with low self-confidence or low self-esteem. This is clearly evident in andrology clinics, where an increasing number of often very young men present with perceived or actual sexual complaints and symptoms. The sexual problems, negative thoughts, and beliefs regarding body image—including body image disorders—among Generation Z youth, who are entering adolescence (in part) in the online space, represent a new challenge not only for andrology but also for the rapidly evolving fields of sexual medicine and sexual psychology.

The unlimited access to content in the online space and on social media has contributed to the aforementioned negative body image, lack of self-confidence/low self-esteem, and the oversaturation with excessive visual content very often manifests itself in sexual problems—if the individual even manages to enter a relationship at all. And once they do, the superficiality of these relationships, along with a lack of self-confidence and intimacy, very often leaves its mark on the couple’s sex life as well. We must not forget that the overwhelming majority of relationship problems can manifest as sexual dysfunction in the male partner. In such cases, it is not uncommon for men consulting an andrologist to have self-diagnosed their condition; very often, they arrive at the appointment already in possession of lab results.

What exactly is testosterone, and what effects does it have?

Testosterone is a steroid hormone that begins functioning in men shortly after conception. The male external genitalia develop under the influence of testosterone produced in the embryonic testes. Shortly after birth, a phase known as “mini-puberty” occurs, characterized by a temporary rise in testosterone levels; this is associated with the maturation of the genitalia and subsequent fertility.

The male external genitalia develop under the influence of testosterone produced in the embryonic testes. Shortly after birth, a phase known as “mini-puberty” occurs, characterized by a temporary rise in testosterone levels; this is essential for the maturation of the genitalia and for future fertility. During puberty, this hormone is necessary for the development of male secondary sexual characteristics. In healthy men, adequate testosterone levels play a role in the development and maintenance of sexual motivation, fantasies, and libido, as well as in erection, ejaculation, and the sensation of orgasm. In addition, adequate levels of this hormone are necessary for maintaining healthy physical fitness, concentration, and cognitive functions.

What should we know about physiological changes in testosterone levels?

Men’s testosterone levels fluctuate according to a daily, so-called circadian rhythm. The highest serum levels typically occur in the early morning hours; when hormone levels are normal, this correlates well with the frequency of morning erections. The circadian rhythm of testosterone production can be influenced by numerous factors, including the quantity and quality of sleep, physical activity, diet, and prolonged stress. Generally speaking, a slow decline in serum free testosterone levels can be observed with advancing age, amounting to approximately 1% per year after the age of 30.

What symptoms may indicate low testosterone levels?

In cases of testosterone deficiency, also known as hypogonadism, low testosterone levels are accompanied by general and sexual symptoms indicative of this condition. General symptoms include reduced physical stamina, difficulty concentrating and memory problems, and sleep disturbances. Sexual symptoms are most often dominated by a lack of sexual motivation and libido, but erectile dysfunction and other sexual problems may also be present. A decrease in the frequency or cessation of morning erections may also indicate a hormonal imbalance.

What should I look out for if I want to check my testosterone levels?

It is common in andrology clinics for patients to arrive with lab results already in hand to support their complaints. In this regard, I consider it important to emphasize that if you request lab testing without a specialist’s referral, there are a few details to keep in mind to avoid false results. Due to the circadian rhythm mentioned above, it is important that the test be performed a few hours after waking up, preferably on an empty stomach. And if we receive particularly abnormal results, it is advisable to repeat the test at least once more.

What should I do if my testosterone level is low based on the lab test results?

If you receive abnormal lab results, it is always recommended to have them interpreted by an andrologist or endocrinologist. The test result generally represents a snapshot of a momentary condition and does not, on its own, constitute a diagnosis. In cases of abnormal results, a medical history, physical and imaging examinations, and additional laboratory tests may be necessary to establish a diagnosis.

Does a low testosterone level automatically mean testosterone replacement therapy?

Not necessarily, at least not based solely on a laboratory abnormality. In many cases, I find that patients—through direct or indirect hints—already arrive at the appointment seeking testosterone replacement therapy, looking for a solution to their perceived or actual sexual problems. After all, the latter often seems like a simpler solution than facing the real causes and roots of the problems. 

But then, who is eligible for testosterone replacement therapy in Hungary today?

The indications and contraindications for testosterone replacement therapy in Europe, including Hungary, are defined by strict professional regulations and guidelines. The decision regarding the necessity of treatment is always made by the doctor, who evaluates the patient’s complaints, lab results, and other findings—naturally, with the patient’s involvement.