Low testosterone (male menopause) in Taichung: self-check and tests
“Male menopause” is the everyday name for late-onset hypogonadism: a slow fall in the male hormone testosterone. Low testosterone is diagnosed by symptoms together with confirmed morning blood tests — not by symptoms alone.
Explained by Dr. Chao-An Chen, urologist, at 昭安泌尿科診所 (Morning Urology Clinic), West District, Taichung.
In short
- Blood test: come in the morning after fasting for about 8 hours (a little plain water is fine). Blood is taken before 10:00. The first test is on your first visit; the second is on another morning.
- Diagnosis: symptoms, and both morning tests below 350 ng/dL (about 12 nmol/L).
- Treatment: this clinic has a long-acting injection, a skin gel and a nasal gel. If you still want children, testosterone is not used.
- Follow-up: usually every 3 months, checking testosterone, haematocrit (the share of red blood cells), PSA and blood pressure.
- Doctors: Dr. Chao-An Chen (urology and surgery specialist) or Dr. Kai-Wu Yang (urologist). You can choose when you book.
Is it low testosterone?
Tiredness, low mood, lower sex drive, weaker erections and more belly fat can all come with low testosterone. But lack of sleep, sleep apnoea (breathing stops during sleep), obesity, diabetes, thyroid disease, anaemia, depression, long-term illness and some medicines can cause very similar changes. So the European Association of Urology (EAU) advises testing only men with related symptoms, not giving testosterone routinely because of age.
If changes like these started in the last 6 months to 1 year, a morning blood test is worth having. Fewer morning erections are also a sign to note.
The ADAM self-check. The ADAM questionnaire (Androgen Deficiency in Aging Males) has 10 yes/no questions. (The Chinese page has a tick-box version that runs only in your browser; nothing is sent to the clinic.)
- Is your sex drive lower?
- Do you have less energy?
- Has your strength or endurance gone down?
- Have you lost height?
- Do you enjoy life less?
- Do you feel sad or low?
- Are your erections less firm?
- Has your ability to exercise gone down?
- Do you fall asleep after dinner?
- Are you doing less well at work?
The result is positive if you answer “yes” to question 1 or 7, or to any 3 of the other 8. Then a morning blood test is worth arranging. But:
- Positive does not mean low testosterone. ADAM is sensitive but not specific: poor sleep, obesity, diabetes, thyroid disease, anaemia and depression can also give many “yes” answers. The 2026 EAU guidelines do not advise self-filled questionnaires for systematic screening.
- Zero “yes” answers does not mean all is fine. A clear change in sexual function is worth a morning blood test whatever the score.
Diagnosis: two morning blood tests
Testosterone is usually higher in the morning. The 2026 EAU guidelines advise testing total testosterone between 07:00 and 10:00, fasting, and repeating a low result on a different day before treatment. One man’s level can vary a lot between days, so this clinic bases the diagnosis on two morning tests on different days.
At this clinic: the clinic opens at 09:00 on weekdays and Saturdays, and blood is taken before 10:00. Blood taken in the afternoon or evening may wrongly look low. Delay the test if you have a cold or fever or were recently ill. If you work nights, have the test after a full sleep, fasting, and tell us your shifts when you book.
- First test: total testosterone; PSA (a prostate blood test) as well if you are 40 or over.
- Second test: total testosterone, plus LH (a signal hormone from the pituitary gland), prolactin and haematocrit. Results in 1 working day.
- If needed: blood sugar or HbA1c, blood fats, thyroid. FSH and SHBG are not tested here.
If the second total testosterone is still below 350 ng/dL:
- LH high-normal or raised, and haematocrit 50% or lower: low testosterone is confirmed.
- Haematocrit above 50%: treatment is put on hold, and you are referred to internal or family medicine to find the cause.
- LH low or low-normal: prolactin is checked. Normal: confirmed. High: tested again; if still high, referral to endocrinology or a pituitary MRI.
- Total testosterone below 150 ng/dL with LH low or low-normal: a pituitary MRI, whatever the prolactin.
How low is low? Do not judge only by the “normal range” on the lab report. The 2026 EAU guidelines use below 12 nmol/L (about 350 ng/dL) as an important threshold for men with symptoms, and still require symptoms and repeat tests together. This clinic uses 350 ng/dL; the American Urological Association (AUA) 2018 guideline uses 300 ng/dL. A low number with no symptoms does not always need treatment. Many symptoms with a normal number means looking for other causes.
