Men should seek testosterone replacement therapy (TRT) when they exhibit symptoms of testosterone deficiency and have confirmed low testosterone or low free testosterone levels. According to the American Urological Association (AUA), the diagnosis of testosterone deficiency requires both a low total testosterone measurement (below 300 ng/dL) on at least two separate occasions and the presence of symptoms such as reduced libido, erectile dysfunction, depression, fatigue, poor concentration, and poor memory.[1]
In addition to the guidelines from the American Urological Association (AUA), it is important to recognize that men can experience symptoms of low testosterone even when their total testosterone levels are within the normal range but their free testosterone levels are low. This can occur due to variations in sex hormone-binding globulin (SHBG) levels, which affect the amount of bioavailable testosterone. The Endocrine Society recommends measuring free testosterone in conditions where SHBG is altered or when total testosterone is borderline, as this can provide additional diagnostic information.[2]
Common symptoms of low testosterone include reduced energy, diminished work and physical performance, fatigue, depression, reduced motivation, poor concentration, impaired memory, irritability, infertility, reduced sex drive, and changes in erectile function.[3-4] These symptoms can significantly impact quality of life and warrant evaluation for potential TRT.
The American College of Physicians (ACP) suggests that clinicians discuss initiating testosterone treatment in men with age-related low testosterone who have sexual dysfunction and wish to improve sexual function. They also recommend reevaluating symptoms within 12 months and periodically thereafter, discontinuing treatment if there is no improvement.[5] At Indy Elite, we check your levels every 8-12 weeks and make adjustments to your plan accordingly. Remaining on a dosage of testosterone for 12 months with no follow up is not a way to get dialed into your best quality of life.
Guidelines recommend to confirm low testosterone or low free testosterone levels with blood draw measurements and consider the patient’s clinical presentation before initiating therapy. This approach ensures that TRT is appropriately targeted to those who are most likely to benefit from it.[3-4][6]S
To get the whole picture of your testosterone hormone, labs should include total testosterone, SHBG, and albumin level to be able to calculate your free testosterone level.
Visit IndyEliteMensT.com for more information on TRT and set up your consultation.
References
1.Evaluation and Management of Testosterone Deficiency: AUA Guideline.
Mulhall JP, Trost LW, Brannigan RE, et al.
The Journal of Urology. 2018;200(2):423-432. doi:10.1016/j.juro.2018.03.115.
Yeap BB, Wu FCW.
Clinical Endocrinology. 2019;90(1):56-65. doi:10.1111/cen.13888.
3.Testosterone Therapy: Review of Clinical Applications.
Petering RC, Brooks NA.
American Family Physician. 2017;96(7):441-449.
4.The Practical Management of Testosterone Deficiency in Men.
Aversa A, Morgentaler A.
Nature Reviews. Urology. 2015;12(11):641-50. doi:10.1038/nrurol.2015.238.
Qaseem A, Horwitch CA, Vijan S, et al.
Annals of Internal Medicine. 2020;172(2):126-133. doi:10.7326/M19-0882.
Leading Journal
6.Optimizing Diagnostic Accuracy and Treatment Decisions in Men With Testosterone Deficiency.
Bhasin S, Ozimek N.
Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2021;27(12):1252-1259. doi:10.1016/j.eprac.2021.08.002.