Low testosterone does not cause migraines in men. At Longevity Benchmark, we review hormone evidence so readers avoid paying for tests that cannot explain their symptoms. Controlled blood measurements comparing men with migraine against healthy controls show no deficit in circulating testosterone.
The Verdict
Hormone Measurements in Men with Migraine
Two controlled studies measuring sex hormones in men with migraine found no deficiency in testosterone concentrations. A 2018 study led by van Oosterhout and colleagues in Neurology compared 17 men with migraine against 22 controls. Free testosterone did not differ between the groups, measuring 357.5 ± 21.4 pmol/L in migraine patients and 332.6 ± 18.7 pmol/L in controls (P=0.35).
Circulating estradiol was higher in the migraine group at 96.8 ± 6.1 pmol/L compared to 69.1 ± 5.6 pmol/L in controls (P=0.001). Higher estradiol concentrations accounted for the lower ratio, while free testosterone did not differ. Our review of estradiol levels in men examines how estrogen balance functions in male physiology.
A larger 2025 study in Frontiers in Neurology tested 60 men with episodic migraine and 60 matched controls. The authors found no difference in testosterone, luteinising hormone (LH), or follicle-stimulating hormone (FSH), and estradiol differences did not reach statistical significance at 0.09 versus 0.12 nmol/L (P=0.07).
Progesterone measured lower in the migraine cohort at 0.2 versus 0.5 nmol/L (P<0.001). This 2025 paper carries a published erratum, so its values are best read as provisional. The 39-patient 2018 study observed elevated estradiol, while the 120-patient 2025 study found no significant difference.
Chronic migraine data is limited to a 14-man pilot published in Neurologia International without a concurrent control group. Mean total testosterone was 322 ng/dL, which sat 62 ng/dL below historical normative medians (P=0.0494). Historical comparisons provide weak evidence.
| Study | Sample size | Free or total testosterone | Estradiol | Ratio outcome |
|---|---|---|---|---|
| van Oosterhout et al. (2018) | 17 migraine, 22 controls | 357.5 pmol/L vs 332.6 pmol/L (no significant difference, P=0.35) | 96.8 pmol/L vs 69.1 pmol/L (significantly higher in migraine, P=0.001) | Significantly lower ratio (3.9 vs 5.0, P=0.03), driven by estradiol |
| Triller, Storch et al. (2025) | 60 migraine, 60 controls | No significant difference between matched cohorts | 0.09 nmol/L vs 0.12 nmol/L (difference not significant, P=0.07) | No significant difference in testosterone-to-estradiol ratio |
| Shields et al. (2019) | 14 chronic migraine, no control arm | Mean 322 ng/dL, 62 ng/dL below historical medians (P=0.0494) | Not measured | Not evaluated |
Discrepancy Between Perceived Symptoms and Blood Levels
Men with migraine frequently report symptoms typical of androgen deficiency while maintaining normal circulating hormone concentrations. In the 2018 van Oosterhout cohort, 61.1% of men with migraine reported deficiency symptoms compared to 27.3% of controls (P=0.031). Their Aging Males' Symptoms questionnaire scores averaged 27.0 ± 1.2 compared to 21.0 ± 1.0 in headache-free men (P=0.002).
Their measured free testosterone remained entirely normal despite those complaints. A larger survey published in the Journal of Headache and Pain in 2021 evaluated 534 men with migraine. Sexual symptoms were reported by 18.4% of men with migraine compared to 7.2% of controls (P=0.001).
That survey adjusted for age, body mass index (BMI), smoking, and lifetime depression. The researchers never collected blood samples or measured hormone levels. Our guide on signs of low testosterone separates validated clinical signs from non-specific systemic fatigue.
Overlap of Chronic Headache and Hormone Deficiency Complaints
Four non-specific systemic complaints appear on diagnostic profiles for both hypogonadism and chronic migraine. Shared symptoms do not demonstrate a shared hormonal mechanism. The Endocrine Society lists decreased energy, depressed mood, poor concentration, and sleep disturbances as non-specific features of testosterone deficiency.
The National Institute of Neurological Disorders and Stroke notes that people with migraine experience identical problems between attacks. Patients report difficulty concentrating, depression, persistent tiredness, and difficulty sleeping. They also face higher rates of clinical sleep disorders than the general population.
- Fatigue and low vitality. Low energy appears on androgen deficiency surveys and forms a core interictal complaint in migraine patients.
- Mood alterations. Depressed mood is a recognized feature of both clinical hypogonadism and frequent migraine attacks.
- Impaired concentration. Cognitive sluggishness and memory difficulties occur in men with low testosterone and between migraine episodes.
