Some Advice Would be Appreciated on Results UK

[Leigh80]

Hi all,

I'm looking for some advice on whether my blood results are consistent with secondary hypogonadism and whether TRT is something I should be considering, or if I should be looking harder for a reversible cause first.

Symptoms:

- Persistent fatigue
- Brain fog / forgetfulness
- Low motivation
- Depression and anxiety
- Difficulty losing weight
- Hot flushes and excessive sweating (although I take duloxetine which may contribute to this)
- Struggling to drop body fat despite efforts to do so
- Lost noticeable muscle mass in the last 5 years

Interestingly, my libido has dropped a little recently, whereas erectile function is normal.

Fatigue and motivation used to be a lot worse before Duloxetine. However, I still wake and don't feel refreshed in the morning, often falling asleep again after 8 hours.

Blood results:

- Albumin: 43 g/L (35–50)
- SHBG: 32 nmol/L (18.3–54.1)
- FSH: 2.8 IU/L (1.5–12.4)
- LH: 5.7 IU/L (1.7–8.6)
- Oestradiol: 69 pmol/L (41–159)
- Total Testosterone: 10.8 nmol/L (Lab range 12–30)
- Calculated Free Testosterone: 0.218 nmol/L (0.20–0.62)
- Free Androgen Index: 33.8 (24–104)
- Prolactin: 234 mIU/L (86–324)
- DHEA-S: 2.94 µmol/L (1.2–8.98)

The lab notes mention that, under the BSSM 2022 guidelines, testosterone levels between 8–12 nmol/L may be considered for treatment if the patient is symptomatic.

I've had two previous testosterone tests that came back as 11.2nmol/L and 13nmol/L and were unfasted and fasted respectively.

Some additional background:

- I'm 45 years old.
- I'm approx 3st overweight and have been told I snore sometimes (1-2 times a month) so I'm also wondering whether sleep apnoea could be contributing.
- I had mumps with painful testicular swelling in my twenties.
- I had normal puberty and have fathered two children.
- Future fertility isn't a concern.
- My symptoms seem to have developed over the last three years, around the time I gained weight.
- Thyroid tests, inflammatory markers and routine bloods have all been normal.

My questions are:

1. Do these results look more like functional secondary hypogonadism than primary testicular failure?
2. Is there anything else you would investigate before considering TRT (sleep study, repeat morning testosterone, pituitary MRI, etc.)?
3. Has anyone with similar numbers and symptoms improved by addressing weight loss and sleep alone, or did you ultimately need TRT?

I'd really appreciate any thoughts or experiences from people who've been in a similar situation.

 

[madman]

Hi all,

I'm looking for some advice on whether my blood results are consistent with secondary hypogonadism and whether TRT is something I should be considering, or if I should be looking harder for a reversible cause first.

Symptoms:

- Persistent fatigue
- Brain fog / forgetfulness
- Low motivation
- Depression and anxiety
- Difficulty losing weight
- Hot flushes and excessive sweating (although I take duloxetine which may contribute to this)
- Struggling to drop body fat despite efforts to do so
- Lost noticeable muscle mass in the last 5 years

Interestingly, my libido has dropped a little recently, whereas erectile function is normal.

Fatigue and motivation used to be a lot worse before Duloxetine. However, I still wake and don't feel refreshed in the morning, often falling asleep again after 8 hours.

Blood results:

- Albumin: 43 g/L (35–50)
- SHBG: 32 nmol/L (18.3–54.1)
- FSH: 2.8 IU/L (1.5–12.4)
- LH: 5.7 IU/L (1.7–8.6)
- Oestradiol: 69 pmol/L (41–159)
- Total Testosterone: 10.8 nmol/L (Lab range 12–30)
- Calculated Free Testosterone: 0.218 nmol/L (0.20–0.62)
- Free Androgen Index: 33.8 (24–104)
- Prolactin: 234 mIU/L (86–324)
- DHEA-S: 2.94 µmol/L (1.2–8.98)

The lab notes mention that, under the BSSM 2022 guidelines, testosterone levels between 8–12 nmol/L may be considered for treatment if the patient is symptomatic.

I've had two previous testosterone tests that came back as 11.2nmol/L and 13nmol/L and were unfasted and fasted respectively.

