TESTING FOR HYPOGONADISM

The potential of early detection of significant long-term health issues is an enticing prospect. The following tests can point to hidden issues which tend to be discovered later in life. We recommend early testing for prevention, rather than crisis intervention in older people, which appears to the case today.
The following tests are recommended by the A.A.C.E. in their new guidelines.1

It is important to test at the same time of day.

  • Serum Testosterone – The total Testosterone produced by the body
  • Luteinising Hormone (LH) – The “messenger” between Pituitary gland and the “Testosterone Factory”
  • Follicle Stimulating Hormone (FSH) – The “fertility hormone” for men and women
  • Prolactin – Measures the Pituitary Gland Function.
  • Sex Hormone Binding Globulin – Binds Testosterone completely. Elevated SHBG can mean an underlying condition.The new “Testosterone Profile”, has the effect of redefining Hypogonadism. Instead of relying on unreliable Serum Testosterone values, other elements are included, in order to provide a complete picture.Any out of range reading suggests Hypogonadism of one form or another. However, normal readings do not mean the matter is closed. The doctor is encouraged to look further if symptoms persist.
    An elevated Prolactin with normal LH and FSH readings and Low Serum Testosterone levels indicates secondary Hypogonadism at the Pituitary Gland.
    Low Serum Testosterone with elevated LH or FSH are indicators of Primary Hypogonadism at the testicle or ovary.Normal levels of Serum testosterone with elevated LH and/or FSH tend to indicate Secondary Hypogonadism.

    The Second Test
    Normal results with prevailing symptoms indicate repeating the first profile with the addition of SHBG or a Free Testosterone assay, because there are other factors, such as SHBG, Albumin bound and Free testosterone to measure. The AACE 1 recommend referral to an expert for this process.

    Discussion
    Bio-available Testosterone, (what is available for the body to use on demand), has been shown to be the most sensitive test for determining Hypogonadism.7
    As SHBG levels rise, and LH measures become unreliable in men when they age, bio-available resources of Testosterone for the rest of the body are reduced and its testing becomes the most reliable indicator of the condition.

    In Hypogonadal young men, the failure to produce Testosterone sufficiently for any reason, leads to lowered Bio-available Testosterone levels.
    The importance of this test is underlinded by Dr Andre Valcour’s “FreeT or not Free T?” CME course 7 published in November 2001.

Opinion

If Bio-available Testosterone is the most sensitive predictor of Hypogonadism, this measure may be the most useful and cost-effective to perform as the test to establish Hypogonadism. Although it is recognised that testing Bio-available Testosterone is both complex and expensive, surely this process would ultimately save money and time when compared to the time taken by two doctor’s visits and exhaustive background analysis prior to establishing the cause of the patient’s problem.
The more complex and expensive series of tests to determine the source of the problem, as outlined by the AACE would only be required for those deemed to be Hypogonadal from the result of the initial test.