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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
New Member Question Re "Standard Range=86.98 - 780.10 ng/dL"?
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<blockquote data-quote="madman" data-source="post: 195078" data-attributes="member: 13851"><p><u>From the 2018 AUA Guideline</u></p><p></p><p></p><p></p><p><strong>Guideline Statements Diagnosis of Testosterone Deficiency </strong></p><p><strong></strong></p><p><strong><em>1. <u>Clinicians should use a total testosterone level below 300 ng/dL as a reasonable cut-off in support of the diagnosis of low testosterone</u>. (Moderate Recommendation; Evidence Level: Grade B) </em></strong></p><p><em><strong></strong></em></p><p><em><strong>2. The diagnosis of low testosterone should be made only after two total testosterone measurements are taken on separate occasions with both conducted in an early morning fashion. (Strong Recommendation; Evidence Level: Grade A) </strong></em></p><p><em><strong></strong></em></p><p><em><strong>3. The clinical diagnosis of testosterone deficiency is only made when patients have low total testosterone levels combined with symptoms and/or signs. (Moderate Recommendation; Evidence Level: Grade B) </strong></em></p><p><em><strong></strong></em></p><p><em><strong>4. Clinicians should consider measuring total testosterone in patients with a history of unexplained anemia, bone density loss, diabetes, exposure to chemotherapy, exposure to testicular radiation, HIV/AIDS, chronic narcotic use, male infertility, pituitary dysfunction, and chronic corticosteroid use even in the absence of symptoms or signs associated with testosterone deficiency. (Moderate Recommendation; Evidence Level: Grade B) </strong></em></p><p><em><strong></strong></em></p><p><strong><em>5. The use of validated questionnaires is not currently recommended to either define which patients are candidates for testosterone therapy or to monitor symptom response in patients on testosterone therapy. (Conditional Recommendation; Evidence Level: Grade C).</em></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>Adjunctive Testing </strong></p><p><strong></strong></p><p><strong><em>6. In patients with low testosterone, clinicians should measure serum luteinizing hormone levels. (Strong Recommendation; Evidence Level: Grade A) </em></strong></p><p><em><strong></strong></em></p><p><em><strong>7. Serum prolactin levels should be measured in patients with low testosterone levels combined with low or low/ normal luteinizing hormone levels. (Strong Recommendation; Evidence Level: Grade A) </strong></em></p><p><em><strong></strong></em></p><p><em><strong>8. Patients with persistently high prolactin levels of unknown etiology should undergo evaluation for endocrine disorders. (Strong Recommendation; Evidence Level: Grade A) </strong></em></p><p><em><strong></strong></em></p><p><em><strong>9. Serum estradiol should be measured in testosterone deficient patients who present with breast symptoms or gynecomastia prior to the commencement of testosterone therapy. (Expert Opinion) </strong></em></p><p><em><strong></strong></em></p><p><em><strong>10. Men with testosterone deficiency who are interested in fertility should have a reproductive health evaluation performed prior to treatment. (Moderate Recommendation; Evidence Level: Grade B) </strong></em></p><p><em><strong></strong></em></p><p><em><strong>11. Prior to offering testosterone therapy, clinicians should measure hemoglobin and hematocrit and inform patients regarding the increased risk of polycythemia. (Strong Recommendation; Evidence Level: Grade A) </strong></em></p><p><em><strong></strong></em></p><p><em><strong>12. PSA should be measured in men over 40 years of age prior to commencement of testosterone therapy to exclude a prostate cancer diagnosis. (Clinical Principle)</strong></em></p><p></p><p></p><p></p><p></p><p>As you can see what is stated below clearly makes it difficult for many men to get treatment let alone reap any of the beneficial effects of trt by being dead set on keeping you in range LMFAO!</p><p></p><p><strong>*It was decided that a cut-off value was critical to define testosterone deficiency and that this cut-off be based on at least two total testosterone levels drawn in an early morning fashion at the same laboratory using the same assay. <u>The cut-off of 300 ng/dL was chosen based on the mean total testosterone levels cited in the best available literature with a view to maximizing the potential benefit from prescribing testosterone while minimizing the risks of such treatment</u>.</strong></p><p><strong></strong></p><p><strong>*<u>The Panel defines success as the achievement of therapeutic testosterone levels to the normal physiologic range of 450 -600 ng/dL (middle tertile of the reference range for most labs) accompanied by symptom/sign improvement/resolution</u>.</strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>Reference Ranges </strong></p><p><strong></strong></p><p><strong><em>Well-established reference ranges constitute the essential basis for identifying whether the circulating levels of a particular analyte, testosterone, in this case, are normal or low. <u>Due to the challenges in testosterone methodology, there is considerable variability in testosterone reference ranges</u>.13 The specific reference ranges used to diagnose testosterone deficiency are discussed in more depth later in this document. <u>However, practicing clinicians who review testosterone lab results will commonly face the dilemma of whether to use the reference ranges published by their specific lab or the absolute measure itself</u>.</em></strong></p><p><strong><em></em></strong></p><p> <strong><em><u>As an example, a total testosterone value of 250 ng/dL may be considered low based on the current guideline but be marked within the normal range by the laboratory</u>. </em></strong></p><p><strong><em></em></strong></p><p><strong><em><u>This situation commonly occurs as reference laboratories often define a normal value as ranging within the 5th (or 2.5th) and 95th (or 97.5th) percentiles of a sampled population</u>. </em></strong></p><p><strong><em></em></strong></p><p><strong><em><u>However, as the testosterone literature uses absolute values to define low testosterone, the absolute value is ultimately the most important factor to determine whether patients may expect to achieve benefits with testosterone therapy</u>.</em></strong> </p><p></p><p><strong><u>In cases of discrepancy between laboratory reference ranges and this guideline, clinicians are recommended to utilize the absolute value with the understanding that all labs (including CDC-certified LCMS) include some degree of variability</u>. Clinicians wishing to identify laboratories meeting CDC standards are encouraged to refer to the list of sites currently meeting CDC requirements listed on the CDC Hormone Standardization Program. </strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p>No need to get caught up in the s**t show!</p><p></p><p>Again find a doctor who specializes in hrt/trt.</p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p></blockquote><p></p>
