Let’s review each type of test in detail.

Testosterone Test

A testosterone test measures the blood level of the male sex hormone testosterone. Testosterone, which plays an important role in sexual development, is produced mainly by the testes in men and in much smaller amounts by the ovaries in women. Testosterone is also produced by the adrenal glands in both women and men.

In young boys, testosterone levels are normally low. As puberty approaches — usually between the ages of 10 and 14 — the pituitary gland (a pea-sized gland near the base of the brain) secretes two hormones (luteinizing hormone, or LH; and follicle-stimulating hormone, or FSH) that work together to stimulate the testes to make testosterone.

Increased testosterone production is what causes men to develop deeper voices, bigger muscles, and body and facial hair. It also helps the testes produce sperm, and it plays a role in speeding growth in height during puberty. Testosterone is also important for bone health.

Two separate assessments may be performed as part of a testosterone test:

• total testosterone, which measures the entire amount of testosterone in the body, including both the amount bound to proteins that help transport the hormone through the bloodstream and free testosterone;
• free testosterone, which measures only the testosterone that’s not attached to proteins.

The doctor may order one or both tests. However, because sexual development involves many other hormones, a more complete picture can often be obtained by performing other tests at the same time, including an LH or FSH test.

For example, low levels of testosterone can be due to a problem with the testes’ production of testosterone or to the pituitary gland not making enough of the hormones that stimulate the testes to produce testosterone.

Why It’s Done

Doctors may order a testosterone blood test if a boy appears to be entering puberty earlier or later than expected. High levels are associated with precocious (early) puberty, while low levels may indicate a delay in sexual development. In girls, high levels can be associated with the appearance of masculine characteristics, such as facial hair.

The test may also be used in either men or women to check for damage or disease of the testes, ovaries, adrenal glands, or pituitary gland, or to check for steroid use.

In teens and adults, testosterone levels can help doctors evaluate fertility or menstrual problems and sexual function.

Preparation

No special preparations are needed for this test. The doctor may want to perform the test in the morning when testosterone levels usually are highest.

On the day of the test, it would be helpful to wear a T-shirt or short-sleeved shirt to allow easier access for the technician who will be drawing the blood.

The Procedure

A health professional will clean the skin surface with antiseptic, and place an elastic band (tourniquet) around the upper arm to apply pressure and cause the veins to swell with blood. Then a needle is inserted into a vein (usually in the arm inside of the elbow or on the back of the hand) and blood is withdrawn and collected in a vial or syringe.

After the procedure, the elastic band is removed. Once the blood has been collected, the needle is removed and the area is covered with cotton or a bandage to stop the bleeding. Collecting blood for this test will only take a few minutes.

What to Expect

Collecting a sample of blood is only temporarily uncomfortable and can feel like a quick pinprick. Afterward, there may be some mild bruising, which should go away in a few days.

Hypogonadism is a condition in which the body fails to make enough hormones because of a problem with the testicles, pituitary gland, or brain.

Men use testosterone products to help with fatigue, erectile dysfunction, and loss of sex drive. A number of prescription testosterone products are available to treat hypogonadism. Testosterone products come in different forms, including gels, injectable solutions, patches, pills, and pellets implanted under the skin.

Once a patient starts testosterone therapy, they usually undergo lifelong treatment which means that doctors will monitor the patient’s hormone levels every six months to a year. Depending on the patient, the checkups may be more frequent.

Subtle Symptoms of Low Testosterone

The symptoms of low testosterone are sometimes obvious, but they also can be subtle. Testosterone levels decline naturally in men as they age over the decades. But certain conditions can also lead to an abnormally low level. Symptoms of low testosterone include:

• low sex drive (libido);
• erectile dysfunction;
• fatigue and poor energy level;
• decreased muscle mass;
• body and facial hair loss;
• difficulty concentrating;
• depression;
• irritability;
• low sense of well-being.

If men have symptoms of low testosterone and tests show they have an abnormally low testosterone level, a doctor may suggest treatment. For millions of men who have low testosterone levels but no symptoms, no treatment is currently recommended.

Types of Testosterone Products

Testosterone can be administered in a skin patch, skin gel, pill, or cream form — or as an injection, a solution applied to the armpit or a patch, or a buccal system applied to the upper gum or inner cheek.

While many testosterone products are available only with a prescription, some drug stores and health food stores sell them over the counter. A few of these products also claim to be all-natural.

Gels (Androgel and Testim)

Testosterone gel is a prescription medication applied directly to a man’s skin — on the shoulders and upper arms and/or abdomen, depending on the brand. Testosterone gel can inadvertently transfer from your body to others and can lead to serious health reactions.

To avoid such contact, apply testosterone gel to clean, dry, intact skin that will be covered by clothing. Wash your hands right away with soap and water after applying. Once the gel has dried, cover the area with clothing and keep it covered until you have washed the area well or have showered.

Injections (Depo-Testosterone)

First approved in 1979, Depo-Testosterone is one of the older drugs of its kind on the market. It’s a liquid and is designed for injection deep into the gluteal muscle. The active ingredient, testosterone cypionate, is a white or creamy white powder mixed with other ingredients to make a solution. The drug is available in two strengths, 100 mg, and 200 mg.

