Order Guide: Testosterone
Testosterone is one of the primary sex hormones in both men and women. Testosterone is produced by the testes in men, ovaries in women and small quantities are also produced in the adrenal glands in men and women. Current estimates are that biochemical testosterone deficiency is estimated to be 25% among men aged 40-62.
- Sexual dysfunction: decreased libido, delayed ejaculation, reduced ejaculate volume, decreased intensity of orgasm, erectile dysfunction, loss of morning erections, infertility
- Cognitive/Psychological: fatigue, changes in mood, depression, insomnia, poor concentration/memory, irritable
- Physical: decreased energy, anemia, breast development, decreased muscle mass and strength, increased body fat, loss of facial hair, low bone density
- Irregular menstrual cycles
- Excessive hair growth
Testosterone should be measured in the morning between 8 and 10 AM following an overnight fast. Testosterone experiences considerable variability and is affected by food ingestion, time of day and can also be affected by acute medical conditions like a recent illness. We recommend testing when sleep-wake patterns are stable (relevant for shift workers) and avoiding periods with a recent illness.
Testosterone circulates in the bloodstream attached to proteins (Sex Hormone Binding Globulin, Albumin, Corticosteroid-Binding Globulin) and freely unattached to any proteins. Most laboratories offer measurements of free and total testosterone.
- Recent illness
- Medication (opioids and glucocorticoids)
- Alcohol consumption
- Extreme exercise
- Sleep Apnea
- Extreme nutritional deficiencies and anorexia
- Diseases of the hypothalamus and pituitary gland
- Having an androgen-secreting tumour (i.e. ovarian or adrenal tumour)
- Current guidelines do not recommend treatment with testosterone if you do not have symptoms of testosterone deficiency.
- We recommend repeat testing of testosterone on three separate occasions to make a diagnosis of testosterone deficiency. If you have low testosterone levels a physician will recommend follow-up testing to rule out other causes of testosterone deficiency. Before suggesting supplementation, we also recommend treating reversible causes of testosterone deficiency (See “What are the common causes of low testosterone?”)
- Taking testosterone actually causes low sperm counts and suppresses the signals for sperm production in the body. Men interested in increasing testosterone production can try other treatments that increase testosterone production Human Chorionic Gonadotropin (HCG), SERMS like clomiphene and tamoxifen and aromatase inhibitors (anastrozole, letrozole, testolactone). We do not prescribe these medications but if you are looking for guidance, we suggest reaching out to a local endocrinologist through your local walk-in clinic.
- Men with a history of prostate cancer
- Men with a history of breast cancer
- Men with symptoms of an enlarged prostate
- Individuals with increased hematocrit (> 50%)
- Sleep apnea that is severe and untreated
- Type 2 Diabetes
- Metabolic syndrome
- Sleep Apnea