Some additional background:

- I'm 45 years old.
- I'm approx 3st overweight and have been told I snore sometimes (1-2 times a month) so I'm also wondering whether sleep apnoea could be contributing.
- I had mumps with painful testicular swelling in my twenties.
- I had normal puberty and have fathered two children.
- Future fertility isn't a concern.
- My symptoms seem to have developed over the last three years, around the time I gained weight.
- Thyroid tests, inflammatory markers and routine bloods have all been normal.

My questions are:

1. Do these results look more like functional secondary hypogonadism than primary testicular failure?
2. Is there anything else you would investigate before considering TRT (sleep study, repeat morning testosterone, pituitary MRI, etc.)?
3. Has anyone with similar numbers and symptoms improved by addressing weight loss and sleep alone, or did you ultimately need TRT?

I'd really appreciate any thoughts or experiences from people who've been in a similar situation.

I've had two previous testosterone tests that came back as 11.2nmol/L and 13nmol/L and were unfasted and fasted respectively.


Blood results:

- Albumin: 43 g/L (35–50)
- SHBG: 32 nmol/L (18.3–54.1)
- FSH: 2.8 IU/L (1.5–12.4)
- LH: 5.7 IU/L (1.7–8.6)
- Oestradiol: 69 pmol/L (41–159)
- Total Testosterone: 10.8 nmol/L (Lab range 12–30)
- Calculated Free Testosterone: 0.218 nmol/L (0.20–0.62)
- Free Androgen Index: 33.8 (24–104)
- Prolactin: 234 mIU/L (86–324)
- DHEA-S: 2.94 µmol/L (1.2–8.98)


The lab notes mention that, under the BSSM 2022 guidelines, testosterone levels between 8–12 nmol/L may be considered for treatment if the patient is symptomatic.


Yes!

We always want to test at the peak (6-10 am) in a fasted state otherwise your results would be skewed as in your T levels will come back lower than what they really are.

No need to test FAI as it is useless.

As you can see your TT 311.5 ng/dL (10.8 nmol/L) is low based on the labs reference ranges lower limit and is far from robust.

If you lived in the US the standard clinical lower limit is 300 ng/dL would would have had your TT close to the bottom end as in sub-par but not low and even then your TT would not be considered healthy by any doctor truly in the know.

Keep in mind although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.

The only way to know where your FT truly sits would be testing using the most accurate assay the gold standard Equilibrium Dialysis especially in cases of altered SHBG.

Seeing as you live in the UK the gold standard ED assay is. not routinely used/widely available so most doctors use/rely on the next best testing method the go to calculated linear law-of-mass action Vermeulen (cFTV) which will give a good approximation.

Your FT was done using the calculated Vermeulen method and as you can see the most critical fraction is sitting at the bottom end as in dismal.

With a sub-par TT 10.8 nmol/L, normal SHBG 32 nmol/L and Albumin 4.3 g/dL your FT 0.218 nmol/L (6.28 ng/dL) would be flagged as low if you base the results on the official cFTV reference range 6.5-25 ng/dL.

Free & Bioavailable Testosterone calculator

FT <5 ng/dL would be considerd low.

FT 5-9 ng/dL would be considered the grey zone where some men may experience symptoms of low-T.

FT 10-15 ng/dL would be healthy.

FT 20-25 ng/dL would be high-end/high.

Your FT is far from healthy and would easily qualify for treatment of low-T.



My questions are:

1. Do these results look more like functional secondary hypogonadism than primary testicular failure?
2. Is there anything else you would investigate before considering TRT (sleep study, repeat morning testosterone, pituitary MRI, etc.)?
3. Has anyone with similar numbers and symptoms improved by addressing weight loss and sleep alone, or did you ultimately need TRT?


You would be considered secondary.

Definitely need to get tested for sleep apnea especially seeing as it can drive up the hematocrit which is a critical blood marker that needs to be monitored when using exogenous T.

Use of exogenous T will drive up RBCs, hemoglobin and hematocrit so you would need to get a baseline CBC which includes the critical blood markers.

Your prolactin/sub par TT low 300s would not raise a red flag for pituitary MRI.

Sleep is critical when it comes to natty T as lack of quality sleep can hammer down your testosterone seeing as natty endogenous T starts to gradually rise overnight reaching peak levels in the early am.

