Testing For Testosterone Deficiency In Men
Serum total testosterone is the initial test of choice. Specimens must be collected in the morning,8;preferably before 10AM, or within 3 hours of waking, and preferably in a fasting state.5, 9;Testing should occur when the sleep-wake pattern is stable . Testing of serum total testosterone should be performed when patients are clinically well; do not test during acute illness or hospitalization.
If the total testosterone level is below the lab-specific lower limit of normal , and 6 nmol/L in older men ),1013;and a diagnostic question remains, cBAT can be used to confirm or rule out hypogonadism.
For men, total testosterone levels may be low but the cBAT normal when the SHBG concentration is decreased. Total testosterone levels may be normal but cBAT low when SHBG concentration is increased. Idiopathic elevations in SHBG are well known as are other conditions that are associated with mild to marked changes in the SHBG concentration. Refer to Appendix C: Conditions Associated with Altered SHBG Concentrations in Men and Women .
Note that testosterone is characterized by episodic secretion: 30% of men with mildly hypogonadal serum testosterone levels will have a normal level on retesting.
Testosterone Levels In An Unhealthy Population
As you may imagine, these ranges are not set to optimal levels. They are from a cross-section of men aged 20 to 80. Many of whom may be sick or diseased, from a lifetime of unhealthy habits.
Upon receiving the results of your blood test, your T levels may be close or under the bottom of the range. If your doctor refuses treatment, a gentle reminder of what optimal health entails may be in order.
After pointing out, you have the T levels of a sick 80 year old hopefully, your doctor will come around.
Testosterone In The Body: Free T Vs Total T
In men, most testosterone is made by the testes through a complex series of biochemical reactionsâwhich convert cholesterol into testosterone .
Testosterone molecules are then secreted directly into the bloodstreamâwhere many of them soon bind to other molecules known as sex hormone binding globulin, or SHBG . Other testosterone molecules bind to albuminâan important type of blood protein.
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Is My Testosterone Level Normal What Should My Testosterone Level Be For My Age
Men commonly ask the following questions when they inquire about testosterone therapy:
1) What should my testosterone level be for my age?
2) Is my testosterone level too low for my age?
3) How high should we aim to get my serum testosterone level on testosterone therapy?
There is no defined level of serum testosterone for a man by age. Rather, we utilize a reference range of testosterone levels from 250-950ng/dL as being within normal. There are many variables that can account for a mans serum testosterone level that include age, genetics, muscle mass, fat mass, diet, exercise routine and co morbidities. Therefore, when a man asks what is a normal testosterone level the answer is between 250-950ng/dL.
When measuring your serum testosterone, a testosterone level measured in man to be below 150ng/dL should have an addition workup. A testosterone level below 150mg/dL needs be investigated to rule out other pathologies emanating from the pituitary gland. A level less than 150ng/dL is considered to be too low for a man.
We aim to keep a patients serum testosterone level in the high normal or supra-physiological range while monitoring labs every 3-6 months. Factors that can limit a mens testosterone from being in the high supra-physiological range include medication side effects on the body, elevation in hemoglobin and hematocrit, rise in prostate specific antigen among other laboratory values.
Testosterone Levels In Women By Age
Just as with men, determining what is considered to be an acceptable testosterone level in women is often complicated. The wide range of fluctuation in normal testing levels makes it difficult to set an ideal number. Doctors are often left on their own to determine who requires treatment for Low T.
In fact, the guideline for determining normal testosterone levels in women by age varies from one laboratory to another. It is necessary to look to published studies to find answers that can help doctors make a proper decision as to who can be helped by receiving treatment.
According to a report out of Boston University School of Medicine regarding Sexual Medicine cited in 2002, women under the age of 50 can be considered to have Low T if they have a plasma testosterone level of less than 25 ng/dL. Women over 50 are ruled deficient with anything less than 20 ng/dL.
Free testosterone levels under 1.5 pg/mL for those under age 50, and below 1.0 pg/mL for the over 50 female are also indicative of Low T.
Maintaining adequate testosterone levels in women by age will help keep bones strong, metabolism converting food into energy, brain functions sharp, and the heart healthy.
How Is Low Testosterone Tested
If you have one or more of the above symptoms, we will measure your testosterone level with a blood sample.
Testosterone levels vary throughout the day. Men have much higher testosterone in the early morning than they do at night. This is called diurnal variation. Because of this variation, its important to schedule a blood draw in the morningespecially for younger men, whose testosterone levels vary more drastically than those of a man over 65.
Any level over 350 is considered average. Some labs report testosterone levels up to 800 or 1000, but the average man probably wont measure that high, and there is not a benefit to having a significantly higher testosterone level. For instance, your sex drive at 500 is not going to differ from your sex drive at a level of 350.
Its when the testosterone level is below 300 that we begin to think about treatment options for most men.
