Who Should Receive Testosterone Replacement Therapy
In cases of primary and permanent secondary hypogonadism diagnosed in the prepubertal male, life long testosterone treatment is needed. The usual treatment is initiation of therapy with small doses of testosterone every 3 to 4 weeks at the appropriate psychosocial stage in development. When a final adult height is thought to have been obtained, the adult dose of testosterone replacement is inaugurated.
In the postpubertal period, once the diagnosis of testosterone deficiency has been made, replacement therapy should be considered in light of the clinical signs and symptoms in conjunction with the laboratory values. The objective of testosterone replacement therapy is to normalize serum testosterone and maintain the level within the eugonadal state. In addition, treatment objectives might include improving sexual dysfunction, intellectual capacity, depression, and lethargy maintaining bone mineral density and possibly reducing fracture risk increasing muscle mass and strength and enhancing the quality of life.13,9
There are some absolute contraindications to testosterone replacement therapy. These include prostate cancer, which must be assessed by history and clinical examination. If on DRE the prostate is enlarged or if the PSA level is greater than 4.0 ng/mL, biopsy of the prostate should be undertaken to confirm a diagnosis of prostate cancer or benign prostatic hyperplasia .3
Diagnosis Of The Cause Of Hyperandrogenism In Women
The diagnosis of testosterone excess is based on medical history and physical findings, followed by investigational tests. The most common cause of hirsutism20 and of excess androgen production in pre-menopausal women18 is polycystic ovary syndrome . It is important to rule out non-classic congenital adrenal hyperplasia, which occurs in 1.56.8% of women with hyperandrogenism.21 A history of rapid virilization is suggestive of ovarian or adrenal malignancy and such patients should be immediately referred. For more information refer to Appendix B: Conditions Associated with Alterations in SHBG Concentration in Men and Women and Appendix C: Medications that May alter Testosterone Levels in Men and Women . Complete guidance for the investigation and diagnosis of female hyperandrogenism is beyond the scope of this document. Indications for urgent or non-urgent referral are outlined in Table 2 below.
More Than Just A Number
Even if your testosterone levels are below the recommended range, you still might not have to worry. Doctors say that a reading between 200 and 300 ng/dL is sort of a gray area.
Levels that are just slightly low arenât a cause for concern by themselves. But if you have other symptoms, youâll want to see your doctor. âEveryone agrees that if you have a phenomenally low level, youâd benefit from treatment. But if itâs just slightly low, as is more common, youâd definitely want to have symptoms,â says Bradley Anawalt, MD, chief of medicine at the University of Washington.
Those symptoms include:
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Signs And Symptoms Of Low Testosterone
A testosterone test measures the level of the hormone in your blood.
Some people are born with conditions that cause low testosterone levels. You may have a low testosterone level if you have an illness that causes damage to your testicles or ovaries, which make the hormone.
Levels may drop as you grow older. However, the advises against getting testosterone replacement therapy for low levels caused by aging alone.
Low testosterone levels can cause changes in sexual function, including:
What Are The Signs And Symptoms Of Low Testosterone Levels In Men
The most common “out of balance” testosterone levels are found to be on the low side of normal this occurs because a male’s highest testosterone level usually peaks at about age 20, and then it decreases slowly with age. It has been suggested that a 1% decrease in testosterone level per year is not unusual for middle-aged and older males. While this decrease may not be noticeable in some men, others may experience significant changes starting in their middle-aged years or more commonly at age 60 and above. This drop in testosterone levels is sometimes termed hypogonadism, “male menopause” or andropause.
Low testosteronelevels may result in a decline in
- physical energy,
Additional symptoms of in low-T in men may include the following:
- More aches and pains in the bones and joints than normal
- A decline in libido and erections
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Getting Your Testosterone Levels Checked
After you undergo the simple blood test that measures your testosterone levels, your doctor will give you the results represented by three different numbers:
- Total testosterone. This represents the total amount of testosterone that is circulating throughout your body, so it includes both types of bonded T plus free T
- Bioavailable T, which consists of testosterone attached to albumin plus free T
Now comes the complicated part. The definition of normal testosterone varies, depending on the expert and the testing lab used. The good news is that there are general guidelines for normal testosterone. Here are the generally accepted normal ranges of total, free, and bioavailable T, given in nanograms of testosterone per deciliter for different age groups:
- 240 to 950 ng/dL for men age 19 years and older
- 5.05 to 19.8 ng/dL for men 25 to 29
- 4.86 to 19.0 ng/dL for ages 30 to 34
- 4.65 to 18.1 ng/dL for ages 35 to 39
- 4.46 to 17.1 ng/dL for ages 40 to 44
- 4.28 to 16.4 ng/dL for ages 45 to 49
- 4.06 to 15.6 ng/dL for ages 50 to 54
- 3.87 to 14.7 ng/dL for ages 55 to 59
- 3.67 to 13.0 ng/dL for ages 60 to 64
- 3.47 to 13.0 ng/dL for ages 65 to 69
- 3.28 to 12.2 ng/dL for ages 70 to 74
- 83 to 257 ng/dL for men 20 to 29
- 72 to 235 ng/dL for men 30 to 39
- 61 to 213 ng/dL for men 40 to 49
- 50 to 190 ng/dL for men 50 to 59
- 40 to 168 ng/dL for men 60 to 69
How Do These Normal Testosterone Levels Compare
There are differences in laboratory ranges and recommended ranges across the world. These depend on the population of the country, the studies used to produce the ranges and the laboratory analyser company behind the ranges used.
