Testosterone Deficiency Diagnosis

In 2018, the American Urological Association (AUA) updated its guidelines for the evaluation and management of testosterone deficiency in adult males. Testosterone deficiency syndrome (TDS), also known as hypogonadism, is a significant medical problem for some men. Effective treatment relies upon accurate diagnosis of low testosterone levels. A testosterone deficiency diagnosis is a multi-step yet straightforward process that enables physicians to prescribed customized testosterone replacement therapy (TRT) to those affected. Unfortunately, there are no current guidelines in place for a female low testosterone level diagnosis. Doctors prescribe testosterone therapy off-label for use by women who test positive by acceptable standards for low testosterone levels. Those standards include both symptoms of testosterone decline along with blood test results backing up a decrease in testosterone levels.

How is low testosterone diagnosed in men?

Confirmation of diagnosis for testosterone deficiency begins with a man noticing that he has symptoms associated with androgen deficiency. Testosterone is the primary androgen hormone in males, responsible for sex drive, red blood cell production, and muscle mass. Men also require testosterone for a healthy metabolism, brain and heart functions, bone density, and hair growth. Once a man notices a decline in any of these areas, or his sleep patterns, energy levels, motivation, mood, or productivity, he should contact a hormone specialist for a consultation. At that time, a full medical history is taken for review. Blood analysis and physical examination are necessary to ensure no underlying health conditions are causing the symptoms.

A testosterone deficiency diagnosis requires both low serum testosterone levels as well as symptoms of hypogonadism.

Testing for Testosterone Deficiency

The diagnosis of testosterone deficiency requires a medical consultation with a hormone specialist. That can be accomplished both in an office setting or via telemedicine phone calls. Many people today choose telemedicine for the convenience, privacy, and now, with Covid-19, the safety of not having to venture out into multiple healthcare settings. At Kingsberg Medical, we have been at the forefront of telemedicine, providing free phone consultations to men and women for many years. While it is still necessary to visit a doctor for the physical examination, and a local lab for the blood sample collection, both of these steps are easily accomplished in the least amount of time. It may also be necessary to repeat the testosterone blood test a second time before receiving a testosterone deficiency diagnosis to confirm the findings. When it comes to testing for testosterone deficiency, how to diagnose this condition accurately is why you want to contact a hormone specialist in the first place. General physicians do not have advanced training in endocrinology and hormone replacement to accurately assess and treat TDS.

Free Testosterone and Total Testosterone

Part of the testosterone deficiency diagnosis is the determination of which testosterone panels to run. Total testosterone is the primary marker, showing the sum of all testosterone in the bloodstream. Free testosterone measures only that small amount unattached to one of two proteins that transports it through the blood. Testosterone is not water-soluble, so it requires binding to a protein (sex hormone-binding globulin or albumin) to move through the bloodstream to the androgen receptors. Once there, testosterone separates from the protein to enter the receptor cell. Doctors always measure total testosterone to determine a low testosterone medical diagnosis. Depending on the symptoms and the man’s health, free testosterone levels may also be checked. The low testosterone diagnosis algorithm is a guideline for doctors who prescribe testosterone treatment for men. However, as stated by the AUA, “the Panel urges clinicians to use their clinical judgment” when managing patients who have total testosterone levels higher than 300 ng/dL when accompanied by symptoms of TDS. The current acceptable range for normal total testosterone is 264 to 916 ng/dL. As you can see, the lower end of the scale is considerably below the 300 ng/dL set by the AUA as a point of reference for low testosterone diagnosis. In the charts below, we look at the average level of total serum testosterone, based on age and percentile. To be in the mid-range of men in their sixties, falling into the 50th percentile, a man would require a total testosterone level of 477 ng/dL. The goal of treatment with TRT is 450 to 600 ng/dL in the middle tertile of the reference range provided by most laboratories. This first chart is for all men, with no differentiation for weight (obese men typically have lower testosterone levels): The chart below shows how testosterone levels are higher for men who are not overweight: An accurate testosterone deficiency diagnosis sometimes requires testing of free testosterone levels, with the normal range based on age, shown in the chart below:

How to Prepare for the Testing

Preparation for the test for testosterone deficiency is relatively simple. The doctor will ask you to fast, beginning at midnight of the evening before the scheduled visit to the laboratory. Your appointment will be first thing in the morning – with 10 am being the latest recommended time to have your blood drawn. The earlier, the better, so aim for a first appointment of the day, which will also get you in and out of the lab quickly. Because certain medications and supplements may alter the test results, make sure to be honest about everything you take during your consultation. For the physical examination part of the testosterone deficiency diagnosis testing, the doctor will examine the body, including checking weight, body hair, testicles size, prostate exam, and breast composition. Blood pressure, temperature, and pulse measurements are also taken. The doctor will also inquire about personal as well as family medical history, erectile functions, sleep, and memory.

Both physical examination and blood analysis are crucial aspects of a testosterone deficiency diagnosis.

Are Testosterone Tests Reliable?

The tests for testosterone deficiency are extremely reliable when the preparation instructions are followed. Consuming food before the blood draw will result in erroneous readings. Also, do not exercise in the morning before visiting the lab as exercise can alter testosterone levels. Once you receive a testosterone deficiency diagnosis from a hormone specialist, you can then discuss the prospect of treatment. The doctor will rerun the blood tests to measure testosterone levels following one month of TRT to assess how well the body is responding to the medication. When dealing with a low testosterone diagnosis and treatment, it is crucial to ensure that TRT is working as planned. After all, that is the only way to get the desired results. At the one-month mark, the doctor may determine that a change in dosage is necessary, or that everything is proceeding on course. Familiarizing yourself with the testosterone results timeline can help you understand what to expect and when.

How Much Does Testosterone Testing Cost?

Low testosterone diagnosis tests range in price from roughly $250 to under $500 – depending on which of the three panels is recommended. The difference is due to the symptoms presented and the overall health of the individual. Some men may require the more in-depth testing, especially if there are concerns over elevated cortisol and prolactin levels. These tests can run over $2,000 when ordered elsewhere. Some people have asked their family physicians to run these tests through their insurance companies in the past, only to receive a large bill in the mail after the insurance company turned down coverage of some of the panels. That is why Kingsberg Medical has already negotiated low rates with a national chain of laboratories to serve our clients better and save them money and stress. Please contact Kingsberg Medical today for more information about getting a testosterone deficiency diagnosis. Consultations are free of charge and strictly confidential.
Brian Leeber