Any dysfunction thyroid/adrenals can easily mimic low-T symptoms.

Losing adipose can drive up natty T levels but you need to lose a significant amount in order to see a big jump in T.

Following a healthy diet, exercising (weight training/cardiovascular fitness), getting quality sleep and minimizing stress (physical/mental) will have a positive impact on maintaining healthy T.

Even when using exogenous T the 4 pillars diet, exercise, sleep and stress can make or break the overall effectiveness of T-therapy!

Keep in mind you do not have to jump in head first with full blow T therapy as you have other options such as hCG momotherapy or a serm (clomid/enclomiphene).

I would definitely seek out a doctor that is well versed in treating men for low-T as your FT is far from healthy.








The lab notes mention that, under the BSSM 2022 guidelines, testosterone levels between 8–12 nmol/L may be considered for treatment if the patient is symptomatic.


Yes look over my reply from this thread!

Post in thread 'low testosterone blood results'

Jun 21, 2026

Yep, the blood test was taken in a fasted state and before 10am. I have an appointment with my doctor, but I have a feeling that since I still fall within the NHS limits—which are quite broad in the UK—he will not want to do anything.

Even if I somehow manage to get a referral to an endocrinologist, the waiting time is very long. I think my only option is to go private to an online TRT clinic if I want to start getting things sorted sooner, but they are just going to prescribe testosterone.

Yes you will most likely have a difficult time unless you seek out a private clinic.

Dr...

• madman

Thread 'BSSM: Position Statement for the Potential Use of Enclomiphene in the Treatment of Male Hypogonadism'

Feb 28, 2026

* Enclomiphene is one of two stereoisomers of clomiphene, the other being Zuclomiphene. Whilst zuclomiphene is more oestrogenic, enclomiphene is more anti-oestrogenic. Zuclomiphene is generally antigonadotropic due to its effects on oestrogen receptors, which leads to a subsequent reduction in testosterone production. Essentially, isomerically pure enclomiphene is pro-gonadotropic and can therefore improve secondary hypogonadotropic hypogonadism in men without the same adverse oestrogenic side effects often observed with clomiphene. Clomiphene is currently commonly...

• madman
• enclomiphene fertility health hypogonadism
• Replies: 1
• Forum: hCG, Clomid & Others for Fertility, PCT or Low T

Thread 'Pros and cons of using TRT vs HCG for treatment low-t symptoms'

Dec 15, 2020

Human chorionic gonadotropin treatment: a viable option for management of secondary hypogonadism and male infertility (2020)
Julius Fink, Brad J. Schoenfeld, Anthony C. Hackney, Takahiro Maekawa & Shigeo Horie


Abstract

Introduction: Low testosterone and its symptoms is a condition affecting many males with severe repercussions on health. Testosterone affects metabolism, bones, joints and ligaments, the cardiovascular system, liver, sexual functions, muscle mass, and the nervous system. Nowadays, due to recent research showing the benefits of testosterone replacement...

• madman
• trt vs hcg
• Replies: 10
• Forum: hCG, Clomid & Others for Fertility, PCT or Low T

• 

 

[Leigh80]

I've had two previous testosterone tests that came back as 11.2nmol/L and 13nmol/L and were unfasted and fasted respectively.


Blood results:

- Albumin: 43 g/L (35–50)
- SHBG: 32 nmol/L (18.3–54.1)
- FSH: 2.8 IU/L (1.5–12.4)
- LH: 5.7 IU/L (1.7–8.6)
- Oestradiol: 69 pmol/L (41–159)
- Total Testosterone: 10.8 nmol/L (Lab range 12–30)
- Calculated Free Testosterone: 0.218 nmol/L (0.20–0.62)
- Free Androgen Index: 33.8 (24–104)
- Prolactin: 234 mIU/L (86–324)
- DHEA-S: 2.94 µmol/L (1.2–8.98)


The lab notes mention that, under the BSSM 2022 guidelines, testosterone levels between 8–12 nmol/L may be considered for treatment if the patient is symptomatic.


Yes!

We always want to test at the peak (6-10 am) in a fasted state otherwise your results would be skewed as in your T levels will come back lower than what they really are.

No need to test FAI as it is useless.

