Male Menopause and Low Testosterone:

When Your Testicles Get Tired, So Do You

Dr. Joseph Pazona, Board Certified Urologist

As a baseball fan and a urologist, I was fascinated and saddened by the baseball steroid scandal during the late 90s. “Roids” and “juicing” were all over the news.

While the talking heads were debating the morals and ethics of using anabolic steroids (synthetic male hormones) to improve sports performance, behind the scenes there were millions of men suffering from low testosterone (also known as low T).

Unfortunately, no one is talking about that. I’m on a mission to change this and to eliminate low T in Nashville.

Male menopause is a thing! Ladies, you’re not alone in this not-so-fun journey towards hot flashes, fatigue and weight gain. Let’s start off with some basic anatomy and a physiology lesson.

Where Does Testosterone Come From?

The testicles (or “balls” for those who giggle every time they hear the word testicle) produce the male hormone testosterone. This starts even before birth and continues throughout the life of most men. Testosterone is released directly into the bloodstream and is involved in the following:

  • Erections and libido (Doctor term for why men think about sex 536 times a day)
  • Deepening of the voice (Hello Barry White!)
  • Facial hair and later hair loss (Hello Telly Savalas!)
  • Muscle mass and bone strength (Hello Ahnold!)
  • Acne, stinky, oily skin (Hello puberty!)

What Are The Symptoms Of Low Testosterone?

If T levels are low, men may complain (and complain we do!) of the following symptoms:

  • Loss of erections
  • Low libido
  • Depression
  • Fatigue
  • Fat gain, muscle loss
  • Man boobs (moobs)
  • Hot flashes

Now, I’m sure there are some women who are reading this and thinking...

  • “Boo-hoo! We have to deal with hot flashes all the time! Maybe he’ll have a little sympathy for me now!”
  • “Thank god!” Maybe he won’t want to get frisky so much! I’m exhausted.”
  • “Wait a minute . . . he won’t want to have sex? That doesn’t sound good.”

What Causes Low T Levels?

In some cases, the testicles eventually get tired and stop making testosterone at appropriate levels. This can happen to men in their 20s.  Another common cause for low T levels . . . Bad dietary habits (hello chalupas).


Unhealthy eating, lack of exercise, and weight gain can lower testosterone levels. 


Fat contains an enzyme that converts testosterone to the female hormone estrogen. This hormone imbalance in men causes weight gain, fatigue, depression. And this leads to avoiding the gym, sitting on the couch, and eating Taco Bell. Thus putting on more weight and perpetuating the cycle towards moobs and unhappiness. 

How Can You Treat Low Testosterone?

So what can a man do about this horrible condition? Let’s start with the holistic and more conservative options and move towards the good stuff.

Natural testosterone boosters

First, eat healthier and take some exercise. If you don’t start making healthier lifestyle decisions then what’s the point of starting testosterone replacement? Yes, you’ll feel better in the short term, but eventually being overweight will worsen as you age.

Obesity, regardless of testosterone levels, is linked to erectile dysfunction, depression, heart disease, etc. This is bad.

You may not want to hear it, but good food choices and exercise are a must.

Testosterone supplements

We’ve all seen those male enhancement pills advertised on TV. They work, right? Wrong. Don’t waste your money. Either you’re buying snake oil or worse, they could contain hormones at unknown doses that cause dangerous side effects.

It’s a little known fact that sugar pills (or placebos) in most studies help about 40-50% of patients. So just because your buddy swears by Super Beta Penis Grower, doesn’t mean it’s actually doing him any good (if it worked all, men would take it . . . trust me).

Testosterone Replacement Therapy (TRT)

Finally, let’s talk about the “juice.” Testosterone replacement therapy or TRT. Every man, if given supplemental testosterone, will feel better. No question.

But (and this is a big but) you must be monitored closely by a physician with expertise in hormone optimization. Possible side effects can include:

  • Worsening sleep apnea,
  • Aggressive behavior
  • Liver dysfunction

With close monitoring and appropriate treatment, however, these side effects of testosterone can be caught early, reversed, or avoided all together.

What Are The Different Types Of Testosterone Replacement?

Testosterone can be administered a variety of ways. Let’s go through the pros and cons of each option:

Topical testosterone

Testosterone gel, creams or foams are used on a daily basis. It’s painless and easy to apply. However, you can transmit it to your loved ones if you’re not careful.

It’s important to rub the testosterone on a part of your body that will be covered with clothing (thighs or shoulders). You also need to be diligent about washing your hands afterwards.

In my experience, only 50% of men will absorb enough of the testosterone gel to see symptom relief. Men are also forgetful (what did you say?) and the compliance with daily use is low.

Testosterone injections

The quickest way to see if testosterone replacement therapy is right for you is with intramuscular or subcutaneous injections. It’s typically effective and allows for tweaking of dosages.

The downsides however are many. First, to receive the most benefit, you need to perform injections twice a week. I ain’t too good at math, but I’m not interested in 100+ injections per year.

Next men complain of “peaks and valleys” with less frequent injections. You feel REALLY good right after the injection and then not so much over the next 7-14 days.

Finally, this method is the least “natural way” of delivering testosterone. Our bodies have a daily rhythm to producing and utilizing testosterone. As a result, I see side effects such as elevated red blood cell counts more often with injections.

Testosterone pellet insertions

Through a quick, relatively painless office procedure, 8-12 rice kernel sized testosterone pellets are inserted underneath the skin in the upper buttocks. After taking it easy for a few days, men are back to normal.

The pellets are then slowly absorbed into the bloodstream at steady levels, as your body requires. This mimics the normal cycle of testosterone release and usage.

Lasting anywhere from 4 to 5 months, men can “set it and forget it” and focus on feeling awesome.

My go-to low T treatment in Nashville is bio-identical hormone pellet insertions through BioTE. Their pellets are safe, accurate, and allow us to calculate the right dose for you.

Of men who try the BioTE method, 95% continue with this option. Learn more about the BioTE method here.

So what have we learned? 

  • Male menopause is a real thing. (Ladies, you’re not alone.)
  • If you have symptoms suggestive of low testosterone, GET YOUR LEVELS CHECKED.
  • Super Beta Penis Grower is a waste of money.
  • With appropriate monitoring, replacing testosterone can provide a big boost in the bedroom and overall quality of life. 

Looking for a Low T Doctor in Nashville?

Further questions, comments, ideas for future topics? Drop me a line at hello@pazonamd.com.

Even better let’s get that consultation scheduled to discuss low T in Nashville.

Until then, let’s spread the word about male menopause and put down the chalupas.

- Dr. P

Dr. Joseph Pazona is a board-certified urologist in Nashville, TN with expertise in diagnosing and treating both men and women with low testosterone.

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About the Author

Doctor Joseph Pazona is the founder of Pazona MD, a specialty urology practice located in Nashville, TN. He has been published in medical journals on the topic of urology & authored several consumer ebooks on a variety of urologic conditions in addition to the topics of telemedicine, and continuing medical education (CME). When he’s not treating patients or writing he enjoys traveling, hiking, running, cooking, and spending time with his three children and fiancé, Catherine.


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