T troubles? Test testosterone5 years ago | Men's Health
By Franz Gliederer, MD, MPH
Testosterone is big business. Testosterone prescription drugs raked in over 2.4 billion dollars in revenue in the U.S. in 2013, and sales are projected to reach 3.8 billion by 2018.
Where there is hype, there are also many people giving it a try without necessarily knowing all the facts. Testosterone, often referred to simply as “T,” can do a lot of good, especially for middle-aged males with declining hormone levels. However, they may be out of place, or frankly illegal, for those who are just trying to get an edge, such as taking high doses of T to enhance your sports performance. Even the UFC (Ultimate Fighting Championship) has been pushing to end performance-enhancing steroids, which have adverse health effects.
How is testosterone tested?
Most doctors do a single blood test called “total testosterone” to get a baseline for where your T is at. Some doctors may simply assess symptoms without actually checking T levels, but this is certainly not advisable.
Types of testosterone testing
Total testosterone – This gives the amount of T circulating in your body. It is bound to small protein particles and is the inactive form.
Free testosterone – This is the actual active T, which is able to interact with T receptors and exert the effects of testosterone. It can fluctuate within a few minutes. Morning testosterone levels tend to be higher than later in the afternoon.
Di-hydro testosterone (DHT) – This is a more powerful testosterone. It has benefits of greater muscle strength, but also can accelerate hair loss and voiding difficulty in men with prostate problems.
Estrogen – This is an important marker. Decreasing T levels frequently go hand in hand with increasing estrogen levels. Estrogen levels can be controlled with other medications or some supplements.
Sex-binding hormone (SBH) – This is a small protein floating in the blood stream. It actually binds free T to itself, effectively inactivating it. SBH tends to increase as males age and is also related to increased body fat.
Testosterone and a number of T metabolites can be tested in the urine and give another perspective. There are also hormones such as luteinizing hormone (LH) that stimulate natural T production. In sports, a ratio of testosterone/epitestosterone may be tested to uncover performance enhancers. A PSA test may be needed at times to monitor prostate health under testosterone therapy.
Why is it important to test?
- Assess need for T treatment. Generally, only males with low testosterone levels should receive testosterone treatment.
- Monitor T treatment. Prolonged T treatment can cause a temporary or permanent decrease of a person’s own testosterone production (causing testicular shrinkage).
- Detect excess T. Excess T is associated with side effects including increased blood thickness, increased risk for strokes/heart attack in certain individuals, accelerated prostate enlargement, acne and hair loss.
Factors influencing T levels
There are daily and seasonal variations of T levels. T levels are affected by time of the day. They tend to be highest in the morning, and then drop in the early evening, followed by a rise again. Different labs may have somewhat different testing methods and normal ranges. Letting a sample stand at room temperature may give falsely elevated T levels.
Evaluation of testosterone can be very useful tool for detecting low levels of the hormone, in order to potentially supplement T. Supplementing deficient T can lead to a number of health benefits, including better body fat composition, improved muscle strength, libido, mood, endurance and bone density. For testing, schedule an appointment with our experienced doctors.
Consider lifestyle changes that can help you naturally boost T. Read here.
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