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What Are Normal Testosterone Levels
Normal testosterone levels in men range between 300-1,200 ng/dL . Testosterone levels depend largely on age, genetics and existing medical conditions.
Adult males under 50 years of age with testosterone levels between 230-350 ng/dL and adult males over 50 years of age with testosterone levels between 300-500 ng/dL are typically diagnosed with Low T.;
Low testosterone is the underproduction or lack of production of testosterone. Common causes of Low T include chronic medical conditions like diabetes, infections, obesity or other hormonal conditions.
Testosterone Analysis In Women
Testosterone testing is indicated for investigation of signs and symptoms of hyperandrogenism in women based on medical history and clinical examination. Testosterone testing is not indicated for the investigation of women with low libido.16
The upper limit of normal for testosterone in women is approximately 2-3 nmol/L, or slightly higher depending on menstrual phase and use of oral contraceptive medications.17;In polycystic ovarian syndrome, total testosterone concentrations are within the normal reference interval or slightly higher. Consequently, testosterone concentrations greater than twice the upper limit of normal suggest an alternate etiology, such as an androgen-secreting tumour.
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Testosterone Deficiency In Men
Routine biochemical screening for testosterone deficiency in asymptomatic men is not recommended. A decision to test must be guided by the medical history and clinical examination. In the case of isolated, or non-specific symptoms only, a comprehensive general assessment is required to exclude potential alternative explanations3 and to guide further investigations. In the case of follow up of a previously ordered, relatively low, testosterone measurement, in a minimally symptomatic man, refer to Appendix A: Differential Diagnosis of Hypogonadism in Men and Appendix B: Medications that May Alter Testosterone Levels in Men and Women for conditions and medications associated with changes in testosterone concentration.
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Increased Strength Of The Musculoskeletal System
Optimal levels of testosterone in the body help to improve the bone density. As you age, your bomewrun the risk of developing osteoporosis, a serious condition which makes the bone surface porous, thereby losing their strength. The presence of testosterone helps in avoiding this condition and retains the strength of the bones.;
How Is Low Testosterone Treated
Low testosterone is treated with testosterone replacement therapy, which can be given in several different ways:
- Intramuscular injections , usually every 10 to 14 days;
- Testosterone patches, which are used every day and are applied to different parts of the body, including the buttocks, arms, back, and abdomen
- Testosterone gels that are applied every day to the clean dry skin of the upper back and arms
- Pellets that are implanted under the skin every two months
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The Guidelines And Protocols Advisory Committee
The principles of the Guidelines and Protocols Advisory Committee are to:
- encourage appropriate responses to common medical situations
- recommend actions that are sufficient and efficient, neither excessive nor deficient
- permit exceptions when justified by clinical circumstances
Contact Information:Guidelines and Protocols Advisory CommitteePO Box 9642 STN PROV GOVTVictoria BC V8W 9P1Website: www.BCGuidelines.ca
DisclaimerThe Clinical Practice Guidelines have been developed by the Guidelines and Protocols Advisory Committee on behalf of the Medical Services Commission. The Guidelines are intended to give an understanding of a clinical problem, and outline one or more preferred approaches to the investigation and management of the problem. The Guidelines are not intended as a substitute for the advice or professional judgment of a health care professional, nor are they intended to be the only approach to the management of clinical problem. We cannot respond to patients or patient advocates requesting advice on issues related to medical conditions. If you need medical advice, please contact a health care professional.
Men Naturally Lose Testosterone As They Age But There Are Low
Testosterone is the hormone that gives men their manliness. Produced by the testicles, it is responsible for male characteristics like a deep voice, muscular build, and facial hair. Testosterone also fosters the production of red blood cells, boosts mood, keeps bones strong, and aids thinking ability. Lack of testosterone, often nicknamed, low-t, can cause unwanted symptoms.
Testosterone levels peak by early adulthood and drop as you ageabout 1% to 2% a year beginning in the 40s. As men reach their 50s and beyond, this may lead to signs and symptoms, such as impotence or changes in sexual desire, depression or anxiety, reduced muscle mass, less energy, weight gain, anemia, and hot flashes. While falling testosterone levels are a normal part of aging, certain conditions can hasten the decline. Low t risk factors include:
- injury or infection
- chemotherapy or radiation treatment for cancer
- medications, especially hormones used to treat prostate cancer and corticosteroid drugs
- chronic illness
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What Does The Testosterone Test Measure
Testosterone travels through your blood in two ways:
- Attached to the proteins albumin and sex hormone binding globulin
- Free — not attached to any proteins
Usually you’ll get a total testosterone test as a screening test. This measures both free and attached testosterone. To diagnose certain conditions, doctors sometimes look only at free testosterone levels.
In males, the testosterone test can help find the reason for sexual problems, like reduced sex drive or erectile dysfunction. If youâre having a hard time getting your partner pregnant, the test can tell if your blood testosterone level is low. A low testosterone level can also mean a problem with the hypothalamus or pituitary gland, which controls how much testosterone your body makes.
