madman
Super Moderator
Abraham Morgentaler * Men’s Health Boston, Beth Israel Deaconess Medical Center, Harvard Medical School, MA, USA 1.
6. What studies are needed?
Based on 40 yr of research and clinical experience with T [15], I believe that FT is the most accurate indicator of a man's androgen status, and I will offer treatment to a symptomatic man with low FT, regardless of his total T value. In nearly all cases, a discrepancy between total T and FT values is explained by a generous SHBG concentration. Future research is required to investigate this more thoroughly and prospectively.
Calculated FT is the most practical measurement of FT for most clinicians, requiring only total T and SHBG concentrations, and access to an online calculator. Albumin is usually included in the equation; however, it has little influence on cFT results, and most calculators provide a constant value for convenience. Direct measurement of FT, often called the analog assay, has an excellent correlation with both equilibrium dialysis (EqD) and cFT [16]; however, it requires a different scale than cFT or EqD due to lower numerical values.
A key study to be performed is to take a population of men with a defined symptom or set of symptoms characteristic of TD and expose them to treatment, regardless of baseline T levels. The goal of such a study is to determine the likelihood of symptomatic response based on baseline concentrations of androgen tests, which at a minimum should include total T, FT, and bioavailable T. The most predictive of these will be the most clinically useful. Clinicians would do well to think about T levels providing information as to the likelihood of symptomatic response rather than “normal” versus “abnormal”.
There will be great value for the world of andrology if the diagnosis of TD came to be based on solid evidence, rather than rigid adherence to arbitrary thresholds for unreliable tests.
6. What studies are needed?
Based on 40 yr of research and clinical experience with T [15], I believe that FT is the most accurate indicator of a man's androgen status, and I will offer treatment to a symptomatic man with low FT, regardless of his total T value. In nearly all cases, a discrepancy between total T and FT values is explained by a generous SHBG concentration. Future research is required to investigate this more thoroughly and prospectively.
Calculated FT is the most practical measurement of FT for most clinicians, requiring only total T and SHBG concentrations, and access to an online calculator. Albumin is usually included in the equation; however, it has little influence on cFT results, and most calculators provide a constant value for convenience. Direct measurement of FT, often called the analog assay, has an excellent correlation with both equilibrium dialysis (EqD) and cFT [16]; however, it requires a different scale than cFT or EqD due to lower numerical values.
A key study to be performed is to take a population of men with a defined symptom or set of symptoms characteristic of TD and expose them to treatment, regardless of baseline T levels. The goal of such a study is to determine the likelihood of symptomatic response based on baseline concentrations of androgen tests, which at a minimum should include total T, FT, and bioavailable T. The most predictive of these will be the most clinically useful. Clinicians would do well to think about T levels providing information as to the likelihood of symptomatic response rather than “normal” versus “abnormal”.
There will be great value for the world of andrology if the diagnosis of TD came to be based on solid evidence, rather than rigid adherence to arbitrary thresholds for unreliable tests.
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