Many doctors get confused about low testosterone levels being only related to erectile dysfunction (ED) or low libido (reduced sex drive). Low testosterone (low T) is becoming an epidemic – low testosterone epidemic.
Many doctors only do lab tests for total testosterone. There are other important lab tests that should be performed to get the best picture of your testosterone levels, including free testosterone (bio-available testosterone).
In some ways, the free testosterone level test is the most important because this is the portion of your total testosterone level that is active. Most of the testosterone in your body is attached to a protein, called sex hormone-binding globulin (SHBG) and is inactive.
Other important tests that should be done when checking for low testosterone levels in men include:
Low testosterone levels can be tested using blood, urine, or saliva. In men, the most studied method to test for low testosterone levels is blood lab testing. We sometimes use urine testing and never use saliva because we have found it to correlate poorly with symptoms. In our clinic, we use a patented testing method to check your blood total testosterone level while you wait in just 15 minutes. We then typically send your blood to one of the biggest labs in the country (Labcorp) to double-check our work.
When we do a low testosterone level test we also want to try and match up your symptoms to your level. It is interesting that not all men with “low testosterone” levels have symptoms of low testosterone and many men with “normal testosterone” levels have many symptoms of low testosterone.
Some men may have “low normal” levels of testosterone and if there are multiple symptoms of low testosterone we may want to consider different treatments to optimize your testosterone levels. Every patient is different and not all our patients even use testosterone to optimize their levels.
Unfortunately, there are limited data on the effects of testosterone on the quality of life of men with [low testosterone levels], but the information that exists suggests that testosterone can improve the quality of life significantly (to the same level as men with normal testosterone levels) and the more severe the symptoms before treatment, the greater the benefits of testosterone replacement. These promising early results need to be confirmed in more detailed quality of life studies.2
“The AMS scale showed a convincing ability to measure treatment effects on quality of life across the full range of severity of complaints before therapy. The distribution of complaints of testosterone deficient men before therapy almost returned to normal values after 12 weeks of testosterone treatment.1″
The more symptoms from above that you are experiencing the more likely you have low testosterone levels. There are also other questionnaires that are used to screen for low testosterone levels.
Physicians should consider screening for low testosterone levels in certain subgroups of depressed men.3
The Androgen Deficiency in the Aging Male (ADAM) Questionnaire has been shown to be helpful to screen for symptoms of low testosterone levels. Some doctors will only check your testosterone levels if you have multiple low testosterone symptoms. In our experience, if you even think you have one of these symptoms it is worth checking your testosterone levels. Either way, at least you know your testosterone level.
Low testosterone levels can occur at any age and the prevalence of erectile dysfunction (ED) is increasing in men under the age of 40 years old.
This exploratory analysis showed that one in four patients seeking first medical help for new-onset ED was younger than 40 years. Almost half of the young men suffered from severe ED, with comparable rates in older patients. Overall, younger men differed from older individuals in terms of both clinical and sociodemographic parameters.4
New research published in the Journal of the Aging Male in 2013 found that low testosterone treatment improved frailty in older men with diabetes. Low, frequent doses of testosterone are safest in men with diabetes because it helps reduce the conversion of testosterone to estrogen and improve the testosterone to estrogen ratio. Men with diabetes often convert too much of their testosterone to estrogen.
“This study indicates that low-to-intermediate dose TRT may be safely utilized in LOH patients to ameliorate somatic and psychological frailty symptoms in association with improved anthropometric and glyco metabolic parameters in aging, overweight men with LOH and impaired fasting glucose.6″
Men who are considering treatment for low testosterone levels are often concerned about the effects of low testosterone treatment on fertility. New research is showing that while testosterone treatment may reduce sperm production, within 8 months of discontinuing low testosterone treatment sperm levels are likely to return to normal.
“After the withdrawal of androgen therapy, sperm concentration and serum follicle-stimulating hormone level returned to the normal range at a median 8.5 months (range: 7-10 months).7″
There are also ways to help maintain your sperm production while being treated for low testosterone levels. There are ways to stimulate sperm production while taking testosterone or after discontinuing testosterone.
“Exogenous testosterone supplementation decreases sperm production. Studies of hormonal contraception indicate that most men have a return of normal sperm production within 1 year after discontinuation. Clomiphene citrate is a safe and effective therapy for men who desire to maintain future potential fertility. Although less frequently used in the general population, hCG therapy with or without testosterone supplementation represents an alternative treatment.8″
Our experienced physicians can help you optimize your testosterone and estrogen levels and help you maintain your natural testosterone and sperm production. Every patient is different and we individualize every treatment. The first step is getting checked for low testosterone levels and meeting with a doctor to discuss your options.
1. Aging Males’ Symptoms scale: a standardized instrument for the practice. Heinemann LA. J Endocrinol Invest. 2005;28(11 Suppl Proceedings):34-8.
2. Testosterone and men’s quality of life. Moncada I. Aging Male. 2006 Dec;9(4):189-93.
3. The Effect of Testosterone Levels on Mood in Men: A Review. Johnson JM, Nachtigall LB, Stern TA. Psychosomatics. 2013 Sep 6. pii: S0033-3182(13)00133-3. doi: 10.1016/j.psym.2013.06.018. [Epub ahead of print]
4. One patient out of four with newly diagnosed erectile dysfunction is a young man–worrisome picture from the everyday clinical practice. Capogrosso P, Colicchia M, Ventimiglia E, Castagna G, Clementi MC, Suardi N, Castiglione F, Briganti A, Cantiello F, Damiano R, Montorsi F, Salonia A. J Sex Med. 2013 Jul;10(7):1833-41. doi: 10.1111/jsm.12179. Epub 2013 May 7.
6. Low-intermediate dose testosterone replacement therapy by different pharmaceutical preparations improves frailty score in elderly hypogonadal hyperglycaemic patients. Strollo F, Strollo G, Morè M, Magni P, Macchi C, Masini MA, Carucci I, Celotti F, Ruscica M, Gentile S. Aging Male. 2013 Jun;16(2):33-7. doi: 10.3109/13685538.2013.773305. Epub 2013 Mar 21.
7. Reversible infertility associated with testosterone therapy for symptomatic hypogonadism in infertile couple.
Bang JK, Lim JJ, Choi J, Won HJ, Yoon TK, Hong JY, Park DS, Song SH. Department of Urology, CHA Gangnam Medical Center, CHA University, 566 Nonhyeon-ro, Gangnam-gu, Seoul 135-913, Korea. Yonsei Med J. 2013 May 1;54(3):702-6. doi: 10.3349/ymj.2013.54.3.702.
8. Crosnoe LE, Grober E, Ohl D, Kim ED. 2013. Exogenous testosterone: a preventable cause of male infertility. Translational Andrology and Urology; Vol 2, No 2 (June 2013)
*There is no guarantee of specific results, your results can vary. We offer a money-back guarantee for patients, if they experience no results.
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It could be said that testosterone is what makes men, men. It gives them their characteristic deep voices, large muscles, and facial and body hair. It plays a role in sperm production, fuels libido, and contributes to normal erections. It also fosters the production of red blood cells, boosts mood, and aids cognition.