As you can see your TT 311.5 ng/dL (10.8 nmol/L) is low based on the labs reference ranges lower limit and is far from robust.

If you lived in the US the standard clinical lower limit is 300 ng/dL would would have had your TT close to the bottom end as in sub-par but not low and even then your TT would not be considered healthy by any doctor truly in the know.

Keep in mind although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.

The only way to know where your FT truly sits would be testing using the most accurate assay the gold standard Equilibrium Dialysis especially in cases of altered SHBG.

Seeing as you live in the UK the gold standard ED assay is. not routinely used/widely available so most doctors use/rely on the next best testing method the go to calculated linear law-of-mass action Vermeulen (cFTV) which will give a good approximation.

Your FT was done using the calculated Vermeulen method and as you can see the most critical fraction is sitting at the bottom end as in dismal.

With a sub-par TT 10.8 nmol/L, normal SHBG 32 nmol/L and Albumin 4.3 g/dL your FT 0.218 nmol/L (6.28 ng/dL) would be flagged as low if you base the results on the official cFTV reference range 6.5-25 ng/dL.

View attachment 57709

View attachment 57708

FT <5 ng/dL would be considerd low.

FT 5-9 ng/dL would be considered the grey zone where some men may experience symptoms of low-T.

FT 10-15 ng/dL would be healthy.

FT 20-25 ng/dL would be high-end/high.

Your FT is far from healthy and would easily qualify for treatment of low-T.



My questions are:

1. Do these results look more like functional secondary hypogonadism than primary testicular failure?
2. Is there anything else you would investigate before considering TRT (sleep study, repeat morning testosterone, pituitary MRI, etc.)?
3. Has anyone with similar numbers and symptoms improved by addressing weight loss and sleep alone, or did you ultimately need TRT?


You would be considered secondary.

Definitely need to get tested for sleep apnea especially seeing as it can drive up the hematocrit which is a critical blood marker that needs to be monitored when using exogenous T.

Use of exogenous T will drive up RBCs, hemoglobin and hematocrit so you would need to get a baseline CBC which includes the critical blood markers.

Your prolactin/sub par TT low 300s would not raise a red flag for pituitary MRI.

Sleep is critical when it comes to natty T as lack of quality sleep can hammer down your testosterone seeing as natty endogenous T starts to gradually rise overnight reaching peak levels in the early am.

Any dysfunction thyroid/adrenals can easily mimic low-T symptoms.

Losing adipose can drive up natty T levels but you need to lose a significant amount in order to see a big jump in T.

Following a healthy diet, exercising (weight training/cardiovascular fitness), getting quality sleep and minimizing stress (physical/mental) will have a positive impact on maintaining healthy T.

Even when using exogenous T the 4 pillars diet, exercise, sleep and stress can make or break the overall effectiveness of T-therapy!

Keep in mind you do not have to jump in head first with full blow T therapy as you have other options such as hCG momotherapy or a serm (clomid/enclomiphene).

I would definitely seek out a doctor that is well versed in treating men for low-T as your FT is far from healthy.








The lab notes mention that, under the BSSM 2022 guidelines, testosterone levels between 8–12 nmol/L may be considered for treatment if the patient is symptomatic.


Yes look over my reply from this thread!

Thanks for taking the time to write such a detailed reply, it's really helpful and much appreciated.

One thing I'd like to understand is whether functional secondary hypogonadism (as you've flagged as relevant in this instance), caused by something like excess weight or sleep apnoea, can be corrected by actively working on such issues. Could I realistically expect to bring my testosterone and free testosterone back into a healthy range, or would there be only a modest improvement? Or possibly none?

My diet is healthy in that I eat sufficient fruit and vegetables, protein, healthy fats, etc. I add to this with vitamin D, zinc, magnesium, and omega 3 supplements. While any calories are alloted for through monitoring of serving size. I've already lost around 9 lb between my first and most recent blood tests using this method, but my testosterone has actually fallen over that period! As a consequence I'm left feeling unconvinced weight loss would lead to a meaningful improvement.