Why a first low result is not treated at once: poor sleep, weight gain, poorly controlled blood sugar and long-term stress can push testosterone down (functional hypogonadism). Treating the cause may bring the level back, and starting medicine early may hide a reversible problem. In Taiwan, a BMI of 24 or more, or a waist of 90 cm or more in men, is a warning sign of overweight or belly obesity. For overweight men, weight loss, diet and exercise come first. But diet and exercise alone usually raise testosterone by only about 1–2 nmol/L (about 30–60 ng/dL), and 60–86% of lost weight often returns within three years. If symptoms are clear and both tests are low, the doctor may start testosterone during weight loss; evidence for combining them is still limited.
Treatment options
Two questions come before choosing a form. Do you plan to have children? Testosterone from outside the body suppresses sperm production. Can it be stopped easily? A long-acting injection cannot be stopped at once like a gel, so older men, men with heart or blood vessel disease, and men with high haematocrit usually start with a form that is easier to adjust. You and the doctor choose together (shared decision-making, as the EAU advises).
| Form | How it is used |
|---|---|
| Testosterone undecanoate injection (long-acting) No daily medicine | Deep injection into the upper outer buttock muscle, given by our medical staff. Second injection at week 6, then about every 10–12 weeks. A blood test around week 10 decides whether the next one keeps the same interval, is delayed or is paused. Not given at age 65 or over, or to men who have or had a liver tumour. |
| Testosterone gel (through the skin) No injections; easy to adjust | Once every morning on the upper arms and shoulders (the area a short-sleeved shirt covers). Cover with clothing once dry and wash your hands. Until it is dry, keep the area away from the skin of women and children. |
| Nasal testosterone gel Skin gel not practical | Following the Taiwan product information, it starts at 2 times a day, at least 6 hours apart. Wash your hands with warm water and soap if it gets on them. Not advised with a history of nose disease, nose or sinus surgery, a recent broken nose, inflamed nasal lining or sinus disease. |
| Clomiphene plus DHEA (tablets) Still want children | Helps the body make its own testosterone. Only if the testicles can still make it (LH not high). Off-label use (see below). |
The EAU lists testosterone gel and long-acting testosterone undecanoate as products with more mature safety data. The injection needs closer attention to rising haematocrit than gels. Gel and nasal gel are prescribed until your next visit, about 3 months’ supply. You do not need to choose before coming.
What may improve. In men who truly have hypogonadism, the evidence is stronger for sex drive, some mild erectile dysfunction (ED), satisfaction with sexual function, more lean tissue, less of some fat, some mild mood symptoms and bone density. If firmness does not follow, the erection itself needs its own assessment (for example oral PDE5 inhibitors or low-intensity shockwave therapy), not a higher dose. Testosterone is not a weight-loss treatment or an anti-ageing cure; the EAU does not advise it only for weight loss, heart and metabolic health, or thinking.
How soon? Some symptoms change within weeks to months. The first check of the effect is at month 3. If testosterone is in the normal range but symptoms have not changed after 3–6 months, stopping or looking for other causes is discussed.
Still want children? Ask before starting
Testosterone from outside the body suppresses the LH and FSH signals from the pituitary gland, which lowers the testicles’ own testosterone and sperm production. The 2026 EAU guidelines advise that men trying to have children should not use testosterone therapy (TRT). The approved Taiwan product information says testosterone is not a treatment for male infertility, and that long-term use or high doses may cause low sperm count. The AUA/ASRM male infertility guideline (2024 amendment) also says men who want children now or later should not be prescribed testosterone. Neither guideline makes an exception for any form, including the nasal gel.
If you still want children, this clinic has an oral path. Clomiphene makes the pituitary send more LH and FSH, so the testicles make more themselves. DHEA is a raw material the body uses to make hormones. It works only if the testicles can still make testosterone (LH not high); it does not work in primary hypogonadism. For secondary hypogonadism with active plans for a baby, the guidelines’ standard treatment is gonadotropin injections, with referral to a reproductive medicine team if needed. A semen analysis (Chinese) can be done here, with the report on the same day.
This path is off-label use
In Taiwan, clomiphene is approved to induce ovulation in women. DHEA is regulated as a prescription medicine and has no approved use for low testosterone in men. Both are off-label for men. It is not a routine first choice. It is discussed only when family plans, blood results and risk assessment support it. The doctor first explains why, how uncertain the effect is and what must be monitored; then you decide.