[QUOTE="madman, post: 195078, member: 13851"] [U]From the 2018 AUA Guideline[/U] [B]Guideline Statements Diagnosis of Testosterone Deficiency [I]1. [U]Clinicians should use a total testosterone level below 300 ng/dL as a reasonable cut-off in support of the diagnosis of low testosterone[/U]. (Moderate Recommendation; Evidence Level: Grade B) [/I][/B] [I][B] 2. The diagnosis of low testosterone should be made only after two total testosterone measurements are taken on separate occasions with both conducted in an early morning fashion. (Strong Recommendation; Evidence Level: Grade A) 3. The clinical diagnosis of testosterone deficiency is only made when patients have low total testosterone levels combined with symptoms and/or signs. (Moderate Recommendation; Evidence Level: Grade B) 4. Clinicians should consider measuring total testosterone in patients with a history of unexplained anemia, bone density loss, diabetes, exposure to chemotherapy, exposure to testicular radiation, HIV/AIDS, chronic narcotic use, male infertility, pituitary dysfunction, and chronic corticosteroid use even in the absence of symptoms or signs associated with testosterone deficiency. (Moderate Recommendation; Evidence Level: Grade B) [/B][/I] [B][I]5. The use of validated questionnaires is not currently recommended to either define which patients are candidates for testosterone therapy or to monitor symptom response in patients on testosterone therapy. (Conditional Recommendation; Evidence Level: Grade C).[/I] Adjunctive Testing [I]6. In patients with low testosterone, clinicians should measure serum luteinizing hormone levels. (Strong Recommendation; Evidence Level: Grade A) [/I][/B] [I][B] 7. Serum prolactin levels should be measured in patients with low testosterone levels combined with low or low/ normal luteinizing hormone levels. (Strong Recommendation; Evidence Level: Grade A) 8. Patients with persistently high prolactin levels of unknown etiology should undergo evaluation for endocrine disorders. (Strong Recommendation; Evidence Level: Grade A) 9. Serum estradiol should be measured in testosterone deficient patients who present with breast symptoms or gynecomastia prior to the commencement of testosterone therapy. (Expert Opinion) 10. Men with testosterone deficiency who are interested in fertility should have a reproductive health evaluation performed prior to treatment. (Moderate Recommendation; Evidence Level: Grade B) 11. Prior to offering testosterone therapy, clinicians should measure hemoglobin and hematocrit and inform patients regarding the increased risk of polycythemia. (Strong Recommendation; Evidence Level: Grade A) 12. PSA should be measured in men over 40 years of age prior to commencement of testosterone therapy to exclude a prostate cancer diagnosis. (Clinical Principle)[/B][/I] As you can see what is stated below clearly makes it difficult for many men to get treatment let alone reap any of the beneficial effects of trt by being dead set on keeping you in range LMFAO! [B]*It was decided that a cut-off value was critical to define testosterone deficiency and that this cut-off be based on at least two total testosterone levels drawn in an early morning fashion at the same laboratory using the same assay. [U]The cut-off of 300 ng/dL was chosen based on the mean total testosterone levels cited in the best available literature with a view to maximizing the potential benefit from prescribing testosterone while minimizing the risks of such treatment[/U]. *[U]The Panel defines success as the achievement of therapeutic testosterone levels to the normal physiologic range of 450 -600 ng/dL (middle tertile of the reference range for most labs) accompanied by symptom/sign improvement/resolution[/U]. Reference Ranges [I]Well-established reference ranges constitute the essential basis for identifying whether the circulating levels of a particular analyte, testosterone, in this case, are normal or low. [U]Due to the challenges in testosterone methodology, there is considerable variability in testosterone reference ranges[/U].13 The specific reference ranges used to diagnose testosterone deficiency are discussed in more depth later in this document. [U]However, practicing clinicians who review testosterone lab results will commonly face the dilemma of whether to use the reference ranges published by their specific lab or the absolute measure itself[/U]. [U]As an example, a total testosterone value of 250 ng/dL may be considered low based on the current guideline but be marked within the normal range by the laboratory[/U]. [U]This situation commonly occurs as reference laboratories often define a normal value as ranging within the 5th (or 2.5th) and 95th (or 97.5th) percentiles of a sampled population[/U]. [U]However, as the testosterone literature uses absolute values to define low testosterone, the absolute value is ultimately the most important factor to determine whether patients may expect to achieve benefits with testosterone therapy[/U].[/I][/B] [B][U]In cases of discrepancy between laboratory reference ranges and this guideline, clinicians are recommended to utilize the absolute value with the understanding that all labs (including CDC-certified LCMS) include some degree of variability[/U]. Clinicians wishing to identify laboratories meeting CDC standards are encouraged to refer to the list of sites currently meeting CDC requirements listed on the CDC Hormone Standardization Program. [/B] No need to get caught up in the s**t show! Again find a doctor who specializes in hrt/trt. [B] [/B] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
New Member Question Re "Standard Range=86.98 - 780.10 ng/dL"?
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