I've attempted to see an endo privately but they won't entertain this without a referral letter, which my Doctor won't provide unless I have an additional blood test provided by the NHS. The issue appears to be that the latest is a private (medichecks) test and not NHS, so my GP won't recognise it. The same GP also went so far as to say that the endo won't either. However, it waits to be seen how much my GP knows about TRT as they stipulated I must avoid caffeine and meat the evening before, and up until, the blood test. I also suspect it will be a testosterone only blood test.

I'm persevering with the NHS as I have concerns whether there could be something more sinister causing this. know you mentioned my prolactin and LH/FSH don't really point towards a pituitary problem, but is there still any possibility of something like a pituitary tumour or another underlying condition, or would my bloodwork make that unlikely?

I'm just trying to understand whether this is likely to be something reversible that I need to keep working on, or whether it's more likely that my body simply isn't producing enough testosterone anymore.

Again, thank you for your help!

 

[madman]

Thanks for taking the time to write such a detailed reply, it's really helpful and much appreciated.

One thing I'd like to understand is whether functional secondary hypogonadism (as you've flagged as relevant in this instance), caused by something like excess weight or sleep apnoea, can be corrected by actively working on such issues. Could I realistically expect to bring my testosterone and free testosterone back into a healthy range, or would there be only a modest improvement? Or possibly none?

My diet is healthy in that I eat sufficient fruit and vegetables, protein, healthy fats, etc. I add to this with vitamin D, zinc, magnesium, and omega 3 supplements. While any calories are alloted for through monitoring of serving size. I've already lost around 9 lb between my first and most recent blood tests using this method, but my testosterone has actually fallen over that period! As a consequence I'm left feeling unconvinced weight loss would lead to a meaningful improvement.

I've attempted to see an endo privately but they won't entertain this without a referral letter, which my Doctor won't provide unless I have an additional blood test provided by the NHS. The issue appears to be that the latest is a private (medichecks) test and not NHS, so my GP won't recognise it. The same GP also went so far as to say that the endo won't either. However, it waits to be seen how much my GP knows about TRT as they stipulated I must avoid caffeine and meat the evening before, and up until, the blood test. I also suspect it will be a testosterone only blood test.

I'm persevering with the NHS as I have concerns whether there could be something more sinister causing this. know you mentioned my prolactin and LH/FSH don't really point towards a pituitary problem, but is there still any possibility of something like a pituitary tumour or another underlying condition, or would my bloodwork make that unlikely?

I'm just trying to understand whether this is likely to be something reversible that I need to keep working on, or whether it's more likely that my body simply isn't producing enough testosterone anymore.

Again, thank you for your help!

You eat healthy, hopefully trying to exercise which can be an uphill battle in your situation as your FT is low which will not only kill your energy/drive but also have a big impact on your metabolic health due to loss of muscle mass and increased adipose especially midsection/visceral which you have already experienced and to make matters worse you are most likely not getting enough quality sleep.

The body is less resilient metabolically and physically (mental/physical) stress when you are running low on T.

Even if you somehow managed to lose more adipose which would be an uphill battle in your current state highly doubtful the natty boost in T would be meaningful here.

Your FT is already bottomed out.

Once you address your low T it will be much easier to add some muscle and lose adipose let alone improve your overall health.




Symptoms:

- Persistent fatigue
- Brain fog / forgetfulness
- Low motivation
- Depression and anxiety
- Difficulty losing weight
- Hot flushes and excessive sweating (although I take duloxetine which may contribute to this)
- Struggling to drop body fat despite efforts to do so
- Lost noticeable muscle mass in the last 5 years




Some additional background:

- I'm 45 years old.
- I'm approx 3st overweight and have been told I snore sometimes (1-2 times a month) so I'm also wondering whether sleep apnoea could be contributing.
- I had mumps with painful testicular swelling in my twenties.
- I had normal puberty and have fathered two children.
- Future fertility isn't a concern.
- My symptoms seem to have developed over the last three years, around the time I gained weight.
- Thyroid tests, inflammatory markers and routine bloods have all been normal.




As I stated previously lack of quality sleep long-term and carrying excess adipose especially visceral. can easily hammer down natty T levels.

When it comes to weight loss you would need to lose. a significant amount of adipose in order to see a big boost in T.