Follow-up, the heart and the prostate
At this clinic you usually come back every 3 months, with blood tests each time: testosterone, haematocrit, PSA and blood pressure, plus blood sugar, blood fats, weight and waist by your risk. The guidelines’ minimum is testosterone and haematocrit at months 3, 6 and 12, then at least yearly. Haematocrit is the key safety marker: above 54%, the dose is lowered, the interval is made longer or treatment is paused. Follow-up is not optional; it is what makes this treatment safe.
Heart. In the large TRAVERSE trial (men with symptoms of low testosterone and heart disease or high heart risk), major cardiovascular events were not more common with testosterone gel than placebo. In 2025 the US FDA removed the earlier boxed warning on this, but added a warning that blood pressure may rise. If you have high blood pressure or heart disease, the doctor assesses you first and refers you to cardiology if needed.
Prostate. The EAU says testosterone has not been shown to raise prostate cancer risk, but long-term data are still needed. In TRAVERSE (which first excluded men at high risk of prostate cancer), over about 3 years, prostate cancer did not differ between groups, but PSA rose more with testosterone. So a baseline PSA and regular checks are needed. If you also have urinary symptoms, see enlarged prostate: symptoms and treatment.
Visits, and the first day
| Visit 1 | Assessment, symptom questionnaire, first blood test before 10:00 (PSA too if 40 or over). Allow 30 minutes to 1 hour. |
| Visit 2 | Second blood test on another clinic morning; the first result is explained. |
| Visit 3 | The second result usually comes in about 1 working day, by LINE. If both are low and symptoms match, treatment starts (the injection at the clinic; gel or nasal gel handed to you). |
| After that | Usually every 3 months. Injections, prescriptions and follow-up can be at any session, including evenings and Saturday mornings. |
A recent morning fasting report from elsewhere can count as one of the two tests. From outside Taichung, the tests can be on two clinic days in a row with one night’s stay. Bring a list of all your medicines, including supplements and products bought online or abroad. If you have used gym steroids, even months ago, say so: suppression may not have worn off yet.
Injection day: if you want to cough, or feel chest tightness, shortness of breath or dizziness during or just after the injection, tell the staff at once. If chest tightness or shortness of breath starts after you get home, go directly to an emergency department. Do not wait for a LINE reply.
Costs
Testosterone treatment is self-paid. If you are not enrolled in Taiwan’s National Health Insurance, the consultation and tests are self-paid. The total depends on the blood tests, the form you choose (each is charged in a different unit), the dose and interval set by your results, and follow-up. Costs are explained at the consultation. You can also ask about costs on LINE before you come. After diagnosis, the doctor gives you the full cost of your chosen form, including follow-up, before you decide.
Frequently asked questions
If I take testosterone, can I stop my erection tablets?
Not always. Treatment may improve some mild ED. More severe ED may still need oral PDE5 inhibitors such as sildenafil. The EAU also supports discussing a PDE5 inhibitor plus testosterone for some men with low testosterone and more severe ED.
Can I stop? Will I be worse than before?
You can stop, but you usually return to how you were before treatment. Testosterone treats symptoms; it does not “repair” the body. Plan stopping with the doctor; do not stop suddenly. Functional low testosterone may not need treatment once the cause improves; a primary problem usually needs long-term treatment.
Will my testicles get smaller? Will they recover?
Long-term use can make the testicles smaller and lower sperm production, with every form; the Taiwan product information for all three mentions it. After stopping, sperm usually return, but often only after several months, sometimes more than a year; slower after longer use or the injection, and some men never fully recover. How long testicle size takes to return has not been measured at treatment doses.
What if my partner or child touches the gel?
In product information studies, 15 minutes of skin rubbing without washing or covering raised the partner’s testosterone by about 280%. With clothing over the area, it rose only about 6%. Washing hands straight away removed about 96% of the medicine on the hands. With young children at home or a pregnant partner, this is part of choosing the form.
Can I donate blood while on testosterone?
Taiwan has no blood donation rule written for testosterone, so there is no official waiting time; it is decided at the donation site on the day. Do not stop your medicine to donate. Donation is not a way to lower haematocrit: that is done by changing the dose, interval or form, or pausing. This clinic does not do venesection (removing blood) and refers you if needed.
I already take testosterone elsewhere. Can I continue here?
