Q: I had low energy levels and low voice tone, due to which I got my free testosterone tests done. The result came out as 20 (15-40 normal). How am I supposed to find out my correct level? I really feel that after all the exercises and healthy diet, my energy levels are quite lower than a normal person. I am hypothyroid too, but its level is almost fine tuned.

A:In summary, you are a 28 years old male who has almost 5 years of low energy levels, low voice tone, lack of sexual desire and you have under active thyroid gland, for which appropriate replacement has been done. I assume that you had this blood test taken between 8 to 9 AM and your thyroid blood test is completely normal. Your testosterone levels are fine as it falls within the normal range. All sexual problems related in men are not related with low testosterone. Sexual problems in men can be of different types - like lack of erection, lack of interest in sex (diminished libido) or ejaculation problem. Anything that limits blood flow to the penis can cause erection problem. The common conditions that limit blood flow include cigarette smoking, diabetes mellitus, hypertension, alcoholism, drug abuse, normal male aging, and depression and some medications (not thyroxine as long as it is adequately replaced). Psychological causes like depression and anxiety can cause lack of interest in sexual activity. In order to know the cause, a sexual history, a physical examination, and blood tests (testosterone prolactin, thyroid function test) are required to determine the cause. You will need a further evaluation and few more tests and most important is a detailed history that can help with the diagnosis.