- Disturbed sleep. Sleep disturbance sits on the Endocrine Society's non-specific list, and NINDS reports difficulty sleeping between migraine episodes.
Distinction Between Migraine and Cluster Headache
Cluster headache is an entirely distinct primary headache disorder characterized by unilateral cranial autonomic activation and a strong male predominance. The International Classification of Headache Disorders, 3rd edition (ICHD-3) classifies cluster headache as a trigeminal autonomic cephalalgia. Attacks produce severe orbital, supraorbital, or temporal pain lasting 15 to 180 minutes when untreated.
Episodes occur from once every other day up to eight times daily. Pain is accompanied by ipsilateral autonomic signs or restlessness. The classification notes that men suffer from cluster headache three times more often than women.
A meta-analysis by Fischera and colleagues in Cephalalgia calculated a lifetime prevalence of 124 per 100,000. That analysis reported a male-to-female ratio of 4.3 to 1 across published populations. Migraine displays the reverse demographic pattern.
In the American Migraine Prevalence and Prevention study, Lipton and colleagues screened 162,576 individuals in Neurology using International Classification of Headache Disorders, 2nd edition (ICHD-2) criteria. Migraine affected 17.1% of women and 5.6% of men, representing an 11.7% overall prevalence. By contrast, survey data published by Burch and colleagues in Headache reported a 3-month prevalence of 14.2% for migraine or severe headache.
That survey found age-adjusted rates of 19.1% in females and 9.0% in males. The figures diverge because a household survey tracking severe headache uses a broader case definition than strict neurological screening. Prospective testing in cluster headache also fails to establish a primary androgen deficit.
A 2026 study by Naber and colleagues in Headache evaluated fasted morning blood in 30 men with chronic cluster headache, 33 with episodic cluster headache, and 30 headache-free controls. Biochemical hypogonadism was present in 20% of chronic cluster patients, 9% of episodic patients, and 7% of headache-free controls. The crude testosterone difference in chronic cluster was not statistically significant (B = −2.35 nmol/L, 95% confidence interval [CI] −4.79 to 0.09, P=0.059).
After adjusting for body mass index and age, the statistical association essentially vanished (B = −0.93 nmol/L, 95% CI −3.81 to 1.95, P=0.524). The authors attributed the attenuation to differences in body mass index and participant age. Strictly unilateral attacks lasting 15 to 180 minutes, with ipsilateral autonomic signs or restlessness, are the ICHD-3 description of cluster headache rather than of migraine.
| Diagnostic feature | Migraine | Cluster headache |
|---|---|---|
| Classification | Primary headache disorder under ICHD-3 | Trigeminal autonomic cephalalgia under ICHD-3 |
| Sex ratio | More common in women (17.1% vs 5.6% in AMPP study) | More common in men (about 3:1 in ICHD-3, 4.3:1 in meta-analysis) |
| Attack duration | 4 to 72 hours when untreated | 15 to 180 minutes when untreated |
| Pain location and quality | Often unilateral, pulsating, moderate to severe | Strictly unilateral, severe orbital, supraorbital, or temporal pain |
| Associated features | Nausea, vomiting, photophobia, and phonophobia | Ipsilateral autonomic signs or restlessness |
Published Evidence on Testosterone Administration
No randomised controlled trial has evaluated testosterone replacement therapy (TRT) as a treatment for migraine in men. The published interventional literature consists entirely of small observational case series. A 2006 case series by Stillman in Headache reported symptom improvement in 9 patients with refractory cluster headache.
Earlier work by Nicolodi and colleagues in Cephalalgia evaluated 7 cluster patients and reported that testosterone administration did not alter the headache course. A separate case report described 2 transmasculine patients with chronic migraine. Those three small reports represent the entire interventional literature.
Head pain is documented on drug labeling as a known side effect rather than a therapeutic benefit. The prescribing information for AndroGel approved by the Food and Drug Administration (FDA) reports headache rates of 4% on 50 mg, 3% on 75 mg, and 0% on 100 mg. Approved indications cover replacement therapy for primary and hypogonadotropic hypogonadism, with no mention of headache relief.
The FDA label states that safety and efficacy of AndroGel 1% in men with age-related hypogonadism have not been established. Our guide to TRT side effects and risks outlines cardiovascular and hematologic considerations. In a 2018 review in the Journal of Headache and Pain, Delaruelle and colleagues noted that the role of sex hormones in male headache remains vague.
What would change our assessment: a randomised trial testing testosterone against placebo in men with migraine, or a confirmed replication of the 2018 estradiol findings in a large cohort. Until such data exists, prescribing testosterone for migraine lacks scientific foundation.