Yes. Bring your blood reports and medicine details (form, dose, date of last use or injection). After the doctor’s assessment, treatment can continue on your first visit. Without records, a full assessment is arranged.
Medical risks and when testosterone is not used
In men with confirmed hypogonadism, some symptoms can improve. It is a treatment that needs long-term monitoring.
- Fertility: it suppresses sperm production. Men with family plans do not use it (a contraindication in the guidelines).
- Haematocrit may rise; regular tests are needed. Above 50% before treatment, treatment is put on hold.
- Prostate and breast: no testosterone with active or untreated prostate cancer, or male breast cancer (including treated). A high PSA is retested and the prostate assessed first. PSA rises slightly on treatment. A few men have breast tenderness or breast enlargement.
- Heart: after a heart attack or stroke in the last 3–6 months, treatment does not start yet. With heart disease or a family history of blood clots in the veins, a risk assessment comes first. Blood pressure may rise and is measured at visits (an FDA warning added in 2025). In TRAVERSE, atrial fibrillation, acute kidney injury and pulmonary embolism were slightly more common with testosterone (pulmonary embolism 0.9% vs 0.5%).
- Urinary symptoms: if severe (IPSS score above 19), they are treated first.
- Sleep apnoea: the 2026 EAU guidelines find no evidence that testosterone causes or worsens mild or moderate sleep apnoea, or severe sleep apnoea treated with CPAP, but the Taiwan product information warns it may worsen. The guidelines advise haematocrit every 3 months in the first year for these men.
- Other limits: too many red blood cells, severe heart failure and untreated severe sleep apnoea. No long-acting injection with a past or present liver tumour, or at age 65 or over.
- Injection reaction: rarely, cough, shortness of breath, chest tightness or dizziness during or just after the injection (from tiny drops of the oily medicine). It usually passes.
- Testicles may get smaller and sperm production fall; this varies by person, dose and length of treatment.
- Gel can pass to a partner or child by skin contact.
- Other effects: acne, fluid swelling (oedema), mood changes.
- Not a cure: symptoms usually return after stopping.
Medicines other than testosterone (off-label)
Some are not approved in Taiwan for male hypogonadism, and data are more limited. The doctor explains the reason, expected effect and risks before prescribing, and you decide.
Clomiphene: blurred vision or flashes of light, mood swings, headache, breast tenderness; rarely blood clots. If your vision changes, stop and come back.
DHEA: acne, oily skin, body hair or hair loss changes, mood swings. Not for men with a history of hormone-sensitive tumours such as prostate cancer.
Related pages
- Low-intensity shockwave therapy for erectile dysfunction
- Enlarged prostate: symptoms, diagnosis and treatment
- Minimally invasive treatments for an enlarged prostate
- Hormones and sperm for men planning a child (Chinese)
- Male pattern hair loss (Chinese): part of the testosterone becomes DHT, so hair loss may show more in men with sensitive hair follicles
Appointments and access
Consultations are conducted in Mandarin, and can also be conducted in English.
Book a morning slot and come fasting. On LINE, send your name, mobile number, preferred date and preferred doctor, and say “testosterone test”. The clinic has private consulting rooms; you do not need to explain why you are here in the waiting area.
昭安泌尿科診所 (Morning Urology Clinic)
No. 98, Boguan 2nd St., West District, Taichung City 403, Taiwan（403 臺中市西區博館二街98號）
Consulting hours: Monday to Saturday (closed Sunday). Online booking is open 24 hours.
This page was produced by 昭安泌尿科診所 (Morning Urology Clinic). Medical content last updated: October 2026 (same as the Traditional Chinese version). English version published: 5 November 2026. Medically reviewed by Dr. Chao-An Chen, urologist.
Sources: EAU Guidelines on Sexual and Reproductive Health — Male Hypogonadism (2026) / product information approved by the Taiwan Food and Drug Administration / Lincoff AM, et al. TRAVERSE. N Engl J Med. 2023;389(2):107–117 / Bhasin S, et al. JAMA Netw Open. 2023;6(12):e2348692 / US FDA labelling change for testosterone products (28 February 2025) / AUA/ASRM: Diagnosis and Treatment of Infertility in Men (2020, amended 2024) / AUA: Evaluation and Management of Testosterone Deficiency (2018) / Health Promotion Administration: adult obesity and waist standards.
This page provides general medical information and does not replace an individual diagnosis or treatment plan.