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Male Hypogonadism: Caveats of Testosterone Therapy

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madman

madman

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Testosterone and Hypogonadism

This webcast will discuss Testosterone and Hypogonadism.
mediasite.osu.edu mediasite.osu.edu




Roger Harty, MD
  • Endocrinology, Diabetes & Metabolism
Clinical Assistant Professor of Internal Medicine


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DELATESTRYL®

Testosterone Enanthate Injection, USP

200 mg/mL
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Take Home Points
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In order to know where your free testosterone truly sits Equilibrium Dialysis is where it's at!




Free Testosterone Testing
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Measuring Free Testosterone
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Testosterone Testing
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madman

Thread 'Reference Intervals for Free Testosterone in Adult Men Measured Using a Standardized Equilibrium Dialysis Procedure'

Again you heard it here first only at Nelson's ExcelMale!

@Nelson Vergel

Was going to drop this bomb a few days ago but you let down the curtains early LOL!




Reference Intervals for Free Testosterone in Adult Men Measured Using a Standardized Equilibrium Dialysis Procedure (2022)
Ravi Jasuja, Ph.D.; Karol M. Pencina, Ph.D.; Daniel J. Spencer, BS; Liming Peng, MS; Fabiola Privat, BS; Waljit Dhillo; MD, Ph.D.; Channa Jayasena, MD, Ph.D.; Frances Hayes, MD; Bu B. Yeap, MB, BS, Ph.D.; Alvin M. Matsumoto...
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madman

Thread 'CDC STANDARDIZED TOTAL T and ESTRADIOL ASSAYS and soon to be FREE TESTOSTERONE!'

How the CDC Clinical Standardization Programs Are Improving Hormone Tests - AACC.org

WHAT PROGRESS HAS CDC MADE WITH STANDARDIZING TOTAL TESTOSTERONE AND ESTRADIOL TESTS?



Since HoSt began in 2010, CDC has had more than 350 participants in 15 countries. Participants have shown measurable improvements for both total testosterone (TT) and estradiol (E2). Specifically, the among-laboratory bias has decreased from 16.5% in 2007 to 2.8% in 2017 for TT and from 54.8% in 2012 to 13.9% in 2017 for E2. Not only has bias improved, but data...
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madman

Thread 'Importance of free testosterone measurement in assesssing androgen disorders'

As usual Nelson's house is where it's at!




Importance of free testosterone measurement in assessing androgen disorders

Thursday, March 27, 2025 at 1:00 PM Eastern Daylight Time.
event.on24.com event.on24.com


Testosterone imbalances affect men, women, and children differently. In males, testosterone deficiency (hypogonadism) can lead to low libido, fatigue, and muscle loss, while excess may contribute to aggression and cardiovascular risks. In females, testosterone excess (hyperandrogenism), often associated with polycystic ovary syndrome (PCOS) or adrenal disorders, can cause excess hair growth, weight gain, and menstrual irregularities. In children...




madman

Thread 'Testosterone Assays: Current Techniques and Pitfalls'

* Ensuring the accuracy of serum testosterone level is vital for diagnosing hypogonadism across diverse clinical settings. However, numerous challenges arise, such as inconsistencies in laboratory standardization, reference range variations, and the expenses linked with top-tier equipment. Additionally, technical and logistical obstacles further complicate assay procedures. This chapter aims to explore the diverse array of testosterone assays and their interpretation to provide clarity in clinical practice.








Testosterone plays a pivotal role in regulating various...




madman

Thread 'Direct Measurements of Free Hormones Using Mass Spectrometry-Based Methods'

Only at Excel, are we gonna take you deep!


Clinical Utility and Analytical Aspects of Direct Measurements of Free Hormones Using Mass Spectrometry-Based Methods (2022)
Mark M. Kushnir, Heather A. Nelson, and Kelly Doyle

Screenshot (26472).png


Background

The free hormone (FH) hypothesis states that hormone action and the corresponding biological effects are mediated by the unbound (free) fraction of hormone in circulation. The in vivo relationship between protein-bound and FH is complex and dynamic. In most individuals, measurement of total hormone (TH) is usually...
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madman

Thread 'UPLC-MS/MS Analysis for Clinical Research of: Free Testosterone and Free T4/Free T3'

We do it big here.....Nelson's house is where it's at!








madman

Thread 'Re-evaluating the role of Free Testosterone and SHBG'

We do it big here at Nelson's stomping ground!

Dr. Leen Antonio (UZ Leuven)!

She has collaborated with the heavyweights in the field Dr. Bhasin and Dr. Jasuja (Brigham and Women's Hospital)), Dr. Fiers and team (UZ Ghent) on research related to free testosterone.


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madman

Thread 'Dr. Shalender Bhasin: Optimizing the Diagnosis and Treatment of Hypogonadism 2025'

Nelson's house u heard it here first!