Relation of Weight Loss and Hypogonadism

Impact of Bariatrics

* Reported results of up to 300 ng/dL testosterone increase

Relation of Weight Loss and Hypogonadism

Impact of Diet Management

* Dietary interventions resulting in 10 kg weight loss--->average T increases of 80 ng/dL total T

Thread 'Testosterone and Fertility - Lifestyle Modifications to Raise Endogenous Testosterone'

Oct 14, 2025

Str8 from the master blaster!

Dr. Lipshultz!

Summary of Clinical Practice Implementation

Life-Style Changes to Increase T

• madman
• fertility hypogonadism lifestyle testosterone
• Replies: 19
• Forum: hCG, Clomid & Others for Fertility, PCT or Low T

• 

* TTh, when indicated, offers multi-dimensional benefits – enhancing sexual function, mood, cognition, muscle and bone strength, and metabolic profile – which in concert restore much of what hypogonadal men often feel they have “lost” with the decline in their hormonal milieu. Particularly in older men with FH, management must be holistic: addressing lifestyle factors and comorbid illnesses is as important as prescribing the hormone itself. By treating the whole patient, including encouragement of weight loss and exercise (facilitated by the patient's renewed vigor on testosterone), clinicians can break the vicious cycle of obesity, inflammation, and hormone deficiency.


* By following these principles, clinicians can optimize the benefits of TTh while minimizing risks. Treating hypogonadism is not merely about normalizing a laboratory value; it is about restoring a man's quality of life, vitality, and health trajectory. A man with FH who was once fatigued, depressed, and frail can, after appropriate treatment, regain significant physical and mental function, improving not only his own life but also often his engagement in family, work, and society. Modern androgen replacement should thus be viewed as an integral component of healthy aging in men who need it – analogous to hormone therapy in other endocrine disorders – rather than an optional or dangerous indulgence. With the growing evidence base and refined clinical guidelines, testosterone therapy has secured its role as a safe and efficacious intervention for men suffering from the bona fide hypogonadism syndrome.

Thread 'Functional Hypogonadism Uncovered: The Truth About Modern Testosterone Therapy and Men’s Health'

Feb 11, 2026

* Male hypogonadism is etiologically heterogeneous, broadly classified as: primary (hypergonadotropic) hypogonadism due to testes failure (e.g. from genetic conditions, trauma or gonadotoxic insults); secondary (hypogonadotropic) hypogonadism due to hypothalamic-pituitary disorders (e.g. tumors, trauma, exogenous opioids); or functional hypogonadism (FH), a reversible form often associated with systemic comorbidities. FH – sometimes termed age-related hypogonadism – occurs typically in older, multimorbid men and represents a combined dysfunction of both central and gonadal...

• madman
• aging hypogonadism Risks/benefits t therapy
• Replies: 7
• Forum: Testosterone and Men's Health Articles

Thread 'SHOULD FUNCTIONAL HYPOGONADISM BE TREATED?'

Sep 29, 2025

I say Dr. Zitmann for the win!

Take home message

• madman
• health hypogonadism testosterone therapy
• Replies: 16
• Forum: Testosterone and Men's Health Articles

Thread 'Updates in male hypogonadism: what is functional hypogonadism and how should it be managed?'

Sep 26, 2025

Dr Channa Jayasena

Functional hypogonadism - what is it?

SUMMARY: Men with functional. hypogonadism

Conclusion - before considering TRT

Conclusions if initiating TRT

• madman
• hypogonadism Mens Health/trt testosterone
• Replies: 19
• Forum: Testosterone and Men's Health Articles

When the combination of lifestyle interventions and TRT was compared to lifestyle alone, the former resulted in a larger improvement in body composition (including a greater reduction of fat mass and waist circumference and an increase of lean mass) as well as an overall improvement of insulin resistance as derived by surrogate markers (including the HOMA index and triglyceride levels). Finally, the use of TRT along with lifestyle showed a better IIEF score at the end of the trial when compared to that obtained with lifestyle modifications alone.

Thread 'Advances in the treatment of functional male hypogonadism'

May 5, 2024

ABSTRACT

Introduction

Functional hypogonadism is frequently found in obese men, particularly those with metabolic complications. Several possible therapeutic approaches could be considered.


Areas covered

An extensive search on Medline, Embase, and Cochrane databases was performed to retrieve the available studies assessing the change of testosterone (T) and sexual function upon dieting or physical activity programs, as well as glucagon-like peptide 1 analogues. The role of lifestyle interventions associated with T replacement therapy (TRT) was also evaluated...

