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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone and Men's Health Articles
Low Testosterone in Men: Recommendations on the diagnosis, treatment and monitoring
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<blockquote data-quote="madman" data-source="post: 206871" data-attributes="member: 13851"><p><strong><u>Laboratory Diagnosis</u></strong></p><p></p><p><em><strong>*It must however be remembered that RECOMMENDATIONS CAN NEVER REPLACE CLINICAL EXPERTISE </strong></em></p><p></p><p><strong><em>*A large number of men with TD who would be expected to benefit from testosterone treatment, continue to remain undiagnosed and untreated due to deficient basic knowledge and postgraduate medical training in sexual medicine</em></strong></p><p></p><p><em><strong>*Liquid chromatography-tandem mass spectrometry (LCMS/MS) assays are considered the <u>gold standard for TT measurement</u> provide consistently higher accuracy, specificity, and sensitivity than do most immunoassays </strong></em></p><p><em><strong></strong></em></p><p><em><strong>*LCMS/MS should remain the <u>gold standard method even for free T evaluation </u></strong> </em></p><p><em></em></p><p><em><strong>*No consensus has been reached regarding the lower TT threshold defining TD, and there is no generally accepted lower limits of normal TT.</strong> <strong>This lack of consensus follows from the fact that no studies have shown a clear threshold for TT or free T that distinguishes men who will respond to treatment from those who will not</strong></em></p><p><em><strong></strong></em></p><p><em><strong>*The single greatest variable confounding the interpretation of total T is that SHBG concentrations vary enormously from one individual to another, among both younger and older men</strong></em></p><p><em><strong></strong></em></p><p><em><strong>*Routine SHBG testing should be considered for men suspected of T deficiency</strong></em></p><p><em><strong></strong></em></p><p><em><strong>*It is preferred to obtain a serum sample for TT determination between 07.00 and 11.00 h, although diurnal variation is substantially blunted in older men</strong></em></p><p><em><strong></strong></em></p><p><em><strong>*However, other authors have reported that the diurnal circadian rhythm of free testosterone and bioavailable testosterone may persist in men younger than 75 years </strong></em></p><p><em><strong></strong></em></p><p><em><strong>*A large body of evidence has documented that circulating T levels are substantially decreased (from 14 to more than 30%) if not measured in fasting conditions</strong></em></p><p><em><strong></strong></em></p><p><em><strong>*Measurements of serum luteinizing hormone (LH) will assist in differentiating between primary and secondary TD</strong></em></p><p><em><strong></strong></em></p><p><em><strong>*Measurement of serum prolactin level is indicated when TT is <5.2 nmol/L (150 ng/dL) or when hypogonadotropic TD due to a pituitary tumor (like prolactinoma) is suspected. Similar considerations should be applied for pituitary MRI scans</strong></em></p><p><em><strong></strong></em></p><p><em><strong>*<em><strong>Men with significant erythrocytosis (hematocrit >52%), severe untreated obstructive sleep apnea, or untreated severe congestive heart failure should not be started on treatment with TTh without prior resolution of the co-morbid condition.</strong></em></strong></em></p></blockquote><p></p>
[QUOTE="madman, post: 206871, member: 13851"] [B][U]Laboratory Diagnosis[/U][/B] [I][B]*It must however be remembered that RECOMMENDATIONS CAN NEVER REPLACE CLINICAL EXPERTISE [/B][/I] [B][I]*A large number of men with TD who would be expected to benefit from testosterone treatment, continue to remain undiagnosed and untreated due to deficient basic knowledge and postgraduate medical training in sexual medicine[/I][/B] [I][B]*Liquid chromatography-tandem mass spectrometry (LCMS/MS) assays are considered the [U]gold standard for TT measurement[/U] provide consistently higher accuracy, specificity, and sensitivity than do most immunoassays *LCMS/MS should remain the [U]gold standard method even for free T evaluation [/U][/B] [B]*No consensus has been reached regarding the lower TT threshold defining TD, and there is no generally accepted lower limits of normal TT.[/B] [B]This lack of consensus follows from the fact that no studies have shown a clear threshold for TT or free T that distinguishes men who will respond to treatment from those who will not *The single greatest variable confounding the interpretation of total T is that SHBG concentrations vary enormously from one individual to another, among both younger and older men *Routine SHBG testing should be considered for men suspected of T deficiency *It is preferred to obtain a serum sample for TT determination between 07.00 and 11.00 h, although diurnal variation is substantially blunted in older men *However, other authors have reported that the diurnal circadian rhythm of free testosterone and bioavailable testosterone may persist in men younger than 75 years *A large body of evidence has documented that circulating T levels are substantially decreased (from 14 to more than 30%) if not measured in fasting conditions *Measurements of serum luteinizing hormone (LH) will assist in differentiating between primary and secondary TD *Measurement of serum prolactin level is indicated when TT is <5.2 nmol/L (150 ng/dL) or when hypogonadotropic TD due to a pituitary tumor (like prolactinoma) is suspected. Similar considerations should be applied for pituitary MRI scans *[I][B]Men with significant erythrocytosis (hematocrit >52%), severe untreated obstructive sleep apnea, or untreated severe congestive heart failure should not be started on treatment with TTh without prior resolution of the co-morbid condition.[/B][/I][/B][/I] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone and Men's Health Articles
Low Testosterone in Men: Recommendations on the diagnosis, treatment and monitoring
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