The Evaluation of Low Testosterone
The diagnosis of low testosterone is based on your symptoms and your blood work. First, it is important for your clinician to understand what symptoms you have. Because low testosterone presents itself in different ways depending upon the individual, your doctor needs to perform a thorough history of your unique symptoms. An experienced clinician will be able to guide you with this to help you understand how low T might or might not be affecting various aspects of your life.
Second, a complete evaluation of various blood markers is critical. The true cause of your low T cannot be understood unless you doctor obtains them. With complete blood work we can understand the nature of your low T and how it would be best treated. This is where many testosterone clinics miss the mark. In an effort to save money and qualify you for testosterone, many clinics will only do cursory blood work. They often miss the root cause of your low testosterone and make suggestions for treatment without considering the alternative options. Often times the alternative treatments like Clomid or even supplementation are never discussed.
Initial Blood Work:
The goal of the initial blood work is to determine the root cause of your low testosterone. A complete workup allows your physician to understand what is causing your low testosterone and to make the appropriate treatment recommendations. In some cases your clinician can suggest alternative treatments other than testosterone replacement. This is important, especially when we need to preserve fertility or the patient is relatively young.
Here is what our initial blood screening for low testosterone looks like:
Test Name |
Description |
|---|---|
| Leutinizing Hormone (LH) | Signal produced by the brain to stimulate the testes to produce testosterone. Higher LH levels typically lead to increased T production. |
| Total Testosterone (TT) | The total amount of testosterone in the blood at any one time. This includes free testosterone and testosterone that is bound to SHBG and a protein called albumin. |
| Free Testosterone (FT) | Testosterone that is not attached to SHBG or albumin is called free testosterone. Typically, only about 2% of the total testosterone is free. |
| SHBG | SHBG binds and carries testosterone in the blood. Bound testosterone is considered to be inactive. SHBG acts as your “gas tank” holding T in reserve for when it is needed. Low SHBG may indicate the presence of metabolic problems such as diabetes. |
| Estradiol (E2) | Estradiol also called estrogen, is derived from testosterone. Estradiol plays an important role in bone health, blood vessel healing, libido, sexual function and healthy cholesterol levels. Estradiol is a very important hormone in men. |
| PSA | Prostate specific antigen (PSA) is a screening test for prostate cancer. |
| Apolipoprotein B (Apo B) | This is the most accurate indicator of the amount of “bad cholesterol”. Elevated levels of Apo B are now widely accepted as one of the most important blood markers of heart disease. We will measure this periodically, especially if levels are elevated. |
| Lipid Panel | This is the traditional test for good and bad cholesterol. Testosterone can lower the amount of good cholesterol (aka. HDL), so it is important to track cholesterol levels when on testosterone replacement. |
| Complete Blood Count (CBC) | A CBC tells us the amount of red blood cells in the blood. TRT can cause an increase in the number of red blood cells. Typically, this is not an issue, but elevated levels of red blood cells can cause problems with blood pressure. In rare cases you may have to donate blood. |
| Hemoglobin A1C | A screening test for diabetes. Elevated blood sugar (aka insulin resistance) is a major risk factor for heart disease and heart attack. This test gives us an idea how well your blood sugar has been controlled over the previous 2-3 months. |
| Prolactin | High levels of prolactin interfere with testosterone and sperm production. Elevated levels are typically caused by a non-cancerous tumor called a prolactinoma. There are treatments for this, and most men’s testosterone production returns to normal after the issue is addressed. |
| DHEA | DHEA is the most prevalent steroid hormone in the body and levels decrease about 5% per year after age 30. It may play a role in body fat regulation, brain function and heart health. DHEA can be supplemented orally. |
| DHT | This is an optional test, and is typically used if the patient is suffering from low libido. DHT plays the major role in male libido and sexual function. |