You’ve been feeling like crap lately, have a hard time getting out of bed in the morning, your work is suffering, you feel like you’re in a fog and your sex drive is in the toilet, so you reluctantly drag yourself to the doctor to get your T levels checked out and now you’re reeling from the shock of finding out that your T levels are low and you’re trying to figure out your next steps.
You’ve found some on-line Forums and they’re telling you to suck it up and start therapy, your wife is putting pressure on you because she’s at her breaking point, maybe you’ve found a T therapy center where for one low, low price, they’ll treat all your needs, starting you off with a T injection right then and there. It sounds tempting and you are so ready to start feeling better. Should you rush to treatment?
Well, yes and no. Low T can be caused by a multitude of different factors, some reversible and some not. You don’t want to sit back and do nothing because low T rarely corrects itself, but until you take steps to figure out what’s going on, you can actually do more harm than good by immediately starting T therapy.
If you remember, your testes are only partially responsible for T production. Your hypothalamus and pituitary glands also play a crucial role. When problems with T production originate in the testes, it is called Primary Hypogonadism; when the problem occurs in the hypothalamus and pituitary axis, it is called Secondary Hypogonadism. You can also have Mixed Hypogonadism, where the problems are occurring in both the hypothalamus-pituitary axis and the testes. The type of hypogonadism you’re experiencing will determine your best course of action.
The very first thing you need to do upon getting a lab result of a low T level is to confirm it with another test. Testosterone is delivered to the body in pulses and can vary in younger men by as much as 30% during the course of the day. Make sure to get your levels tested as close to 8am as possible, since testosterone is highest in the morning, gradually diminishing through the day. Test on an empty stomach, as consuming glucose can drop your levels by as much as 25%.
If your second test comes back low as well, your next step is to set up a doctor appointment with an experienced HRT specialist and try to determine what’s causing the problem. The tests you’ll need to figure things out are:
- LH (Luteinizing Hormone)
- FSH (Follicle Stimulating Hormone)
- SHBG (Sex Hormone Binding Globulin)
- TSH (Thyroid Stimulating Hormone)
- T4 (Thyroid)
- T3 (Thyroid)
- Ferritin (Iron)
- Estradiol E2 (estrogen)
- Total Testosterone
- Free Testosterone
- PSA (prostate)
- Vitamin D, Zinc & Magnesium levels
Your doctor ideally will ask a lot of questions. Some of those should include whether you’re experiencing sleep apnea, had an acute illness recently, especially if it required hospitalization or administration of opioid medications, or a history of heavy alcohol use, and whether you’ve used certain drugs or steroids, as all of these can affect T levels, and sometimes treating the core problem will correct the T levels.
It is not always possible to determine the exact cause of your low T, but knowing these values can help you and your doctor start narrowing down the list of suspects. For more detailed information about primary and secondary causes, check out this link.
Next up … is it Primary or Secondary?