Your diet is the best source of zinc; along with protein-rich foods like meats and fish, other good dietary sources of zinc include raw milk, raw cheese, beans, and yogurt or kefir made from raw milk. It can be difficult to obtain enough dietary zinc if you're a vegetarian, and also for meat-eaters as well, largely because of conventional farming methods that rely heavily on chemical fertilizers and pesticides. These chemicals deplete the soil of nutrients ... nutrients like zinc that must be absorbed by plants in order to be passed on to you.
Attention, memory, and spatial ability are key cognitive functions affected by testosterone in humans. Preliminary evidence suggests that low testosterone levels may be a risk factor for cognitive decline and possibly for dementia of the Alzheimer's type,[104][105][106][107] a key argument in life extension medicine for the use of testosterone in anti-aging therapies. Much of the literature, however, suggests a curvilinear or even quadratic relationship between spatial performance and circulating testosterone,[108] where both hypo- and hypersecretion (deficient- and excessive-secretion) of circulating androgens have negative effects on cognition.
The IOM report estimated that a study of whether there is an increased risk of prostate cancer in men on testosterone therapy might require following 5,000 men for three to five years. Before launching such an endeavor, the report recommended more firmly establishing the effectiveness of testosterone-replacement therapy, saying that studies of long-term risks and benefits should be conducted only after short-term efficacy has been proven. That means the male equivalent of the WHI remains far off.

I have been on TRT for over 8 years now. I feel GREAT! I read all these studies, hear in the news, and see all these dumb lawsuit commercials about testosterone causing cardiovascular events, blood clots and many other things. If anyone takes the time to do the due diligence and read the studies the picture becomes very clear. Unless you monitor all the other hormones, specifically, Estradiol, DHT, Pregenolone, Total Testosterone, Free Direct Testosterone, and DHEAS you are playing a deadly game. The reason is you must give something to control the pathways of T conversion into estradiol and or DHT. The vast majority of the studies used nothing to control those pathways and they gave men way, way more T than they needed to start with. They also gave forms of T that are not acceptable. Especially the oral version.


Our clients love the results and energy they’ve get once their hormonal levels are fully balanced. Because hormones are so important, we’re proud to lend our medical expertise to ensure all our hormonal treatments are tailored to your specific needs. If you’re curious about NHT, you can take a short quiz to see if NHT would be a good fit for your body.

Now that we know chronic insulin spikes lead to lower Testosterone production, I hope I haven’t sent you running into the low carb camp! There are a few studies out there showing that long term low carb or ketogenic dieting leads to higher cortisol levels (especially with subjects who are training), and decreased testosterone levels (28 & 29). I have used low carb diets in the past with successful results (winning a national bodybuilding title), however the key is to use cyclical carb re-feeds. If you’re going to go on a low carb diet for whatever reason, be sure to work in a large carb reefed once a week.


You can browse Drugs A-Z for a specific prescription or over-the-counter drug or look up drugs based on your specific condition. This information is for educational purposes only, and not meant to provide medical advice, treatment, or diagnosis. Remember to always consult your physician or health care provider before starting, stopping, or altering a treatment or health care regimen.
Men who have prostate cancer or breast cancer should not take testosterone replacement therapy. Nor should men who have severe urinary tract problems, untreated severe sleep apnea or uncontrolled heart failure. All men considering testosterone replacement therapy should undergo a thorough prostate cancer screening -- a rectal exam and PSA test -- prior to starting this therapy.

