Navigating Low Testosterone: Comprehensive Lab Testing for Informed Treatment
Introduction:
Philadelphia Integrative Psychiatry prides itself on a holistic and research-driven approach to mental health care. We understand that conditions like low testosterone can have profound effects on both the body and mind. By considering the full spectrum of a patient's health, including hormonal balance, we can tailor treatments that address the root causes of their symptoms, leading to more effective and personalized care.
Our focus on research ensures that we stay at the forefront of psychiatric practice, particularly when it comes to conditions that intersect physical and mental health. Low testosterone or hypogonadism is one such condition that requires a nuanced understanding for accurate diagnosis and treatment. To this end, we utilize a range of laboratory tests to assess testosterone levels and related hormonal factors.
Total Testosterone: This foundational test measures the sum of bound testosterone (attached to proteins like SHBG and albumin) and free testosterone (not attached to proteins). The preferred method for measuring serum total testosterone is Liquid Chromatography/Mass Spectrometry (LC/MS), known for its accuracy.
Free and Bioavailable Testosterone: These tests are crucial for understanding the amount of testosterone readily available to the body's tissues. Free testosterone is unattached to any proteins, while bioavailable testosterone excludes testosterone bound to SHBG. Direct measurement of free testosterone is particularly important in conditions where SHBG levels are altered, such as obesity (where SHBG decreases with higher BMI) and in the elderly (where SHBG increases with age). Equilibrium dialysis is the gold standard for measuring serum free testosterone, though equilibrium ultrafiltration is a common alternative.
Sex Hormone Binding Globulin (SHBG): SHBG is a protein that binds to sex hormones, including testosterone. The levels of SHBG can influence the availability of testosterone to the body's tissues, making it a significant factor in the assessment of hormonal health.
Estrogen: While typically low in men, estrogen levels can rise in certain conditions like obesity or liver disease. Elevated estrogen can reduce the amount of free testosterone, making its measurement relevant in the context of low testosterone symptoms.
Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH): These hormones, produced by the pituitary gland, are responsible for stimulating the testicles to produce testosterone and sperm. Testing for LH and FSH can help determine whether low testosterone is due to testicular issues or problems with brain signals to the testicles.
Prolactin: High levels of prolactin can inhibit testosterone production. Elevated prolactin can be due to various causes, including medications, tumors, or other conditions, and its measurement is an important part of the diagnostic process.
It's important to note that testosterone levels exhibit a diurnal rhythm, peaking in the early morning. This is especially true for men under 40 but also applies to older individuals. Therefore, serum testosterone should ideally be measured between 7 am and 11 am. While fasting can affect testosterone levels, it is not always necessary to insist on fasting before testing, unless it is feasible for the patient.
In cases where serum free testosterone levels are low, some will recheck on two separate days, ideally four weeks apart, before confirming hypogonadism. This careful approach helps avoid misdiagnosis due to temporary fluctuations in hormone levels.
By integrating these comprehensive lab tests into our practice, Philadelphia Integrative Psychiatry is better equipped to provide research-backed and holistic care. Understanding the intricate role of testosterone in overall health allows us to support our patients with informed and effective treatment strategies, enhancing both their mental and physical well-being.
Citations:
https://www.healthline.com/health/side-effects-of-low-testosterone
https://my.clevelandclinic.org/health/diseases/15603-low-testosterone-male-hypogonadism
https://conciergemdla.com/blog/impact-of-low-testosterone-on-mental-health/
https://www.mariongluckclinic.com/blog/have-you-noticed-these-psychological-effects-of-low-testosterone-in-your-partner.html
https://health.clevelandclinic.org/low-testosterone-and-mental-health
https://wchh.onlinelibrary.wiley.com/doi/10.1002/tre.914
