By: Erin Orth, PharmD
Testosterone is a sex-steroid hormone found in both men and women, and it plays a large role in various biological processes, from muscle formation to stimulating libido. It also helps to keep the cardiovascular system healthy as well as improving our energy and mental clarity1. Due to these important functions and more seen throughout the body, it’s easy to imagine how the decline of testosterone levels can impact activities once deemed routine. Even symptoms often associated with one’s personality can be affected: a confident, decisive, engaging man may morph into a hesitant, submissive, reclusive grouch without enough testosterone in his system2.
With the exception of “Early-onset Testosterone Deficiency” (seen in pre-pubescent and adolescent males), testosterone production in men naturally begins to decline near age 40-502. Multiple factors can compound the decrease in the making of testosterone, including stress, obesity, sleep deprivation, and various drug classes (statins, corticosteroids, and mental health medications like SSRIs and antipsychotics, to name a few)3. Thus, the approach to assessing, diagnosing, and treating testosterone deficiency in men encompasses much more than merely a testosterone level from a laboratory.
Obtaining a baseline testosterone level is essential for assessing hormonal needs as well as dosing considerations for hormone supplementation, however it is not the only important factor. Initial testing of men suspected of hormone imbalance should include the following:
- Testosterone level (total or free)
- Sex-Hormone Binding Globulin (only if total testosterone alone was tested)
- Estradiol and/or estrone (especially if patient is significantly overweight, since fat cells can make their own estrogen)
- Cortisol (use saliva sample, 4 times throughout the day)
- Prostate Surface Antigen (PSA)
- Fasting Insulin + fasting glucose
- Thyroid panel (if hypothyroid symptoms exist, either past or present)
- Cardiac panel (if risk factors present)
According to the above list, it is obvious there are multiple potential causes and risk factors associated with signs and symptoms of low testosterone. Thus, the preferred method to correct low testosterone in men is to attempt to identify and correct the underlying cause(s) of the diminished testosterone level in addition to supplementing with prescription testosterone. For instance, high cortisol levels (which are seen when people are under stress) can decrease testosterone production as well as interfere with testosterone function at the cellular level3. In order to maximize benefit for this stressed patient, addressing the causes/effects of his severe stress must be done in addition to restoring his testosterone level.
Once testosterone supplementation is initiated, follow-up labs should be performed to assess adequacy of the dose. This is typically done 3-6 months after starting the hormone4. The best way to measure testosterone levels depends entirely on the method of drug delivery. For example, topical (cream or gel) testosterone can be measured using saliva samples, but sublingual (under the tongue) testosterone should NOT be measured in the saliva, since it could lead to falsely elevated levels (“contaminating the well”, so to speak). If there are any questions or concerns regarding the testing methodologies, consult the pharmacists at MD Custom Rx. Moreover, there are at-home test kits courtesy of ZRT Laboratories available at no charge for your convenience available also at MD Custom Rx.
- Paoletti, J. (2015) A Practitioner’s Guide to Physiologic Bioidentical Hormone Balance. Grove City, OH: Paoletti Publishing.
- Hertoghe, T. (2006) The Hormone Handbook. Surrey, United Kingdom: International Medical Publications.
- Paoletti, J. (Sept 2016). How to Test for a Male’s Hormone Needs (a blog post). Retrieved from http://www.power2practice.com/hot-test-males-hormone-needs
- Zava, D. (2012-2016). Collection Questions via ZRT Laboratory (a blog post). Retrieved from http://www.zrtlab.com/FAQ/Collection-Questions