The medical evaluation of testosterone deficiency involves two main steps:
Ensuring that testosterone deficiency is indeed present.
Many conditions can cause similar symptoms to testosterone deficiency, so it is important to rule out other potential causes.
Identifying the underlying cause of testosterone deficiency.
Determining the cause is crucial for selecting the appropriate treatment.
There are three common scenarios that lead to suspicion of testosterone deficiency in healthcare settings:
Self-referral - You seek help because you suspect testosterone deficiency.
Physician referral - You present symptoms that the doctor believes may be a result of testosterone deficiency.
Incidental finding - During the investigation of other conditions, deviations are discovered that raise suspicion of testosterone deficiency.
To confirm or refute the suspicion, the following blood tests are typically performed:
Serum testosterone
Sex hormone-binding globulin (SHBG)
Luteinizing hormone (LH)
Hemoglobin (Hb)
Prostate-specific antigen (PSA), especially in men over 45 years of age
The blood sample is usually taken in the morning between 7-10 am, after fasting and a normal night's sleep. If the testosterone level is low, another test may be performed to rule out measurement errors. Depending on the overall picture, additional blood tests, magnetic resonance imaging (MRI), or chromosomal analysis may be considered.
Once testosterone deficiency is confirmed, and the underlying cause has been identified by the healthcare provider, several steps are taken:
Prostate examination and prostate-specific antigen (PSA) test to exclude prostate cancer
Assessment of familial risk for prostate cancer, which affects treatment follow-ups
Breast cancer evaluation
Blood tests for hemoglobin (Hb) and erythrocyte volume fraction (EVF) since treatment may stimulate production of red blood cells which increases the risk of blood clots.
Evaluation of potential heart failure treatment, as it can worsen with testosterone treatment
Evaluation of cardiovascular disease, as it influences treatment decisions
Once it is deemed safe to initiate treatment and all necessary considerations have been made, you will be offered one of two forms of treatment:
Testosterone gel
Testosterone injections
After starting treatment, follow-up appointments typically occur at 3, 6, and 12 months to evaluate treatment efficacy and determine whether to continue treatment and, if so, in what manner. After the first year, follow-up visits usually occur annually. The follow-up assessments include:
Testosterone levels
PSA
Hb
Blood pressure
If you have osteoporosis, it will be monitored separately every other year.
To determine if you have testosterone deficiency, you need to undergo an evaluation for that suspicion. If you experience symptoms consistent with testosterone deficiency, it could be due to one of three possibilities:
Actual testosterone deficiency
Conditions indirectly leading to testosterone deficiency
Conditions causing symptoms similar to those experienced with testosterone deficiency
To know for certain if you have testosterone deficiency, you need to undergo a medical evaluation.
If you suspect that you have testosterone deficiency, you should contact your primary healthcare provider for assistance.
If you experience symptoms and discomfort that negatively affect your daily life and do not resolve on their own, regardless of whether they are due to testosterone deficiency or not, you should consider seeking medical attention. If you suspect that you have testosterone deficiency, you should contact your primary healthcare provider to investigate further.
Untreated testosterone deficiency has been consistently associated with several significant risks in large longitudinal studies, including:
Increased mortality
Increased risk of cardiovascular disease
Increased risk of stroke
Increased risk of osteoporosis
There are primarily three areas of concern associated with testosterone treatment, which can give rise to potentially hazardous conditions:
Polycythemia - an increased amount of red blood cells increasing the risk for blood clots
Increased risk of prostate-related diseases
Decreased high-density lipoprotein (HDL) cholesterol - the “good” cholesterol
(There is a perception that treatment increases the risk of cardiovascular diseases, such as heart attacks and strokes, but this has not been definitively established in comprehensive studies.)
Testosterone deficiency is referred to by various names and designations. While the exact meaning may vary slightly, the underlying principle remains the same: a deficiency of active testosterone in the body. Some terms used to describe testosterone deficiency include:
Testosterone deficiency syndrome
Primary hypogonadism
Secondary hypogonadism
Hypergonadotropic hypogonadism
Hypogonadotropic hypogonadism
Partial androgen deficiency in aging males (PADAM)