• madman
• hypogonadism lifestyle obesity testosterone
• Replies: 10
• Forum: Testosterone and Men's Health Articles

Evaluation to Determine the Cause of Testosterone Deficiency

In men deemed to have testosterone deficiency, the measurement of serum LH and FSH levels is recommended to determine whether the patient has primary or secondary hypogonadism.1 Biotin supplements can interfere with some LH and FSH assays; therefore, these supplements should be stopped at least 3 days before the blood test depending on how much biotin the patient is taking. Men with elevated LH and FSH levels in association with low testosterone levels have primary testicular dysfunction. Karyotyping should be performed in these men to confirm whether they have Klinefelter syndrome, a common cause of primary testicular dysfunction. The other causes of primary testicular dysfunction include cancer chemotherapy, radiation to the testes, cryptorchidism, trauma, torsion, infectious orchitis, HIV infection, anorchia syndrome, and myotonic dystrophy.

Low or inappropriately normal LH and FSH levels in association with low testosterone levels suggest secondary hypogonadism due to disorders of the pituitary or hypothalamus. The causes of secondary hypogonadism include severe obesity; hyperprolactinemia; hemochromatosis; the use of opioids, glucocorticoids, androgenic-anabolic steroids, or androgen deprivation therapy with gonadotropin-releasing hormone (GnRH) agonists or antagonists; body image and eating disorders; idiopathic hypogonadotropic hypogonadism (IHH); head trauma; pituitary tumors or infiltrative disease; acromegaly and hypercortisolism; and pituitary surgery or radiation. Conditions such as aging, heavy alcohol use, hemochromatosis, and some genetic disorders may be associated with dual defects in the testes and pituitary.

In men with secondary hypogonadism, serum prolactin and ferritin levels should be measured, and other pituitary hormones should be evaluated. An imaging study, such as magnetic resonance imaging of the pituitary and hypothalamus, may be indicated to rule out the possibility of a space-occupying lesion, but the cost-effectiveness of an imaging study in the evaluation of middle-aged men with sexual dysfunction has been debated upon because the incidence of pituitary space-occupying lesions among such men is low. Diagnostic yield can be improved by performing imaging studies in men whose total testosterone level is <150 ng/dL or those who have hyperprolactinemia, panhypopituitarism, or symptoms of tumor mass effect, such as new-onset headache or a visual field defect.

Thread 'Testosterone Deficiency in Men'

Jan 23, 2022

Optimizing Diagnostic Accuracy and Treatment Decisions in Men With Testosterone Deficiency (2021)
Shalender Bhasin, MB, BS *, Noelle Ozimek, MSc



Abstract

Objective: This narrative review offers a guideline-based approach for optimizing diagnostic evaluation and treatment decision-making in men being evaluated for testosterone deficiency.

Methods: A narrative review.

Results: Testosterone deficiency is a clinical syndrome that results from the inability of the testes to produce normal amounts of testosterone and is characterized by a...

• madman
• low testosterone
• Replies: 16
• Forum: Testosterone and Men's Health Articles

• 

* When evaluating middle-aged and older men with secondary hypogonadism, the cost-effectiveness of pituitary imaging (magnetic resonance imaging) to exclude pituitary and/or hypothalamic disease is unknown. Surveys of middle-aged and older men with secondary hypogonadism and sexual dysfunction have revealed a low prevalence of hypothalamic–pituitary abnormalities (49). Clinicians can improve the diagnostic yield of pituitary imaging to exclude pituitary and/or hypothalamic tumors by performing this procedure in men with panhypopituitarism, persistent hyperprolactinemia, serum TT < 150 ng/dL (5.2 nmol/L) (49), or symptoms of tumor mass effect (e.g., visual impairment, visual field defect, or new onset headache).

Testosterone Therapy in Men With Hypogonadism: An Endocrine Society* Clinical Practice Guideline

This update to the Endocrine Society’s 2010 testosterone guideline, prepared by an expert panel, describes the diagnosis, screening, treatment, and monitor

academic.oup.com

Testosterone Therapy in Men With Hypogonadism: An Endocrine Society*Clinical Practice Guideline (2018)