Low testosterone, also referred to as hypogonadism, is a form of gonadal deficiency wherein the body’s sex glands malfunction resulting in little or no testosterone secretion. This condition is diagnosed in a multi-step process, and can be experienced by both genders as primary hypogonadism emanates from problems with the male testes, as well as with the female ovaries. Secondary hypogonadism results in a problem with the hypothalamus and/or pituitary gland, and tertiary hypogonadism results from other conditions or external stimuli. Low testosterone is often considered a male condition, as testosterone represents the primary male sex hormone, and is a vital component in male development including: the development of in vitro masculine sex glands; numerous physiological and physical pubertal changes during adolescence; and the consistent maintenance of bodily functions during adulthood. The typical sequence of low testosterone diagnosis is self-reporting, standardized questionnaire, analysis of historical information (personal, sexual, and family), physical exam, and blood test.
Self-Reporting in Low Testosterone Diagnosis
A noticeable reduction in sexual intimacy due to diminished libido/sex drive/interest, or a reduction in performance (any of a variety of erectile dysfunctions) represent the major reasons men seek clinical low testosterone diagnosis. However, testosterone is also an important cog in sustaining the body’s general balance and overall well-being. Consequently, additional reasons men both initially self-report low testosterone levels and seek further testosterone testing may involve feelings excessively depressed mood, muscular weakness, chronic fatigue, and lack of vigor all of which are symptoms common to low testosterone sufferers. Additional adult symptoms include:
- Conception difficulty
- Unusual gains in body fat
- Reduced muscle and/or bone mass
- Irregular or cessation of menstruation
- Resistance to insulin
- Bone fractures
- Peripheral vision loss
- Gynecomastia (male breast enlargement)
- Hot flashes
- Changes in the penis, breasts, testes, scrotum
- Difficulty sleeping
- Breast discharge
- Excessive perspiration and night sweats
- Reduced body, facial and pubic hair
- Concentration and/or memory problems
Common children’s symptoms of low testosterone include: Girls – menstruation stops and spotting, reduced libido, delayed menstruation, delayed breast development, delayed and/or stunted height growth, low libido, hot flashes, loss of body hair; and Boys – reduced beard and body hair development/growth, gynecomastia, decreased beard and body hair, and muscle loss or the inability to develop new muscle.
Another form of self-reporting is often initiated by the physician in the form of a standardized assessment tool for measuring low testosterone. Known as the ADAM (Androgen Deficiency in Aging Men) Questionnaire this simple 10-question test provides doctors with answers in variety of areas that are directly and indirectly related to testosterone levels. A ‘yes’ or ‘no’ answer on ADAM can help the physician quickly assess the patient’s mood, energy, quality of life (work and play), sleep, sexuality, and stature while serving as a preliminary method for diagnosing low testosterone. The ADAM questions are as follows:
|Do you have reduced libido (sex drive)?|
|Do you have a lack of energy?|
|Do you have a decrease in strength and endurance?|
|Have you lost height?|
|Have you noticed less enjoyment of life?|
|Are you sad and/or grumpy?|
|Are your erections less strong?|
|Have you noticed a recent deterioration in your ability to play sports?|
|Are you falling asleep after dinner?|
|Is your work performance suffering?|
ADAM is usually given to the patient while physician is compiling a history of symptoms, which includes the collection of other pertinent historical medical, sexual, and family medical information. Such information aids the physician identifying possible genetic traits and tendencies. Examples of historical profile data are:
- At birth genital abnormalities
- Noted delays in puberty
- Age and number of nocturnal emissions
- Sexual activity (intercourse and masturbation)
- Rigidity of erections
- Frequency of sexual fantasies, desires, and even thoughts
- Changes hair growth the growth of bodily hair
- Changes in muscular size, strength, and ability to gain muscle
- Changes in energy levels
- Allergic reactions (medications, foods, air allergens)
- Blood type
- Past and present major and chronic illnesses
- Presently taken prescription and non-prescription drugs currently
- Previous medical visits (dates and reasons)
- Surgeries and dates
- Immunization dates
- Names of previous and current doctors
- Past positive test results
- Lifestyle habits – alcohol drinking, smoking, binge eating, etc.
- Social relationship problems -family, work and sexual
- Major life changes – births, deaths, adoptions, etc.
- Cancer (all types)
- Kidney disease
- Mental illness
- Blood diseases (hemophilia or sickle cell)
- Other conditions and disorders
Low Testosterone Physical Examination
Low testosterone physical examinations vary at different ages, but for men they tend to include quantifiably visible and tactile assessments of change (both steady and dramatic) in such areas as: loss of body weight; body fat increase; reduced muscle and/or bone mass; loss of body hair; size of or lump development within the testes, scrotum, breasts, or penis; and sleeping complications.
Low Testosterone Blood Tests
Low testosterone diagnoses are also measured via blood test. Although testosterone blood tests vary (especially older ones), a good test uses two samples to measure total testosterone level, and to directly measure or calculate the amount of ‘bound’ (inactive) testosterone and ‘free’ (available for function) testosterone within the bloodstream. Sex hormone-binding globulin (SHBG) is a liver synthesized glycoprotein that binds with and disables circulating both androgens and estrogens, and is also used in the calculation of testosterone levels.
Since the amount testosterone in the body varies depending upon the time of day, blood tests are typically conducted in the morning (8:00 and 9:00 AM) when blood serum concentrations are at their peak. Total testosterone levels have a normal range of 300 – 1,200 nanograms per deciliter (ng/dl), wherein scores at near the lower (300 ng/dL) limit are considered low. Scores below the lower limit are always considered deficient and definitely warrant a diagnosis of low testosterone. Whether or not a male is experiencing hypogonadic symptoms is often an individual characteristic, as a score within the lower range may or may not in negative symptoms. Low testosterone scores below the lower limit, for example 200 ng/dL and below, are always accompanied by adverse hypogonadic symptoms.
When it comes to determining the proper approach for raising low testosterone levels, a doctor may insist on running further tests to determine which of the three basic conditions is responsible for the diagnosis. More specifically, primary hypogonadism originates with a problem in the testicles, secondary hypogonadism originates with a problem in the hypothalamus or the pituitary gland (the two parts of the brain which signal the testicles to produce testosterone), and idiopathic hypogonadism originates from some other internal condition or from an external source of stimuli. Although a blood test is primarily used to assess lower than normal testosterone levels, it can also be used to determine other possible causes such as thyroidal imbalances, infection, type 2 diabetes, injury to the testicles, HIV/AIDS, hormonal disorders, kidney or liver disease, testicular cancer, etc.
Other tests may be used to accurately diagnosis low testosterone of an idiopathic nature such as: luteinizing hormone (LH) and follicle-stimulating hormone (FSH) testing semen analysis; chromosome or genetic testing; pituitary function testing; prolactin level testing; magnetic resonance imaging (MRI) testing; specific anemia tests (measures iron deficiency); etc.