Additionally, at this point it is prudent to consider outside influences on sex hormone production and address these issues first if appropriate. Therefore, except in older men, a morning (7 to 11 AM) serum total testosterone should be checked initially, if testing is necessary. Thus, many men are seeking solutions for these bothersome symptoms, which may involve indiscriminant testing and possible overtreatment. Even the sexual symptoms can be due to many other conditions, including vascular disease, chronic alcohol use, and depressive disorders. One small study investigated this question by looking at groups of men across different age groups who were in "very good or excellent health" (5). It is unclear if the use of testosterone for low levels due to aging is beneficial or harmful. Decline of testosterone production with age has led to interest in androgen replacement therapy. In people who have undergone testosterone deprivation therapy, testosterone increases beyond the castrate level have been shown to increase the rate of spread of an existing prostate cancer. The brain is also affected by this sexual differentiation; the enzyme aromatase converts testosterone into estradiol that is responsible for masculinization of the brain in male mice. Adult testosterone effects are more clearly demonstrable in males than in females, but are likely important to both sexes. Excess testosterone affects your body differently depending on your sex and age. Synthetic testosterone is the main drug of masculinizing hormone therapy. Testosterone levels are naturally much higher in males. Or, an at-home testosterone test can be a convenient first step in understanding your testosterone level. It may also reveal whether underlying conditions, health issues, aging, or lifestyle choices are affecting your testosterone production. While in men older than 80 years, low testosterone level, or less than 300 ng/dL, is common. For females over age 19 years, it’s between 15 ng/dL and 70 ng/dL. The ISSWSH 2021 guideline likewise recommends transdermal options (e.g., gels/creams titrated down from male products) with careful monitoring of testosterone, SHBG, and clinical response (ISSWSH Clinical Practice Guideline, 2021). For cisgender women, systemic testosterone is occasionally used for distressing low sexual desire after other causes are addressed—specifically, hypoactive sexual desire disorder (HSDD). But 200 mg/week exceeds the typical replacement range for many patients and raises safety considerations (hematocrit, blood pressure, lipids, acne, edema). In practice, many patients land somewhere around a modest weekly total for short-acting injectables (often split once or twice weekly), but the right figure depends on labs, symptoms, and timing of blood draws. Clinicians usually titrate to a mid-normal serum testosterone range while keeping safety labs in check. Charts should therefore include a note that dose is a tool to reach safe, therapeutic levels—not a target in itself—plus a reminder to monitor hematocrit, PSA, BP, and lipids on a schedule consistent with guidelines. A, Serum T levels (mean ± SE) over 24 hours during the inpatient day (visit C) in the T gel (closed circles) and the placebo gel (open circles) groups. Only three participants (11.1%) applying the T gel had serum T levels above 1000 ng/dL during the 24-hour sampling period. The maximum and minimum serum concentrations (Cmax, Cmin) and time to reach Cmax were obtained and/or derived from measured serum T concentration levels. The intraclass correlation coefficient was computed to measure the internal consistency of 2-hour postapplication serum T levels over three visit days relative to the total variability. During the course of The TTrial participation, the dose was adjusted (higher or lower) monthly in the first 3 months to attempt to achieve a serum T level within a target range between 400 and 800 ng/dL, later changed to 500–800 ng/dL. A hematocrit test is recommended prior to therapy initiation to establish a baseline for future monitoring. Transdermal forms offer more stable concentrations (13), but they can cause rash in the applied area. Each preparation has advantages and disadvantages and should be presented as an option to the patient (Table 1). For this reason, all men should be assessed for risk of breast and prostate cancer prior to treatment. Further studies are needed to determine the exact role of testosterone and TRT in cardiovascular risk. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly. These have everything you need to collect a blood or saliva (spit) sample to send to a lab for testing. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. Your provider will take a blood sample in the morning, between 7 and 10.
