Diagnosing and confirming low testosterone requires thorough lab testing and careful interpretation of the results. Inaccurate or misinterpreted test results can either falsely diagnose or miss a case of testosterone deficiency. The first step in diagnosing testosterone deficiency is establishing whether a man has the classic symptoms. If the classic symptoms of low testosterone are present, the next step is to measure the level of testosterone in the blood. After measuring your testosterone, your doctor must determine if it is in the normal range.
The main issue with the total testosterone lab test is that a lot of the hormone it measures is not biologically active in the body.
Here is why: A small fraction of the total testosterone, from 1% to 2%, floats around on its own in the blood. But anywhere from 40% to 70% of total testosterone travels around with a protein called sex hormone binding globulin (SHBG). As a result, a large portion of your measured total testosterone actually may be biologically inactive. For example, if a man’s SHBG is on the high side, his total testosterone may be solidly in the normal range even though his biologically active testosterone is low. To obtain a clear-cut diagnosis —either confirming low T or ruling it out—work with a physician who understands the complexities of testosterone testing and can interpret the results in light of a man’s symptoms, says Dr.
A careful evaluation could involve testosterone measurements on more than one day, as well as tests for levels of hormones related to testosterone. Even when lab tests don’t show clear testosterone deficiency, the final decision to offer treatment is a judgment call.
Some men may experience certain side effects of testosterone supplementation, including acne, swelling or tenderness of the breasts, or swelling in the ankles.
Some physicians remain wary of prescribing testosterone supplements to men with active prostate cancer, those who had it in the past, or those who may be at higher risk for it in the future.

By undergoing thorough testing, you can find out if you should even be considering treatment for low testosterone.
Diagnosis of hypogonadism is made by testing a blood sample for testosterone and other hormones.  This blood draw is performed in the early morning to ensure accurate results.
Testosterone pellets (Testopel) are implanted under the skin of the buttock in a 5 minute office procedure.  The pellets release testosterone over 4-6 months, after which time the procedure is repeated. Testosterone injections are given every two weeks at home or at the physician’s office.  Levels fluctuate widely, so this form of TRT is recommended least often by physicians. Some patients who have secondary causes to their hypogonadism need specific pituitary hormones, medications, surgery or radiation. Androgen Deprivation Therapy (ADT), or hormone therapy, for prostate cancer lowers the testosterone level. A Johns Hopkins study found that the pituitary gland makes more luteinizing hormone (LH), which regulates testosterone production.
Cholesterol level changes Antiandrogen pills can lower HDL (good cholesterol) and increase triglycerides in some men. Radiation Oncology, Division of Nursing, James Cancer Hospital and Solove Research Institute, Patient Education Handout, The Ohio State University Medical Center. Your doctor may consider a trial run of testosterone injections or a rub-on gel if you report classic signs of testosterone deficiency and if lab tests confirm that your hormone levels are abnormally low. And because the treatment is not without risks, it’s important to have your testosterone levels assessed carefully before considering supplementation.
If diagnosing testosterone deficiency were based solely on a list of such general symptoms, virtually every man would be labeled as low T. Testosterone levels are highest in the morning, although this effect is less pronounced in older men.
Unfortunately, lab tests for free testosterone are also unreliable—even more so than tests for total testosterone. The reason: In men with advanced prostate cancer, blocking testosterone slows down tumor growth.

Whether or not ADT impacts the risks of heart disease is not well known, but this information reinforces the advice that prostate cancer patients know their cholesterol numbers as well as their PSA level.
Low-T Diagnostic PitfallsLow T causes symptoms that could be signs of other disorders, too.
To get the best result, physicians generally draw blood for testosterone lab tests between 7 a.m.
As a point of interest, the testosterone level goes up immediately after radical prostatectomy. Abraham Morgentaler, an associate clinical professor of urology at Harvard-affiliated Beth Israel Deaconess Medical Center, and author of the book Testosterone for Life.
Many lifestyle changes can help with cholesterol control such as a low-fat diet and daily exercise.
In fact, a study by the Endocrine Society found that measurements of free testosterone in the same blood sample can vary by a factor of five.
Abraham Morgentaler, urologist at Harvard Medical School, and author of the book, Testosterone for Life. Until then, he and some other physicians continue to practice as if testosterone and prostate cancer don’t mix.
New preliminary research shows that low doses of estrogen may also help prevent or treat this condition. Secondary Hypogonadism Secondary hypogonadism is characterized by low testosterone due to suppression of pituitary hormones. Moyad states" I strongly advise prostate cancer patients to stay away from this herbal product because it has been shown to reduce the effectiveness of many medications, including some cancer drugs" (Moyad).

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