In the UK, the ranges differ between 6.9 27nmol/l to 10nmol/l 41nmol/l. The BSSM recommends that testosterone replacement therapy should be offered to patients with levels below 12nmol/l total testosterone or free testosterone of 0.225nmol/l and below.
They also suggest that men with a raised LH should be considered for TRT.
Some experienced doctors believe that a trial of treatment should be provided to see whether this will improve symptoms, regardless of testosterone levels.
Whilst this may be appropriate for some patients, the risk of side effects needs to be weighed up, especially if higher doses are used . There is some evidence that certain symptoms of low testosterone e.g. low mood and energy are present up to 15nmol/l. Even in these studies, the 15nmol/l level is the average significant level and therefore will exclude some men who would probably benefit from testosterone replacement therapy as individuals. There is new evidence that shows TRT is effective in men with testosterone levels up to 14nmol/l if they have prediabetes.
There is even less evidence looking at symptomatology related to free testosterone levels, despite this arguably being a better indicator of low testosterone issues.
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The Facts Behind 5 Supplements
Collagen.Collagen, is one of the most abundant proteins in the body and helps form our skin, bones, muscles, tendons and ligaments. As we age, we naturally start reducing its production. Some studies show that taking collagen supplements can reduce signs of aging, increase bone density and improve joint, back and knee pain. But many of these studies are small and funded by the companies behind such products, increasing the opportunity for bias. Certain products also have flaws that reduce the likelihood of their efficacy: Topical creams, for example, are unlikely to make it into the deeper level of the skin where collagen is produced.
Magnesium.Though low levels of magnesium have been associated with various sleep disorders, the evidence for the benefits of taking it for better sleep in supplemental form is thin. In fact, most people already have sufficient levels of the mineral, which helps support immune health, blood sugar regulation, and nerve and muscle function. Magnesium is easy to get in foods including nuts, greens, seeds, beans, yogurt and fish.
Vitamin B6.This essential nutrient is involved in a number of chemical reactions that are important for the proper functioning of the immune and nervous systems. As with the other essential vitamins, the body cannot produce B6 on its own, so you can only get it from foods or supplements. Most healthy adults get more than enough vitamin B6 from their diets alone, so B6 supplements are generally not needed.
How Do You Test Your Testosterone Levels
There are 3 methods for checking how many Ts coursing through your veins:
Also, you can go out to a remote bar, full of rednecks, thugs, and convicts, first.
After that, you can proceed to call them different names, while at the same time sending your best wishes to their wives/sisters/mothers etc.
In my book, this HAS got to be the most accurate way of measuring ones manliness .
Doesnt take a rocket scientist to realize that the most solid of these three is YEP, the bloody, gore-ish stuff.
With syringes and so on, you know what Im talking about.
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Risks Of Testosterone Blood Tests
Risks for a testosterone blood test are minimal but may include:
- Implantable pellet
Your healthcare provider can help you determine which formulation of testosterone is most suitable for you.
Recent studies have shown that the use of TRT is increasing, and more than half of prescriptions for testosterone are written by primary healthcare providers.
Treatments for high testosterone levels may include lifestyle changes, including exercise to improve symptoms. Healthcare providers may also prescribe antiandrogen medications like Aldactone , diabetes drugs like Actos , or oral contraceptives to help lower testosterone levels or relieve symptoms of high testosterone.
So What Is A Good Testosterone Level To Have
Medical professionals agree that mens normal testosterone levels are between 300-1000 ng/dL in healthy men. As you can see, that is a very broad range that makes defining normal a bit difficult.
Alandmark study published in 2017 examined the normal testosterone levels in men across four major cohorts with data from nearly 10,000 men in the United States and United Kingdom. Researchers established testosterone normal range values for men between the ages of 19-99 years.
- Ages 19-39: 229-902 ng/dL
- Ages 50-59: 192- 902 ng/dL
- Ages 60-69: 190-902 ng/dL
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Is 400 A Good Testosterone Level
It depends on your age, more on your age. Testosterone level of men between the ages of 20 to 30 is around 700 ng/dl to 1100 ng/dl. And during the age of 30 to 50. Men testosterone level is around 400 to 600 ng/dl. After the age of 50, some mens testosterone level starts to decrease. Below is the graph which will tell more on the testosterone level of men based on their age..
These Are The Normal Testosterone Levels By Age
Unfortunately, we dont have good results which show testosterone levels for normal people without symptoms etc. We have to rely on a combination of averages and the studies we do have looking at when patients get symptoms.
