Low Testosterone in Senior Men 2026: Warning Signs, Testing and What Treatment Really Does
Low testosterone is diagnosed by symptoms plus two low blood tests, not by age alone. The Endocrine Society says to test total testosterone in the morning, while fasting, on two separate days (Endocrine Society guideline). In large trials, men qualified when their level was below about 300 ng/dL on two tests.
If treatment is right for you, it can help sex drive and mood a little. It does not reliably boost energy or walking. And the biggest safety trial, TRAVERSE, found no extra heart attacks or strokes, but more AFib, kidney injury, blood clots in the lungs and bone fractures (TRAVERSE, NEJM 2023). Below is what each piece means for a man over 65.
Warning signs to take seriously
Testosterone falls slowly with age in many men. Not every drop causes problems. Signs that point more strongly to low T include:
- Low sex drive and fewer morning erections
- Erectile problems
- Loss of body hair or shrinking testicles
- Hot flashes or sweats
- Breaking a bone after a minor fall, or low bone density
Vaguer signs include tiredness, low mood, poor focus, weaker muscles and more belly fat. These have many other causes, like poor sleep, depression, thyroid problems, diabetes, medicines and too much alcohol. That’s why a blood test matters.
Don’t overlook sleep apnea. It can both lower testosterone and cause tiredness. Testosterone treatment can make untreated severe sleep apnea worse. Our sleep apnea guide covers the warning signs.
How to test it the right way
The Endocrine Society’s 2018 guideline sets these steps:
- Test early in the morning, when levels are highest, after fasting.
- Repeat the test on another day if the first one is low.
- Look for the cause. Your doctor may check LH and FSH, prolactin and iron to find out why levels are low.
- Avoid testing during a short illness, which can lower levels for a while.
Under Original Medicare, lab tests your doctor orders as medically needed usually cost you $0. Our Medicare blood test guide explains the rules.
What the big trials found
The T Trials (2016). 790 men aged 65 and older with testosterone below 275 ng/dL used a gel or a placebo for a year (NEJM 2016). Sexual function and mood improved modestly. Vitality and walking distance did not improve significantly.
TRAVERSE (2023). 5,246 men aged 45 to 80 with heart disease or high heart risk, and two fasting tests below 300 ng/dL, used a gel or a placebo.
- Major heart events: 7.0% on testosterone and 7.3% on placebo. Testosterone was “noninferior,” meaning not worse.
- More common on testosterone: AFib, acute kidney injury and pulmonary embolism (blood clots in the lungs).
Fractures (2024). A TRAVERSE sub-study found more fractures on testosterone: 3.50% versus 2.46% (NEJM 2024). That was unexpected, since many had hoped testosterone would protect bones.
What the FDA changed in 2025
In February 2025, the FDA ordered label changes for testosterone products. It removed the boxed-warning language about higher heart attack and stroke risk, based on TRAVERSE. It added the TRAVERSE results and blood pressure warnings to all testosterone labels.
The FDA kept one key line. The labels still say these products are not approved for low testosterone caused only by aging. They are approved for men with a known medical cause, like a problem with the testicles or pituitary gland. Doctors can still prescribe them “off-label” for age-related low T, but you should know the difference.
Who should not take testosterone
The Endocrine Society advises against starting treatment if you have:
- Breast or prostate cancer
- A PSA above 4, or above 3 if you’re at high risk for prostate cancer, until a urologist checks it
- A high red blood cell count (hematocrit)
- Untreated severe sleep apnea
- Severe urinary symptoms from an enlarged prostate
- Heart failure that isn’t under control
- A heart attack or stroke in the last 6 months
Pros and cons of treatment
| Pros | Cons |
|---|---|
| Modest gains in sex drive and erections | No clear gain in energy or walking |
| Some improvement in mood | More AFib, kidney injury and lung clots in TRAVERSE |
| No rise in heart attacks or strokes in TRAVERSE | More fractures in the TRAVERSE sub-study |
| Gels, shots and patches to choose from | Raises red blood cells; needs regular blood tests |
The American College of Physicians says doctors should discuss treatment only for sexual problems in older men with low T. It advises rechecking within 12 months and stopping if things don’t get better (ACP 2020). It also notes that shots usually cost far less than gels.
Costs and Medicare
Testosterone is a prescription drug. If you have Original Medicare, it’s usually covered by your Part D plan, often with prior approval and proof of a low level. Shots given in a doctor’s office may be billed differently. In 2026, Part D out-of-pocket drug costs are capped at $2,100, and the cap rises to $2,400 in 2027. Compare plans in our Part D 2027 guide.
Watch out for “low T clinics” and online sellers that promise more energy and youth. Some push high doses or skip the follow-up blood tests. “Testosterone boosters” sold as supplements are not the same as testosterone. They aren’t approved by the FDA before sale, and the FDA has found hidden drug ingredients in some products sold for men’s health.
Free steps that help
These won’t cure true low T, but they can raise levels a bit and help symptoms:
- Lose extra weight. Belly fat lowers testosterone.
- Strength train 2 to 3 times a week. Try our resistance band routine or these bone-safe exercises.
- Sleep 7 to 8 hours and get tested for sleep apnea if you snore.
- Limit alcohol and review medicines like opioids with your doctor.
Common questions
What testosterone level is too low for a man over 65?
Most large trials used a total testosterone below about 300 ng/dL on two morning fasting tests. Symptoms also have to be present. Your lab’s range may differ.
Is testosterone therapy safe for older men?
TRAVERSE found no rise in heart attacks or strokes. But it found more AFib, kidney injury and lung clots, and a sub-study found more fractures. Talk through these risks with your doctor.
Does testosterone give older men more energy?
Usually not by much. The T Trials found no significant gain in vitality or walking. The clearest benefits were modest gains in sexual function and mood.
Does Medicare pay for testosterone?
Part D plans often cover testosterone when a doctor prescribes it, usually with prior approval. Lab tests your doctor orders are usually $0 under Part B.
Are testosterone booster supplements worth it?
No. They aren’t testosterone, they aren’t FDA-approved before sale, and some have been found to contain hidden drugs.
Written by Khasim Basha Shaik. I research health topics for readers using primary studies and government sources. I am not a doctor or pharmacist. This article is for general information only. Talk with your doctor before starting or stopping any treatment. Last reviewed October 17, 2026.
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