Male Hypogonadism: Caveats of Testosterone Therapy

madman · 2025-11-12T15:48:42-0600

Testosterone and Hypogonadism

This webcast will discuss Testosterone and Hypogonadism.

mediasite.osu.edu

Roger Harty, MD

Endocrinology, Diabetes & Metabolism

Clinical Assistant Professor of Internal Medicine

DELATESTRYL®

Testosterone Enanthate Injection, USP

200 mg/mL

Take Home Points

madman · 2025-11-12T15:49:47-0600

Objectives

madman · 2025-11-12T15:52:20-0600

Annual Global Spending on Testosterone Therapy

US Testosterone Prescriptions 2001-2011

madman · 2025-11-12T15:53:49-0600

Symptoms

madman · 2025-11-12T15:55:08-0600

Classifying Hypogonadism

madman · 2025-11-12T15:57:26-0600

Endocrine Society Clinical Practice Guideline (2018)

Recommended Workup

madman · 2025-11-12T15:58:38-0600

Testosterone Testing Caveats

madman · 2025-11-12T16:07:09-0600

Measuring Testosterone

Testosterone Testing Caveats

madman · 2025-11-12T16:38:42-0600

In order to know where your free testosterone truly sits Equilibrium Dialysis is where it's at!

Free Testosterone Testing

Measuring Free Testosterone

Testosterone Testing

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

Oct 22, 2022

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!

https://onlinelibrary.wiley.com/doi/abs/10.1111/andr.13310

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...

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

Jan 5, 2019

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...

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

Jun 15, 2025

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

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...

Thread 'Testosterone Assays: Current Techniques and Pitfalls'

Apr 7, 2025

* 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...

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

Jul 25, 2023

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

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...

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

Aug 2, 2025

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

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

Sep 2, 2025

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.

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

Oct 7, 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

The Complete Guide to Low Testosterone: What Every Man Should Know About Diagnosis and Treatment

Medical Disclaimer: This article is for informational...

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

Jun 28, 2025

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

https://academic.oup.com/jcem/advance-article-abstract/doi/10.1210/clinem/dgaf370/8171633?redirectedFrom=fulltext

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...

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

Oct 13, 2025

25th Annual Fall Scientific Meeting of SMSNA!

Grapevine, Texas.

1:14:05-1:29:40

Recommendatios for Dealing with Free T

Concept of Total Hormonal Load

Keep in mind all those men with normal TT and high SHBG!

Reasonable, Evidence-based Recommendation for Managing T

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

Nov 6, 2024

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

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...

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

Nov 18, 2023

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

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...

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

Oct 26, 2024

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...

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

Apr 19, 2024

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...

madman · 2025-11-12T16:44:40-0600

Contraindications to Testosterone Therapy

Obstructive Sleep Apnea Screening

madman · 2025-11-12T16:46:59-0600

Treatment Options

Oral TU (Jatenzo, Tlando or Kyzatrex)

Post in thread 'How do you know when to take an AI.'

Monday at 6:12 PM

JERU!

I meet with doctor again on November 26th i'll ask about the oral TU then. I doubt my insurance will cover it as they gave me a fit over just getting injections covered.

Kyzatrex is a cash pay model only.

Jarenzo

*if commercial insurance rejects coverage, you may pay $150

Tlando

madman · 2025-11-12T16:58:33-0600

Side Effects

Formulation Specific Side Effects

madman · 2025-11-12T16:59:04-0600

Monitoring

madman · 2025-11-12T17:03:20-0600

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