It is worth remembering that all of this is individual. If you have a low testosterone level but no symptoms then that does not mean TRT is the right choice for you. These results have been available since 1996 yet they continue to be ignored in favour of more generalised values.
The best option would be to produce lab ranges that are based on some more comprehensive studies of the average levels of men combined with the levels at which the average man gets symptoms.
These results do show a reduction in testosterone levels with age, as well as an increase in SHBG and a further reduction in average free testosterone levels with age. It also demonstrates why SHBG and free testosterone are so important for testing. You can see the
You can see that SHBG , which attaches to testosterone and makes it unable to bind to receptors in the body, rises with age.
This is one reason why a mans free testosterone drops so much with age. And its another good reason to always have free testosterone checked when worried about low testosterone symptoms.
There are several studies which show that a mans testosterone levels decrease gradually with age around 1.6% on average per year for total testosterone and 2-3% per year for free testosterone .
Emphasize Your Low Male Hormone Symptoms
Perhaps your doctor is stubborn or doesn’t like their patients being active participants in their own healthcare. In that case, you may be better off emphasizing your symptoms of low testosterone.
Noting a loss of sex drive, the development of impotence, and/or reduced muscle mass and strength is a start. That should give any knowledgeable doctor a red flag that T levels aren’t on par.
Depression, fatigue, and loss of motivation are also commonly caused by low testosterone. Sadly, many doctors would rather prescribe an antidepressant. Bringing back to normal, a natural substance your body already makes, may be wiser.
What Are The Foods That Boost Testosterone
Foods that contain natural testosterone include: Oysters Eggs Walnuts Avocados Beef Flax seed Chili peppers Tomatoes Peanuts Garlic Onions Bananas Strawberries Carrots Celery Cabbage Cauliflower Cabbage Beets Spinach Whole grains Dried prunes Black coffee Dried figs Chocolate Tea Mushrooms Water Watermelon Peanut butter Grapes Salmon Sardines Watermelon Pomegranate Water Watermelon And meat Watermelon meat Water again!.
Can You See The Problem With This
If we know that the average mans free testosterone levels drop over time from the age of 30, then it is clear that comparing a 20 year olds levels with the testosterone levels of an 80 year old doesnt make sense. More importantly, the range used is not based on when men get symptoms, but instead on statistical analysis. The levels that labs use for their ranges arent actually normal ranges . Instead, they are the 95% of men in the middle ranges, with the 5% either side of the range being deemed low or high.
The result of this is that men can have low levels for their age and individual situation, and still be considered normal based on the lab results.
Unfortunately, this is what happens in doctor clinics across the Western world, and it means that doctors miss men who have low testosterone levels. Men are being denied treatment despite having low levels of testosterone, mainly because the ranges on the lab forms are incorrect.
One of my friends was told that he couldnt possibly have low testosterone because he could grow a beard and his levels were 10nmol/l . He saw a TRT doctor and was started on testosterone, he is still on it now and reaping the benefits.
Monitoring Issues And Side Effects Of Testosterone Therapy
The goal of replacement therapy is to maintain testosterone in the normal physiological range therefore, a combination of clinical and biochemical measures should be monitored 6 to 12 weeks after initiating therapy. In most cases, an early morning serum total testosterone level is adequate to determine whether dosage adjustment is necessary. However, patients receiving injections of testosterone enanthate or cypionate every 2 weeks will require an earlier measurement of serum testosterone at 1 to 2 weeks after commencement of therapy.3
Examination of the prostate should be performed routinely, although the exact frequency after initiation of testosterone replacement is still debatable. Digital rectal examination of the prostate and PSA assay should be performed before initiation of therapy, along with an assessment of prostate-related symptoms. In elderly men, a DRE and PSA assay should be performed at 3 and 6 months after commencing testosterone therapy and then annually thereafter.3 A high PSA level should be further evaluated with a highly specific PSA assay, if available. A patient should be referred to a urologist if his PSA level increases over time or if he has a PSA level greater than 4.0 ng/mL.3
It is known that testosterone stimulates bone marrow production of erythrocytes, which might result in an increased hematocrit in some men, and therefore this should be checked at the same time as the PSA level.2,3
How To Check Your Testosterone Levels
Checking your testosterone levels is a simple process. You can check your testosterone using a blood test called a testosterone levels test. During this test, a healthcare professional will use a small needle to take a blood sample from a vein in your arm.
This process is quick and easy, although you may feel a slight stinging sensation as the needle is inserted and removed.
Your blood will be analyzed in a laboratory. After this, youll receive information about your testosterone levels.
Its important to understand that there can be multiple symptoms of low testosterone that are both physical and non-physical, and the best way to start the process is by discussing it with your healthcare provider.
You can organize a testosterone level test through your healthcare provider or by contacting a lab testing center in your area.
Reduced bone density and strength
Low sperm count
If youve noticed any of these symptoms and think that low testosterone could be the cause, its important to talk to your healthcare provider about undergoing a testosterone levels test.