Testosterone Replacement Therapy: What Tests Do You Need?

Starting Testosterone Replacement Therapy: What Lab Tests Do You Need?

Testosterone replacement therapy (TRT) can be a powerful tool for men looking to boost their testosterone levels. TRT has been associated with improved energy, libido, and overall quality of life. But before you consider TRT, it’s important to understand the tests that are used to measure your testosterone levels and help you decide if TRT is right for you.

Total & Free Testosterone

Total Testosterone measures the amount of protein-bound testosterone in your body. This is the most common testosterone test guys are familiar with. Most ranges vary from 300-1200 ng/dL. This test is usually done in the morning when testosterone levels are at their highest. It’s important to note that this test won’t tell you how much unbound (free) testosterone is available to your body.

Free Testosterone measures the amount of unbound testosterone in your blood. If your Total T is low, it’s likely that your Free T is also low. However, if you’re already on TRT, it’s possible that your Free Testosterone may be high. Excess Free Testosterone can be converted further into estrogen that may cause another whole list of problems in the male body.

Sex Hormone Binding Globulin

Sex hormone binding globulin (SHBG) is a protein that binds to both testosterone and estrogen in the bloodstream, making them inactive. Too little SHBG means that your Free Testosterone may be high. High levels of SHBG can cause lower free testosterone. 

LH & FSH

Luteinizing hormone (LH) and follicle stimulating hormone (FSH) are produced by the pituitary gland. These two hormones work together to regulate the production of sex hormones in both men and women. If either one of these hormones is low or elevated, it may indicate a problem with your pituitary gland. Testing LH/FSH along with other hormone tests can provide more insight into potential causes for Low T symptoms.

Prostate Specific Antigen

Prostate-specific antigen (PSA) is produced by the prostate gland. High levels can be an indication of prostate enlargement, or potentially cancer. This should be checked at least 2 times a year when on TRT.

Other lab tests that may be ordered include complete blood count (CBC), comprehensive metabolic panel (CMP), thyroid stimulating hormone (TSH), Free T4, and cholesterol levels.

Before starting any type of hormone therapy, it’s important to understand what lab tests are needed to get an accurate assessment of your current health status and evaluate if TRT would be beneficial for you. In addition to total testosterone, free testosterone, LH/FSH, and SHBG measurements should all be taken into account when assessing whether or not TRT would be appropriate for you as an individual patient’s needs vary from patient to patient. 

If you have questions about these lab tests or want more information about how they can help diagnose potential underlying causes for low T symptoms then don’t hesitate to ask! We can provide personalized recommendations based on your unique situation so don’t hesitate to reach out today!

When Should a Man Get A Prostate Exam?

When Should Men Get Their First Prostate Exam?

As we finish out November, also known as “No-shave November” or “Movember” to increase awareness about men’s health issues, I want to touch on a part of men’s health that is at the forefront of most men’s minds: Prostate Health, Prostate Enlargement, and Prostate Cancer.

So, when should men get their first prostate exam – and do you need to have them at all? Let’s clarify those questions.

Early Screening

At Redefined Health Clinic, we screen and monitor for prostate health before we even see you as a patient. Part of our initial intake questionnaire asks you about your personal and family history of prostate diseases. Is there a family history of prostate cancer? Did a first-degree male relative have prostate cancer? Answering yes to these questions might put you at risk. 

Current recommendations call for Prostate cancer screening at age 50. But if you have an early family history of Prostate Cancer, we will screen even earlier at age 40-45.

What Does Screening Look Like?

The old-school way of thought was that starting at age 50, men would get their prostate checked annually, otherwise known as a digital rectal exam (DRE). A DRE is a rectal exam using a gloved and lubricated finger to examine the prostate internally.

However, we have learned that placing just the slightest amount of pressure on the prostate during the DRE can cause a false positive elevation of the Prostate Specific Antigen (PSA) in a blood test. The PSA is a protein produced by both cancerous and noncancerous tissue in the prostate.

What if Your PSA is High?

High levels of PSA may indicate the presence of prostate cancer. But many other conditions, such as an enlarged or inflamed prostate, constipation, vigorous bicycle riding, motorcycle/motocross riding, long horseback rides, and even intercourse can increase PSA levels. When sending a man to the lab to have his PSA level checked, we ask they refrain from those activities for 3-5 days before their blood test.

If your PSA test comes back high, we may need to do further testing which would include more blood tests, a DRE, and a referral to a urologist.

How Does TRT Affect My Prostate?

Despite internet rumors, Testosterone Replacement Therapy does not cause prostate cancer. However, there are some things that we need to screen for before starting testosterone therapy.

First, our initial blood word includes a baseline PSA level. We want to know what your level is even before starting TRT. We check that level again at least annually, if not twice yearly. If your PSA level begins to increase, we decide together how to handle the testosterone dose.

However, if you already have prostate cancer then TRT can cause already-established prostate cancers to grow more quickly. That’s why we screen for it before starting any TRT.

What is BPH vs Prostate Cancer?

BPH stands for Benign Prostatic Hypertrophy. It just means an enlarged prostate. It is not prostate cancer.

Common symptoms of BPH include frequent urination (especially at night), feeling that you can’t empty the bladder all the way, weak urine stream, or difficulty starting a urine stream. This is a common factor in men as we get older. Simple medications can help reduce the size of the prostate, or you may need a referral to a urologist.

There is no sound evidence connecting BPH to TRT. In fact, there is growing evidence that because men lose testosterone as we age that we may be less susceptible to BPH if we are on weekly low-dose TRT.