Clinical Practice Guidelines on Screening and Indications
Professional guidelines do not list migraine as a symptom of testosterone deficiency or as an outcome for therapy. The Endocrine Society clinical practice guideline mentions headache only as a red flag for possible pituitary mass effect during diagnostic evaluation. The American Urological Association guideline likewise omits headache from its clinical diagnostic criteria.
The Endocrine Society explicitly recommends against routine screening of men in the general population for hypogonadism. Low testosterone concentrations occur frequently in asymptomatic individuals. The ICHD-3 criteria for migraine without aura contain no hormonal or laboratory metrics.
The only hormone-related headache diagnoses in ICHD-3 are menstrual entities located in the Appendix due to uncertain independence. No male hormone analogue exists anywhere in the international classification. Neurological guidelines establish that migraine remains a clinical diagnosis based on history and physical examination.
The National Institute of Neurological Disorders and Stroke confirms that imaging tests such as magnetic resonance imaging (MRI) or computed tomography (CT) scans are not usually used to diagnose migraine. No blood test exists for migraine.
Diagnostic Standards for Male Hypogonadism
Establishing a diagnosis of hypogonadism requires documented clinical symptoms paired with consistently low fasting morning testosterone levels. A single blood draw cannot confirm an endocrine disorder. The Endocrine Society notes that 30% of men with an initial testosterone level in the hypogonadal range have normal concentrations on repeat testing.
Diurnal variation drives testosterone levels to their peak during early morning hours. Although ageing blunts this rhythm, morning draws remain standard practice across clinical guidelines. Assay variability also affects diagnostic precision.
When 1,133 laboratories using 14 different assays analyzed identical reference material, reported values ranged from 45 to 365 ng/dL. The Endocrine Society defines the lower limit of normal as 264 ng/dL in healthy, non-obese young men. The American Urological Association establishes a cutoff of 300 ng/dL based on two separate morning draws.
Clinicians measure gonadotropins to differentiate primary from secondary hypogonadism. Low testosterone with elevated LH and FSH indicates primary testicular impairment. Low testosterone with low or inappropriately normal LH points toward secondary hypothalamic or pituitary dysfunction.
Our comparison of free versus total testosterone explains when calculated fractions are necessary. In addition, our overview of normal versus optimal biomarker ranges examines reference intervals.
| Guideline body | Diagnostic cutoff | Measurement protocol | Differential testing |
|---|---|---|---|
| Endocrine Society (2018) | 264 ng/dL (harmonised lower limit in healthy young non-obese men) | Two separate morning fasting blood draws; 30% retest normal | Measures LH and FSH to distinguish primary from secondary hypogonadism |
| American Urological Association | 300 ng/dL | Two early-morning measurements on separate occasions | Evaluates LH to guide clinical management |
Medication Confounders in Hormone Testing
Common pharmaceutical treatments for headache can distort testosterone laboratory panels and produce misleading diagnostic results. Preventive migraine medications alter transport proteins in the bloodstream. The Endocrine Society identifies certain anticonvulsants, including standard migraine preventives like topiramate and valproate, as causes of increased sex hormone-binding globulin (SHBG).
Elevated SHBG alters binding capacity and lowers free testosterone fractions while total testosterone appears normal. The guideline recommends measuring free testosterone by equilibrium dialysis when SHBG is altered or total levels fall between 200 and 400 ng/dL. Our analysis of sex hormone-binding globulin covers protein binding mechanics.
Acute pain medications introduce a second confounding factor. The Endocrine Society advises against testing men for deficiency during acute illness or during short-term use of medications that suppress testosterone, such as opioids. Opioids remain frequently administered for acute headache episodes.
Burch and colleagues observed that opioids were administered during 35% of emergency department headache visits in 2010. Frequent exposure can suppress serum testosterone levels as a consequence of treatment rather than a primary cause of headache. When evaluating hormone values, men can ask their doctor: Could my preventive or acute medications be altering my testosterone reading?
Frequently Asked Questions
Can low testosterone cause migraines?
Clinical research does not support low testosterone as a cause of migraine in men. Two controlled studies directly measuring sex hormones in men with migraine found testosterone levels no different from healthy controls. A 2018 study in Neurology observed higher estradiol in men with migraine, while a larger 2025 study in Frontiers in Neurology found no significant difference in testosterone, estradiol, or gonadotropins. In addition, diagnostic criteria from the International Classification of Headache Disorders include no hormonal markers for male migraine. The belief that low testosterone causes migraines stems from shared symptoms like fatigue and poor sleep rather than measured hormonal deficits.
