Update 6/27/15 in case anyone cares: I improved my diet for testosterone (basically meaning much more fat) and started lifting weights. I referred myself to an endocrinologist since my PCP wouldn't consider anything besides Viagra. After these changes, my testosterone tested at 303 (actually the biggest part of this change is because the first test was taken in the afternoon and testosterone is highest in the morning and that's when it's supposed to be tested). Sexual problems improved but not so much that I wouldn't pay pretty much whatever it takes to make myself normal. The endocrinologist I saw said I was fine and he wouldn't prescribe anything to me. So for the 3rd blood test I read up about how to make my testosterone as low as possible (ate very little fat for a week, drank a lot of alcohol and then the 24 hrs before the blood draw I ate next to nothing and stayed up all night). I tested at 121. The idea was to test at a level that I can find a doctor to prescribe Clomid, a pill that often works if (part of) the problem is with your brain sending the signal rather than your testicles being unable to produce testosterone. I have an appointment with a urologist on Tuesday and frankly at this point, if he just tells me I'm fine I'm ready to go to one of the "men's health" clinics that basically prescribe testosterone shots to anyone who wants them.
For what it's worth, the endocrinologist also did thyroid tests which came back normal. After my sabotaged 121 testosterone result they asked me to come in for a pituitary MRI which I don't plan to do.
If anyone has insight as to how to get a doctor to prescribe Clomid, it would be appreciated. The urologist has not been forwarded any medical records, so I can select which of the three test results he gets to see. I got the impression from the endocrinologist I saw was that in order for him to do anything I'd need to say I'm severely depressed and lack the energy to get out of bed. I'm fairly apathetic towards everything but certainly don't think I'd be diagnosed as clinically depressed and my energy level isn't terribly low.
OP: I'm someone who really puts off going to the doctor and I went this week because I've been having sexual problems, both in terms of desire and ability. The last time I started seeing someone, it ended when I failed to get it up, but I started noticing problems a few months before then (and now a few months have passed since then), so I don't think the problem is psychological. I'll just pretend like this isn't weird to talk about. It isn't that there's nothing going on. (When masturbating) I can usually get to 70-80%, but it is way more difficult to get there and often difficult to maintain.
"Normal" testosterone levels are a wide range, but the average for guys my age is somewhere in the 600s (measured in nanograms per deciliter). One source I read said the 5th percentile is at 388 (edit: Wikipedia also states this). Testosterone replacement therapy (TRT) is usually done in significantly older men, but doctors commonly consider it when levels are below 350. I'm at 217. I've likely always been on the lower end, but I acknowledge that my low level was likely exacerbated by alcohol abuse. I quit drinking a couple months ago and I'm not worried about being able to stay off it.
Of the well supported things that you can do to improve levels naturally- diet, exercise and sleep- the only thing I haven't done is add serious weight training. I've only been doing cardio with a little bit of body weight exercises. Given that I need to double my level to be at the low end of normal, I don't see that happening naturally, but I will try adding weights.
I don't yet know what my doctor will recommend. There are substantial risks and costs associated with TRT. On the cost side, I don't know what insurance will cover but I've heard the cash price of injections and monitoring is $400/ mo, and since you are likely to start producing even less naturally, you're on it for life. But while I'm no ladies man, a life without the possibility of dating and relationships sounds pretty bleak, and I feel like that's where I am right now. Of course the benefits of testosterone are not just sexual. They say low T can cause low ambition and self-esteem, and yeah, I'm there. Increased muscle and energy are a bonus. I can certainly afford it. I have ~$200k in savings (2/3 in retirement accounts), gross $63k and spend maybe $22k currently. ER isn't really a goal of mine. FI and ESR are, but it's not the most important thing.
Of course I'm not just soliciting advice from an anonymous internet finance forum. I have been/ will be talking to my doctor, my dad and friends (one of whom is a doctor) about what I should do. If anyone here has gone on TRT, knows someone who has, or looked into it and decided against it, I'd like to know what you have to say. I haven't talked to my doctor since getting the test results and I'm not scheduled to go back until mid January.