Low Testosterone (Low T): The Case for Testosterone Replacement!

Diagnostic Considerations For Low T and TRT

Determining whether or not you have Low T is actually quite simple. 1. We take a fasting blood sample and check what your total testosterone blood level is whether it is high or low. 2. We take a medical history and if we have one or more signs or symptoms of Low T, the greater the sense of making this diagnosis. 3. The more single indicators of Low T, and the more combinations of signs and symptoms (indicators of Low T), the greater the likelihood of Low T. Hence, diagnosis is not made with blood results alone but the combination of Low T blood level and one or more signs and symptoms fo Low T.

A single measurement of the serum testosterone concentration is very important, however, a single blood test alone may not prove this diagnosis. Repeating, the test for total testosterone more than once, and, when possible, having one or more physical signs and symptoms, allows an increased likelihood for making this diagnosis.

• The normal range in adult men in most laboratories is generally 300 to 800 ng/dL
• Measurement of the serum free testosterone concentration are also valuable in certain situations
• Two common situations of abnormal testosterone generally occur in 1) obesity and 2) aging hence here is where we tend for look for it, yet, we can and do find low T in 20 and 30 year olds as well so we should never let age be a deciding factor in looking for Low T
• Labs testing should be drawn first thing in the morning, after fasting for 12 hours, and after a full night of sleep, whenever possible
• If low levels of testosterone are found, and there are no significant number or pattern of Low T signs and symptoms, then repeating the test should be done under the same conditions within 1 to 3 weeks
• When the presence of Low T is questionable, the likelihood is that the patient is not in trouble so you have time to work the patient up get a second tests, take a comprehensive medical history and make sure you have sufficient likelihood for meaningful Low T and if desired start a trial process of TRT or HRT. Reduction of marginal or mild signs and symptoms, the patient feeling better, positive results improving, are also an excellent indicators that Low T was an accurate diagnosis

Treatment

• Establishment of a positive sleep hygiene situation and consideration of referral for assessment of sleep apnea signs and symptoms if these are issues
• If the diagnosing physician, NP or PA feels Low T is present he/she should refer to a clinician who is well established and well-trained to treat the specific behavioral health concerns relating to Low T
• Referral to integrative practitioner, ob-gyn, urologist or endocrinologist to diagnose and treat as needed low testosterone, low estrogen, low progesterone or testosterone deficiency in a female
• Establishment a dietary and exercise regime geared toward the reduction of body fat and increase in muscle mass, cardiovascular fitness and elimination of hormonal deficiencies

Medication

• There are multiple modalities and methodologies for safe and meaningful hormone replacement
• Bio-Identical hormones, that is those that look like and act exactly like human sex hormones within human males and females are the most logical choice for hormone (TRT and HRT) replacement
• There are reasons and values to using topical, oral (PO), intramuscular (IM) and subcutaneous injectable (SubQ injectables) hormone replacement of individual and combination hormone replacement
• An oral form of Testosterone was approved by the US Food and Drug Administration in March 2019. (https://www.fda.gov/news-events/press-announcements/fda-approves-new-oral-testosterone-capsule-treatment-men-certain-forms-hypogonadism)
• Base line lab taken will allow practitioner to make an accurate diagnosis and start therapy immediately. Follow-up with your physician periodically with periodic blood testing will allow following testosterone and other lab tests to make sure that your TRT or HRT is not causing any problems with your prostate or any other blood chemistry.
• Since testosterone causes red blood cell levels to rise, monitoring your hemoglobin and hematocrit is especially important for fire fighters to prevent their blood from becoming too thick
• Once stable monitoring should be done on a regular basis, depending on the individual between 2 and 4 times yearly

Fire Fighters diagnosed with Low-T must implement health positive lifestyle changes before, or in addition to TRT:

• Dedicated exercise regime
• Dedicated diet and weight loss plan
• Establishment of consistent sleep hygiene
• Relationship with licensed behavioral health professional specializing in warrior culture issues and treatment
• Smoking/tobacco cessation
• Decrease alcohol consumption

If you have potentially reversible causes of low testosterone levels, you should first be treated with lifestyle modification and avoid the need for T supplementation.

Chose practitioner who know what they are doing and have many years of experience. The IAFF study suggested against choosing any clinics that market to men and focus only on non-specific symptoms. I do not know why they make that suggestion but I would agree that the practitioner should really know what he or she is doing and that you might choose to avoid clinics that don’t follow the blood testosterone measurement criteria as we have discussed above. I have no problem agreeing with their suggestion that if you have Low T you get a second opinion from an endocrinologist, but also could suggest, depending on who you are, a urologist, Ob/Gyn or well trained Integrative Medicine specialist. Endocrinologists tend to deal with sick people the others also deal with well people and simple Low T which is not a meaningful medical problem.

Our program at its base is a well-directed HRT/TRT Treatment program with lifestyle support so that you can and will obtain optimal results and total personal control.

For more information and consultation, contact Advanced Wellness Medical by calling 626.365.1084 or e-mail your questions or search for information to info@advancedwellnessmedical.com

Original IAFF PowerPoint Presentation