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IF YOU ARE WEAK on energy, low on libido and low on your gym gains despite a well-timed workout – well, to be honest, a number of things could be to blame. These are some of the more generic and common ailments, all signs of stress, depression and poor diet, to name a few.
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But these are also signs of low testosterone. Hormone levels in men naturally drop about 1-3% every year after age 40, which can cause symptoms including low libido, erectile dysfunction, unexplained anemia, insomnia, depression, and general loss of mental and physical stamina or energy.
Since low T takes a simple blood test to confirm (you test twice), any man who has recently experienced these symptoms should ask his doctor to have his testosterone tested, says Rajiv Jayadevan, MDClinical Assistant Professor of Urology and Male Fertility Expert at The men’s clinic at UCLA Health.
What is a testosterone test?
The most reliable way to test your hormone levels is through a blood test. Skipping saliva tests, which only measure free testosterone, which makes up about 2% of your total T levels, says an andrology expert Charles Welliver, MDassociate professor of urology at Albany Medical College.
Instead, the blood test looks for your total testosterone level, which counts free T as well as that bound to sex hormone-binding globulin (SHBG) proteins and albumin.
Additionally, your doctor may want to test your SHBG-bound testosterone and your bioavailable T (i.e. your free and albumin-bound testosterone). That’s because sometimes your T total may be in the healthy range, but one of those subcategories may be low, which would explain your symptoms but change your treatment, says Dr. Jayadevan.
But regardless, your doctor will always test your total testosterone when checking to see if you’re dealing with low T.
Levels considered healthy vary somewhat, but levels below 264 or 300 nanograms per deciliter (ng/dL) are considered low.
That being said, some research found that guys can have clinically low levels and be inexperienced any symptoms, in which case a low T would not be cause for treatment at this stage, says Dr. Jayadevan.
Do you Truly Need a testosterone test?
Lots of guys get a prescription for testosterone replacement therapy (TRT) without having their current levels tested, especially if they only see a general practitioner and not a specialist such as an endocrinologist or a urologist. Dr. Jayadevan adds that he sees guys who have had testosterone gel or injections every week on the internet.
When administered appropriately, TRT can improve all aspects of sexual function, as well as help reduce fat and increase lean muscle mass in men with hypogonadism.
But TRT also comes with risks, namely that it prevents your pituitary gland from producing its own testosterone and, in many cases, causes your sperm production to reach zero or close to it. In other words: It tanks your fertility. Dr. Jayadevan adds that guys who come into his office with prescriptions from the internet often don’t know it.
There are many reasons why you should advocate for a blood test: For starters, a blood test can reveal nuanced markers that could point to the real culprit of your symptoms that a prescription TRT won’t resolve. For example, the problem might not be in the testicles, as in the case of hypogonadism, but might actually be in the pituitary signaling pathway, Dr. Jayadevan says.
Even if the root of the problem is in the testicles, other treatments might be a better first step for you than TRT. “Exercise and diet have an impressive effect on T levels,” adds Dr. Welliver.
Additionally, it is also important to know if your T levels are clinically low, as this can be related to other health risks which you will want to pay attention to, in particular attached to your heart.
When to do a testosterone test?
“A morning blood test before 10 a.m. is the golden rule [for testing testosterone levels accurately]said Dr. Welliver. This is because your T levels are highest in the morning.
You’ll probably want a second round of testing to confirm these results: There’s about 25% variability in testosterone testing in the same person from week to week or even day to day, explains Dr. Welliver. You may also want a second test if your T total was borderline and the doctor wants to confirm if your symptoms are related to one of the more nuanced markers such as SHBG, bioavailability, or free testosterone.
As to when in life should you get tested: The main reason to get a T-test is if you have symptoms, namely low energy or low libido, although your doctor can tell you suggest if you have another condition that predisposes you to or indicates low T, such as osteoporosis, diabetes, or HIV.
However, some doctors, like Dr. Jayadevan, like to have their patients take a baseline test in their 20s. “Ideally, I’d have your T levels from your mid-twenties when everything was working perfectly – your libido was great, your erections were good, your ability to build muscle wasn’t impaired – to have as a point of comparison for later on,” he explains.
Let’s be clear: having your total T levels tested when you’re asymptomatic and healthy serves no purpose beyond potentially illuminating your future self.
Your asymptomatic test could come back low — even though people function at a “low normal” without any symptoms all the time, says Dr. Jayadevan, knowing that you have naturally low testosterone can mess with some guys’ heads.
And your doctor won’t give you treatment at this point because you don’t need it: Dr. that works so well at their natural levels.
In other words: a low T is only a problem if it causes symptoms before you know the number.
Rachael Schultz is a freelance writer who primarily focuses on why our bodies and brains work the way they do and how we can optimize both (without losing our sanity). She is particularly passionate about hiking, travelling, mindfulness, cooking and very, very good coffee.