Does TRT help migraines?
There is no clinical trial evidence showing that testosterone replacement therapy relieves migraine in men. No randomised controlled trials have tested testosterone for male migraine. The published medical literature consists of small case series evaluating cluster headache and a two-patient report in transmasculine individuals. Furthermore, the Food and Drug Administration prescribing information for AndroGel lists headache as a reported adverse reaction occurring in up to 4% of clinical trial participants. Approved indications for testosterone therapy are limited to primary and hypogonadotropic hypogonadism. Because clinical trials have not evaluated testosterone for male migraine, whether therapy improves, worsens, or has no effect on headaches remains unproven.
Why do I have migraines and low testosterone symptoms at the same time?
Migraine and hypogonadism share non-specific systemic symptoms that frequently overlap without sharing a hormonal cause. The Endocrine Society lists low energy, depressed mood, poor concentration, and sleep disturbance as non-specific features of testosterone deficiency. The National Institute of Neurological Disorders and Stroke separately notes that between migraine episodes, patients frequently experience difficulty concentrating, fatigue, depression, and sleep disruption. When a 2021 study in the Journal of Headache and Pain surveyed 534 men with migraine, participants reported higher rates of androgen-deficiency symptoms and that survey measured no hormones at all. The same four complaints sit on both symptom lists, which is an overlap and not a shared cause.
Is there a blood test for migraine?
No blood test or biomarker panel can diagnose migraine. The National Institute of Neurological Disorders and Stroke confirms that migraine is diagnosed clinically through a comprehensive medical history, physical examination, and neurological assessment. Brain imaging such as magnetic resonance imaging or computed tomography is not usually used to diagnose migraine. The International Classification of Headache Disorders, 3rd edition, defines migraine without aura through clinical features and contains no hormonal or laboratory criterion. No hormone concentration can verify or exclude migraine.
Does testosterone help cluster headaches?
Evidence for testosterone therapy in cluster headache is contradictory and restricted to small observational reports. A 2006 case series of nine patients with refractory cluster headache reported symptom improvement following testosterone administration. Conversely, a 1993 study evaluating seven patients found that testosterone administration did not alter the clinical course of cluster headache. Modern prospective investigations also challenge the presence of a primary androgen deficit. A 2026 study in Headache found that while 20% of chronic cluster patients had low testosterone, 7% of headache-free controls also met that threshold. After statistical adjustment for body mass index and age, the testosterone difference essentially vanished. There are no randomised controlled trials confirming efficacy.
Can migraine medication affect my testosterone test?
Standard medications used for migraine prevention and acute treatment can alter testosterone test results. Anticonvulsant medications such as topiramate and valproate are widely prescribed for migraine prophylaxis. The Endocrine Society notes that certain anticonvulsants increase sex hormone-binding globulin, which lowers free testosterone while leaving total testosterone measurements unchanged. For acute pain relief, opioids remain common in medical practice, administered in approximately 35% of emergency department headache visits according to 2010 data. Opioid exposure actively suppresses testosterone concentrations. The Endocrine Society advises clinicians to avoid testing men for hypogonadism during acute illness or while taking medications like opioids that suppress circulating hormone levels.
Is 320 ng/dL low testosterone?
A total testosterone reading of 320 ng/dL sits above standard diagnostic cutoffs for hypogonadism but falls within a recognized borderline zone. The American Urological Association defines deficiency as a total testosterone concentration below 300 ng/dL confirmed on two early-morning measurements. The Endocrine Society harmonised lower limit of normal is 264 ng/dL for healthy, non-obese young men. While 320 ng/dL exceeds both thresholds, the Endocrine Society identifies 200 to 400 ng/dL as a borderline range where total testosterone may be misleading. In this intermediate range, or when binding proteins are altered, clinical guidelines suggest measuring free testosterone by equilibrium dialysis. Diagnostic decisions require evaluating persistent clinical signs alongside repeat morning blood draws.
Should I get a hormone panel if I get migraines?
Clinical guidelines do not recommend routine hormone testing for men experiencing migraines. The Endocrine Society advises against general population screening for hypogonadism because low concentrations often occur without clinical disease. Migraine diagnostic criteria from the International Classification of Headache Disorders include no endocrine markers, and blood tests do not determine migraine management. However, if a patient exhibits independent physical features of hypogonadism, clinicians follow standard diagnostic protocols requiring two separate fasting morning draws. The Endocrine Society states that clinicians should not test men who have or are recovering from acute illness, or who are on short-term use of medications such as opioids that suppress testosterone. Clinicians typically focus diagnostic resources on established headache preventive strategies rather than exploratory hormone panels.