Dr. Shalender Bhasin!

* over the past 4 decades he has become a global leader in the biology of androgens, sarcopenia and aging related functional decline, his research has shaped clinical guidelines, its informed public health policy particularly around testosterone therapy, anabolic interventions and then the development of function promoting therapies




Pay attention to 25:40-34:36 of the presentation where he explains the importance of measuring free testosterone using a standardized Equilibrium Dialysis method!

Explains the...




madman

Thread 'Debate about the Free Testosterone Hypothesis: Useful Tool or Misguided Mirage?'

Dr. Handlesman and Dr. Anawalt two highlly respected and well known endos in the field!






Abstract:

In this debate, two clinicians discuss the merits and demerits of the free testosterone hypothesis. Although most clinical guidelines recommend the measurement of free testosterone in the evaluation for male hypogonadism (at least in men with suspected low serum sex hormone binding globulin), there remains controversy about underlying hypothesis that serum...
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madman

Thread 'Free T vs Total T - Cutoffs and Symptoms - Where Are the Data?'

25th Annual Fall Scientific Meeting of SMSNA!

Grapevine, Texas.




1:14:05-1:29:40
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Recommendatios for Dealing with Free T
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Concept of Total Hormonal Load
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Keep in mind all those men with normal TT and high SHBG!

Reasonable, Evidence-based Recommendation for Managing T
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madman

Thread 'Use of calculated FT in men: advantages and limitations'

journals.lww.com

Use of calculated free testosterone in men: advantages and... : Current Opinion in Endocrinology, Diabetes and Obesity

hting its relevance in preventing misdiagnosis and overtreatment of male hypogonadism. Recent findings While there is consensus on measuring total T – comprising sex hormone-binding globulin (SHBG)-bound, albumin-bound, and free T – as a first step in diagnosing male hypogonadism, evidence...
journals.lww.com journals.lww.com


INTRODUCTION

Clinical practice guidelines on the diagnosis of male hypogonadism focus on clinical signs and symptoms of androgen deficiency, as well as biochemical assessment of low circulating testosterone (T). However, there is a longstanding debate, as well as a persisting controversy concerning biochemical assessment of serum T and in particular the use (and misuse) of free T. Free T, as advocated by the free hormone hypothesis, represents...




madman

Thread 'Discrepancies in Four Algorithms for the Calculation of Free and Bioavailable T'

academic.oup.com

Discrepancies in Four Algorithms for the Calculation of Free and Bioavailable Testosterone

Testosterone (T) binds to sex hormone-binding globulin (SHBG) and albumin (Alb) to form SHBG-T and Alb-T (1). If total testosterone (TT) is low or SHBG concentr
academic.oup.com academic.oup.com



To the Editor:

Testosterone (T) binds to sex hormone-binding globulin (SHBG)and albumin (Alb) to form SHBG-T and Alb-T (1). If total testosterone (TT) is low or SHBG concentration is altered, free testosterone (FT) is recommended (1). Bioavailable testosterone (BioT) including FT and Alb-T correlates with FT (1, 2). FT and BioT can be measured by equilibrium dialysis and ammonium sulfate[(NH4)2SO4] precipitation, respectively (1). FT and BioT can...
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madman

Thread 'Factors associated with variations in calculated free testosterone in men'

OBJECTIVE

Sociodemographic, lifestyle and medical variables influence total testosterone (T) and sex hormone-binding globulin (SHBG) concentrations. The relationship between these factors and “free” T remains unclear. We examined 21 sociodemographic, lifestyle and medical predictors influencing calculated free T (cFT) in community-dwelling men across ages.


METHODOLOGY

Individual participant data (IPD) were provided by nine population cohorts. Factors associated with cFT were analyzed using two-stage random effects IPD meta analyses...




madman

Thread 'AGE SPECIFIC CALCULATED FREE TESTOSTERONE RANGES IN ADULT MEN'

INTRODUCTION AND OBJECTIVE

Measurement of free testosterone (FT) levels can be an important step in the evaluation of men with suspected testosterone deficiency. While it is well known that FT levels decline with age, its clinical utility is limited due to the lack of data on age specific reference ranges. This study aimed to provide age specific reference ranges for FT to assist in the evaluation of men with suspected testosterone deficiency.


METHODS

The 2013-2016 National Health and Nutrition Examination Survey was used to collect data on a nationally...
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Injectable Testosterone--->true trough (lowest point) before your next injection

Daily--->24 hrs post-injection

EOD--->48 hrs post-injection

Twice-weekly (every 3.5 days)--->84 hrs post-injection

M/W/F--->72 hrs post-injection (Monday morning)

Once weekly--->7 days post-injection




Timing of Testosterone Testing On Therapy
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