Persistent tiredness, weight gain and brain fog in men over 40 are being misread as burnout or depression when low testosterone signs in men over 40 may be the underlying cause, doctors at UAE clinics have said.
Two cases illustrate the point. A 42-year-old corporate executive spent nearly two years being treated for burnout and depression before tests revealed low morning testosterone and undiagnosed sleep apnoea. Treating the sleep disorder restored his hormonal balance. In a separate case, a 38-year-old man with persistent headaches and low libido was found to have a small, non-cancerous tumour in his pituitary gland. Medication brought his testosterone back to normal without the need for testosterone replacement therapy (TRT).
Testing numbers climb sharply
Metabolic clinic recorded a 44 per cent year-on-year rise in patients undergoing total testosterone tests in 2024. That figure jumped by 165 per cent in 2025, when the clinic carried out 2,383 tests.
Dr Ismail Arslan, an endocrinologist at Metabolic with more than 15 years of experience in endocrinology and metabolic diseases, said many men live with symptoms for months or years because they assume they are simply ageing or overworking.
‘The most common reason for their visit is some noticeable change in their sexual health, for example a decrease in libido, having fewer morning erections, or suffering from erectile dysfunction,’ he said.
Other frequent complaints include constant tiredness, loss of muscle mass, weight gain around the abdomen, brain fog, poor concentration and lack of motivation.
Why low testosterone signs in men over 40 are easy to overlook
The diagnostic challenge is that overlapping conditions produce identical symptoms. Poor sleep, obesity, diabetes, thyroid disorders and depression can all cause fatigue, low mood and poor concentration.
Dr Arslan said sleep apnoea is a particular complication. Research published in Frontiers in Endocrinology found that obstructive sleep apnoea disrupts the deep sleep during which testosterone is naturally produced, leading to pituitary-gonadal dysfunction and low testosterone in male patients. ‘Obesity can also affect hormone levels, and testosterone may improve after a patient loses weight,’ Dr Arslan added.
Testosterone levels typically peak in a man’s mid-20s and begin declining after 30, but Dr Arslan said the drop is gradual, unlike the abrupt hormonal shift women experience during menopause. Men who remain healthy and manage conditions such as obesity or diabetes can maintain normal testosterone levels well into their 60s and 70s.
Doctors also caution against relying on a single blood test. The American Urological Association recommends that diagnosis be based on at least two separate low readings taken in the morning, when levels are at their highest (typically between 7am and 10am). A poor night’s sleep, severe stress, a viral infection or a heavy carbohydrate-heavy meal before testing can all temporarily suppress levels, Dr Arslan said.
The Endocrine Society’s 2026 statement on testosterone replacement therapy advises against routine population-level screening, recommending that hypogonadism be diagnosed only in men with compatible symptoms and consistently low testosterone confirmed by repeat morning testing. For men with no other identified cause and a BMI above 27, weight loss is typically the first-line approach before TRT is considered.
Fertility risks of TRT
Dr Ahmad Allam, a urologist and andrologist with more than 30 years of experience at Trust Fertility Clinic in Abu Dhabi, said TRT may be considered for men diagnosed with hypogonadism, but only after other causes are excluded and the required tests are completed.
The fertility implication is direct. External testosterone can reduce sperm production and, in some men, stop it entirely. ‘TRT is not the preferred treatment for men who want children now or in the future. Such patients should discuss fertility with their doctor before starting treatment and may need a semen analysis,’ Dr Allam said.
Doctors advise men who have persistent tiredness, low libido, weight gain or brain fog to seek medical assessment rather than self-diagnosing or seeking testosterone treatment without first establishing what is driving their symptoms.