Patches (Androderm)

Testosterone transdermal patches, including Androderm, come as patches to apply to the skin. Patches work best when applied around the same time each night and are left in place for 24 hours. Testosterone patches are meant to be worn at all times until replaced with new patches. Androderm patches should be changed every 24 hours. The old patch should be removed before applying the new one. You should apply the patches to different spots each night and wait at least seven days before re-using a spot.

Capsules (Methyltestosterone and Android)

The testosterone capsules Methyltestosterone and Android have been discontinued but have been used in men and boys to treat conditions caused by lack of the hormone, such as delayed puberty, and in women to treat breast cancer that has spread to other parts of the body.

Methyltestosterone is a man-made form of testosterone. It can affect bone growth in boys who are treated for delayed puberty.

Women have more estrogen than men do; men have more testosterone than women do. A woman’s estrogen is produced mainly by the ovaries until menopause, which is when the adrenal glands begin to manufacture most of the woman’s estrogen – albeit at lower levels than the ovaries did.

Hormone Replacement for Youth

Bioidentical hormone replacement therapy for men (BHRT) uses hormones that are identical, on a molecular level, to the natural hormones occurring in your body.

The goal of BHRT is to supplement low hormone levels and restore the critical hormone balance in your system. By restoring hormones to appropriate levels, BHRT may help reduce many symptoms associated with aging, low testosterone, and other hormonal imbalances.

People suffering from hormone imbalance can benefit from bioidentical hormone replacement therapy. BHRT has been shown to help men regain:

• higher energy levels;
• better sex drive;
• increased muscle mass;
• restored muscle tone;
• enhanced memory;
• improved mood;
• reduced depression;
• greater stamina;
• strong immune system;
• better skin elasticity.

Hormone replacement therapy must be administered by a well-trained physician who will first evaluate your existing medical condition and run a variety of tests to determine your hormone levels.

Hormone levels should also be monitored during and after your treatment to ensure optimal health results and minimize side effects.

Get in touch with our qualified team to learn more about how you can improve your hormonal balance.

HGH Dosage and Regimen

The starting dose of GH depends on the age and clinical condition of the patient. A dose regimen that is based on age along with dose titration has been associated with less adverse effects compared with a weight-based regimen. The following regimen is suggested:

• age younger than 30 years: 0.4-0.5 mg/day (may be higher for patients transitioning from pediatric treatment);
• age 30-60 years: 0.2-0.3 mg/day;
• age >60 years or those with diabetes mellitus or prediabetes: 0.1-0.2 mg/day.

For patients with adherence issues, a less frequent dose regimen such as alternate days or 3 times per week using the same total weekly dosage can be used.

Follow-up is usually planned at intervals of 1-2 months when the dose of GH can be adjusted by increments of 0.1-0.2 mg/day based on the clinical response, serum insulin-like growth factor-1 (IGF-1) levels, and side effects. Longer time intervals and smaller dose increments are suggested for older patients.

Serum IGF-1 levels are the main determinant for adjusting the dose of GH. A commonly used target is the upper half of the normal range appropriate for age and sex, unless significant side effects develop.

Once maintenance doses of GH are achieved, follow-up is provided at intervals of 6 months. Monitoring includes clinical evaluation, assessment of side effects, and measurement of serum IGF-1, fasting glucose, and lipid profile.

Quality of life (QOL) is also assessed using standardized questionnaires. If the initial bone mineral density findings, measured by dual-energy x-ray absorptiometry (DXA) scanning, are abnormal, repeat testing at intervals of 2-3 years is recommended.

How long to take HGH?

The duration of HGH treatment is determined individually. Patients with childhood GH deficiency who attained adult height and had persistent deficiency on retesting should continue to receive GH therapy.

GH therapy can also be continued indefinitely if benefits such as significant improvement in QOL and objective improvements in biochemistry and body composition are observed. If no objective or subjective benefits are seen after 1 year of treatment, discontinuation of GH therapy should be considered.

Side Effects

The most common side effects of GH therapy are related to fluid retention and include paresthesias, joint stiffness, peripheral edema, arthralgia, myalgia, carpal tunnel syndrome, and increased blood pressure. Most of these adverse effects improve with dose reduction.

GH therapy is associated with a mild increase in both fasting serum glucose and fasting plasma insulin levels. Patients with diabetes mellitus who receive GH therapy may require adjustment in their glucose-lowering medications.

Because GH therapy can decrease levels of serum free T4 and cortisol (thyroid and stree hormones), regular monitoring of thyroid and adrenal function is recommended. Patients on concurrent thyroid or adrenal hormone replacement may need dose adjustments after starting GH therapy.

Patients who have normal thyroid and adrenal function require monitoring of serum free T4 and assessment of the hypothalamic-pituitary-adrenal axis because GH therapy can unmask central hypothyroidism and hypoadrenalism.

Patients who are on testosterone-replacement therapy may require their GH doses to be lowered, because testosterone can potentiate GH action and exacerbate GH-induced adverse effects.

Women who are taking oral estrogen replacement therapy usually need higher doses of GH, but those on transdermal estrogen preparations may not.

Get in touch with our endocrinologist for a free consultation!