In females, this test can find the reason youâre missing periods, not having periods, having a hard time getting pregnant or experiencing male patterns of hair growth such as on your chest or face. Doctors can also use it to help diagnose polycystic ovary syndrome , which causes elevated testosterone. Thatâs a hormone problem that can cause irregular periods and make it hard to get pregnant. Testosterone testing is part of the work-up of certain adrenal tumors.
Causes Of High Testosterone In Men
Abnormally high testosterone levels are also known as hypergonadism.
If you are male, your doctor may consider your testosterone levels too high if:
- Total testosterone level is above 950 ng/dL
- Free testosterone level is above 30 ng/dL
Possible signs and symptoms of high testosterone include:
- Early puberty, in young men
- Excessive hairiness
- High red blood cell count
- Increased risk-taking behaviors
Abnormally high testosterone levels can be caused by:
- Tumors: Adrenal and testicular tumors may cause abnormally high testosterone.
- Anabolic steroid abuse: Sometimes used by athletes and bodybuilders to build more muscle mass or increase athletic performance.;Some athletes;take Clomid illegally;to boost performance.;
- Testosterone supplementation: Sometimes prescribed by a physician, and sometimes purchased illegally without a prescription.
- Testosterone gel: Coming into contact with someone who is using testosterone gel can be an issues. The gel can accidentally be rubbed off onto someone else, raising their testosterone levels unintentionally.
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Regulating Testosterone In Your Body
The control of testosterone levels in your body is handled by a process known as the Hypothalamic Pituitary Gonodal-axis .
The HPG consists of two parts, the hypothalamus which is found in your brain and the pituitary glands; which are also located in your brain.
Whenever your body appears to be low on testosterone a signal is sent to the Leydig cells in your testes. At the same time your hypothalamus receives the information and confirms the decision.
A signal is then sent to your pituitary gland which will start producing luteinizing hormone as well as a follicle stimulating hormone.
These hormones are released into the bloodstream and sent back to the testes; which tells them to start testosterone production.
As soon as enough testosterone has been produced the Leydig cells will send a fresh message to the hypothalamus.
This triggers a message to the pituitary gland to reduce or stop the supply of the two hormones.
This process is undertaken many times throughout the day as your body carefully and precisely self-regulates its testosterone levels.
What is not clear at this stage is how the body decides what level is appropriate.
Average Testosterone Levels In Men By Age
The biggest concern that doctors specializing in hormone replacement often have is that men who are considered to be on the lower end of what is held as normal are actually dealing with the possible debilitating effects of Low T but are not properly diagnosed and prescribed medication to correct this testosterone deficiency.
This is where a specialist will do more than look at a number in a testosterone blood test result, although that is a crucial part of the diagnosis and determination of medication dosage to prescribe. Information gleaned from a physical examination, as well as current symptomology along with the severity of the issues that are present will all go into the equation when a diagnosis and treatment plan are devised.
What are normal testosterone levels in men at the various stages of ones life?
The information below will help to break it down further:
- Testosterone levels in men over 30:
Free: 8.7 25.1 pg/mL
Total: 219 1009 ng/dL; Normal 600 675 ng/dL
- Testosterone levels in men over 40
Free: 6.8 21.5 pg/mL
Total: 201 993 ng/dL; Normal 500 550 ng/dL
- Testosterone levels in men over 50
Free: 7.2 24.0 pg/mL
Total: 170 918 ng/dL; Normal 400 450 ng/dL
- Testosterone levels in men 60 and over
Free: 6.6 18.1 pg/mL
Total: 156 700 ng/dL; Normal 300 350 ng/dL;
Some studies have shown that men over sixty are often found to have total testosterone levels under 241, which could explain the many changes they are experiencing.
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How Low Can Testosterone Go
Unlike women, who have a rapid decline in estrogen at menopause, men may experience a gradual decline in testosterone. Studies show that about 20 percent of men have low T in their sixties and about 50 percent have low T in their eighties. In younger men, low T may be caused by common problems like obesity, diabetes, and stress. Altogether, low T may affect up to 5 million American men.
The lower your testosterone goes, the more likely you are to have the common symptoms like low energy and low libido,” says Daniel Shoskes, MD, a urologist at the Glickman Urological & Kidney Institute at the Cleveland Clinic in Ohio. “A deep reduction can cause less common symptoms like anemia, osteoporosis, depression, and confusion. But the idea that healthy mens testosterone levels need to be monitored to prevent these symptoms is probably nonsense.
When symptoms indicate that you may have a low T problem, a simple test can help make the diagnosis. A morning blood test is the best way to measure testosterone. There is a very wide range of normal, and testosterone levels change during the day, says Dr. Shoskes. The normal range is anywhere from 300 to 800 nanograms per deciliter . You would not be considered to have low T unless you had a number below 300.
At these lowest levels of testosterone, low T symptoms may include:
- Complete loss of libido