Have you experienced a loss of vigor, libido, sexual hair, and muscle mass?
Have you noticed depression, hot flashes, breast development, erectile dysfunction, a loss of nighttime/morning erections, an increase in fat mass, fatigue, irritability, poor concentration, or sleep problems?
If you have noticed any of these signs or symptoms then you may have low testosterone and you may be suffering needlessly. I do see patients for hormone replacement including testosterone replacement at my clinic and a lot of patients get significant relief if their symptoms are addressed adequately. Even women can benefit from testosterone replacement in select cases.
Some of the potential benefits of replacing testosterone include improved libido, lean muscle mass, strength, bone mineral density, mood, well-being, and cognitive function. Interestingly, testosterone replacement can also help with weight loss in overweight individuals.
So what are the causes of low testosterone?
The causes of low testosterone and/or failed sexual development are many. These can include genetic abnormalities, undescended testicles, and testicular/pituitary dysfunctions. There are also acquired conditions such as the mumps, exposure to radiation, steroids (glucocorticoids and androgenic steroids), trauma, testicular torsion, chronic illness (liver cirrhosis, kidney failure, HIV, emphysema), toxins, medicines (ketoconazole, opiates, alkylating agents, anticonvulsants, estrogens, progestins), or many others that can cause testicular failure and consequently low testosterone.
Obesity, age, excessive exercise, acute illness, recent glucose ingestion, thyroid disorders, and diabetes may also affect the amount of bio-available testosterone.
When should you get your testosterone level checked?
If you have any of the signs, symptoms, or conditions associated with low testosterone then you might be at risk. It only takes a simple blood test to see if you have low testosterone and whether you could potentially benefit from testosterone replacement.
So how is low testosterone measured?
Testosterone is generally measured by checking a total testosterone blood level. Sometimes a Sex hormone-binding globulin (SHBG) and free testosterone level can be checked as well. In some rare circumstances such as failed sexual development or severe testosterone deficiency pituitary hormones such as the LH and/or FSH should be measured.
Ideally, the levels of testosterone should be checked between 8 - 10 am in a fasted state. This is more important to do in young men as there is diurnal pattern of testosterone release with higher levels in the morning. This rhythm is blunted and flattened in older men significantly. However, a substantial fraction of older men, 65 to 80 years of age, will still have higher testosterone concentrations in the morning. The reference ranges for testosterone blood levels were also established around obtaining testosterone measurements in the morning. Therefore, getting your testosterone levels checked earlier in the day will provide the most reliable results.
Should you have repeat testosterone testing?
Up to 30 % of men with mildly suppressed testosterone will have normal testosterone on repeat measurement and 15 % of healthy young men will have testosterone below the normal range in a 24-hour period. Therefore, for many men it may be reasonable to confirm a low testosterone measurement at least twice.
Who is appropriate for testosterone therapy?
It may be reasonable to consider testosterone replacement for symptomatic patients with confirmed deficiency. However, testosterone replacement should be avoided in patients with prostate/breast cancer, an elevated PSA test, an elevated hematocrit test, untreated severe sleep apnea, severe prostate urinary obstructive symptoms, uncontrolled heart failure, or in those desiring fertility.
While testosterone replacement may be a consideration for many men and women there are also many natural options that should be explored.
In a future article I will explore some natural ways to increase your testosterone levels as well as testosterone replacement options. So stay tuned!
If you are considering any testosterone replacement options please consult with your physician or give me a call.
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