Two decades ago, Frank maintained a rigorous fitness routine and high energy levels. Today, like many men balancing work, family, and financial pressure, his lifestyle is more sedentary—and his energy has declined with it. After months of unexplained fatigue, medical tests revealed a common but often overlooked issue: low testosterone. Like Frank, a lot of Black men in their forties—and older—are facing similar problems, but sadly know little or nothing about how their testosterone levels impact their health.
Testosterone is a primary sex hormone produced in the testicles and plays a crucial role in the development of physical masculine traits, characteristics, sexual function, and overall well-being. Levels typically peak during adolescence and early adulthood, then gradually decline at a rate of 1%-2% per year between ages 30 and 40.
Although the decline is a normal part of aging, certain medical conditions can accelerate the process. Age-related declines is a slow process with subtle changes, while disease-related declines can present more abruptly, sometimes with signs such as erectile dysfunction (ED).
Some studies have suggested that Black men in the United States often have higher testosterone levels in early adulthood (ages 18-23), but also experience earlier and more substantial decline in total testosterone levels as they age compared to white men.
What drives the age-related decline in testosterone, and what are the implications for men’s health?
Why do Testosterone Levels Decline with Age?
The cells in the human body divide to create new cells and ensure the proper functioning of the body tissues and organs. Cells have a limited lifespan and will continue to divide until they lose the ability. As cells age, they function less efficiently. Their ability to process nutrients, produce energy, and remove waste products diminishes.
Some cells become damaged over time and stop dividing, but do not die (zombie cells or senescent cells). The accumulation of zombie cells leads to tissue dysfunction, chronic inflammation, and increased susceptibility to disease. When the number of healthy Leydig cells in the testes, which are responsible for testosterone production, starts decreasing, the levels will start to decline too. Other age-related factors that contribute to a decline in testosterone levels are highlighted below.
Hypothalamic-Pituitary Dysfunction
As you age, there is a diminished output of growth hormones and sex steroids. When the brain decreases the production of gonadotropin-releasing hormone (GnRH), the result is reduced testicular stimulation, leading to lower testosterone levels.
Hypothalamic-pituitary dysfunction is the disruption of the signal pathway or communication between the hypothalamus and pituitary gland that triggers testosterone production. Age-related illnesses like obesity can interfere with the signal pathway.
Obesity and Metabolic Issues
As we age, we tend to become less active, overeat, have poor sleep, and our stress levels increase due to various factors such as economic pressures. This is truer for economically disadvantaged adults in our community. These factors, including alcoholism (which many turn to for solace), lead to the accumulation of visceral fat.
Visceral fat (deep-seated body fat stored around internal organs) produces high amounts of the enzyme aromatase that converts testosterone into estrogen. Low testosterone leads to more fat accumulation, further increasing the activities of aromatase. A vicious cycle!
This metabolically active fat releases inflammatory chemicals that increase the risk of heart disease and type 2 diabetes. It also promotes insulin resistance, which directly impairs the ability of the testes to synthesize testosterone.
Chronic Inflammation
The accumulation of zombie cells as we age, the buildup of cellular damage, and increased gut permeability all lead to persistent, low-grade, systemic inflammation called inflammaging. Zombie cells release pro-inflammatory signals called senescence-associated secretory phenotype (SASP) that damage surrounding tissues, leading to an inflammatory reaction.
Inflamed adipose tissue increases the expression of aromatase. Inflammatory cytokines, just like elevated estrogen, interrupt testosterone production pathways. It can also trigger fat tissues to convert existing testosterone into estrogen, which leads to hypogonadism (low testosterone).
Reduced Physical Activity
Adulthood comes with increased responsibilities, which often limit our physical activities. Recent studies show that the Black community continues to top other racial groups in physical inactivity. In 2023, Black adults were 3% less likely to meet national aerobic and muscle-strengthening guidelines than other United States adults.
A sedentary lifestyle, worsened by the lack of adequate green spaces or recreational facilities in predominantly Black neighborhoods and expensive gyms, reduces the body’s stimulus to produce testosterone. A sedentary lifestyle induces weight gain and increases abdominal fat, which converts testosterone into estrogen.
How to Know if Your Testosterone Levels Are Low?
As a man in his mid-forties, if you have noticed a gradual decline in your sex drive, fatigue, and low energy, it is likely because you are experiencing testosterone decline. However, these symptoms can also be suggestive of other underlying illnesses. This underscores the importance of scheduling a visit to your physician (usually endocrinologist and urologist) for proper testing.
Urologists will draw your blood (venous sample), which is the most accurate method, to test for total testosterone, free testosterone, and sometimes estradiol. The best time for testosterone test is in the morning (roughly 7 a.m. to 10 a.m.) when testosterone levels are at their peak. If your levels are low, your physician may recommend one of the following:
- Testosterone gels applied daily to the skin of the upper arm, thighs, or shoulders.
- Testosterone injection given every 7 to 14 days
- Skin patches applied once daily, usually in the evenings
- Pellets implanted under the skin to slowly release testosterone over 3-6 months.
Doctors will only recommend treatment if low testosterone levels are combined with symptoms like erectile dysfunction, depression, and loss of muscle mass. During the treatment, they will closely monitor you for potential side effects, including water retention and red blood cell count. The potential side effects of testosterone treatment are the reasons why it must be done under medical supervision.
For More Reading
- AARP. (2025, October 27). What are zombie cells and can removing them slow aging? AARP. https://www.aarp.org/health/conditions-treatments/zombie-cells/
- Cleveland Clinic. (2024, October 7). Gonadotropin-releasing hormone (GnRH): Function & regulation. Cleveland Clinic. https://my.clevelandclinic.org/health/body/22525-gonadotropin-releasing-hormone
- Cleveland Clinic. (2024, October 7). Hypopituitarism: What it is, symptoms & treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22102-hypopituitarism
- Emecheta, A. (2022, April). 4 struggles of Black caregivers. Elevate Black Health. https://www.elevateblackhealth.com/4-struggles-of-black-caregivers/
- Envoque MD. (2018, August 27). How are low testosterone and belly fat connected? Envoque MD. https://envoquemd.com/how-are-low-testosterone-and-belly-fat-connected/
- Jordan, S. E. II. (2023). Addressing irritable male syndrome. Elevate Black Health. https://www.elevateblackhealth.com/addressing-irritable-male-syndrome/
- Mayo Clinic Staff. (2024, January 19). Testosterone therapy: Potential benefits and risks as you age. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/sexual-health/in-depth/testosterone-therapy/art-20045728
- Salamon, M. (2025, December 1). How “inflammaging” shapes our health. Harvard Health Publishing. https://www.health.harvard.edu/diseases-and-conditions/how-inflammaging-shapes-our-health
- University of Central Oklahoma. (2022). Socioeconomic status and physical activity levels in obese and non-obese African Americans [Master’s thesis, University of Central Oklahoma]. ShareOK. https://hdl.handle.net/11244/335528
- Zhang, Y., Li, X., Chen, W., & Wang, J. (2025). The role of testosterone therapy in aging men: Benefits, risks, and clinical considerations. Frontiers in Endocrinology, 16, Article 11978783. https://pmc.ncbi.nlm.nih.gov/articles/PMC11978783
- Zirkin, B. R., & Papadopoulos, V. (2018). Leydig cells: Formation, function, and regulation. Biology of Reproduction, 99(1), 101–111. https://doi.org/10.1093/biolre/ioy059