Reviews.com has an advertising relationship with some of the offers included on this page. However, the rankings and listings of our reviews, tools and all other content are based on objective analysis. For more information, please check out our full Advertiser Disclosure. Reviews.com strives to keep its information accurate and up to date. The information in our reviews could be different from what you find when visiting a financial institution, service provider or a specific product’s website. All products are presented without warranty.
In my late 20’s, I visited an anti-aging doctor who was one of the pioneers of what we now call functional medicine. I got a full hormone test. Shockingly, my testosterone was lower than my mother’s. No wonder I felt crappy and was overweight. My other sex hormones were out of whack too, especially my estrogen levels. They were high because the little testosterone I did make my body converted into estrogen. I went on a mix of topical replacement testosterone cream, plus small doses of pharmaceuticals like clomid and arimidex in order to keep my other sex hormones functioning properly.
First is quality, Advanced BCAA’s are made from whey protein isolate. Typical free form amino acids are made from human hair and other not so favorable sources. In addition many free form amino acids are made in China. Secondly is the “form” the amino acids are in. Advanced BCAA’s are in peptide form. Meaning they are in di and trip peptide form. The body ABSORBS amino acids in di and trip peptide form, through the intestinal wall and into the blood stream. It is still not known whether free form amino acids are absorbed by the body. Keep in mind that free form amino acids supplements have been around since the 80’s. They have never been proved to help muscle recovery and grow. Di and tri peptides have been proven to be beneficial for muscle recovery.

The bones and the brain are two important tissues in humans where the primary effect of testosterone is by way of aromatization to estradiol. In the bones, estradiol accelerates ossification of cartilage into bone, leading to closure of the epiphyses and conclusion of growth. In the central nervous system, testosterone is aromatized to estradiol. Estradiol rather than testosterone serves as the most important feedback signal to the hypothalamus (especially affecting LH secretion).[119] In many mammals, prenatal or perinatal "masculinization" of the sexually dimorphic areas of the brain by estradiol derived from testosterone programs later male sexual behavior.[120]

Another way to look at it is like this: Women are only capable of building a small amount of muscle without the use of performance enhancers, regardless of how hard they train or how rigid their meal plan is. When women reach their physical peak and are unable to move any further than that point, it’s because of their naturally low levels of testosterone.
I have been searching quite a while for a testosterone booster that could help me in a few different ways yet not to be too expensive. Over the years, I have experienced a low irritability tolerance(meaning it doesn’t take much to send me “over the top”) and have moods swings due to negative situations. I would like to be more at peace with myself & around others(without trying to fake it).I don’t usually have a lot of energy at work & rely on energy drinks. I also have a lower sex drive due to what I believe is low blood flow. I am 43 years old and am not over weight, but could stand to tone up and lose a little around the waist. If this site is legit, I would like to know your opinion on what I have disclosed & what you recommend.
In accordance with sperm competition theory, testosterone levels are shown to increase as a response to previously neutral stimuli when conditioned to become sexual in male rats.[40] This reaction engages penile reflexes (such as erection and ejaculation) that aid in sperm competition when more than one male is present in mating encounters, allowing for more production of successful sperm and a higher chance of reproduction.
Men who produce more testosterone are more likely to engage in extramarital sex.[55] Testosterone levels do not rely on physical presence of a partner; testosterone levels of men engaging in same-city and long-distance relationships are similar.[54] Physical presence may be required for women who are in relationships for the testosterone–partner interaction, where same-city partnered women have lower testosterone levels than long-distance partnered women.[59]
Disclaimer: While we work to ensure that product information is correct, on occasion manufacturers may alter their ingredient lists. Actual product packaging and materials may contain more and/or different information than that shown on our Web site. We recommend that you do not solely rely on the information presented and that you always read labels, warnings, and directions before using or consuming a product. For additional information about a product, please contact the manufacturer. Content on this site is for reference purposes and is not intended to substitute for advice given by a physician, pharmacist, or other licensed health-care professional. You should not use this information as self-diagnosis or for treating a health problem or disease. Contact your health-care provider immediately if you suspect that you have a medical problem. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease or health condition. Amazon.com assumes no liability for inaccuracies or misstatements about products.

Grape seed extract is another ingredient with not enough research to suggest a dosage. Grape seed extract can interact with drugs like “blood thinners, NSAID painkillers (like aspirin, Advil, and Aleve), certain heart medicines, cancer treatments, and others.” If this sounds like you (or if you ever pop an Advil to clear off a headache), you’ll need to speak with a doctor to make sure this supplement is safe to take.

show that total testosterone levels increase after exercising, especially after resistance training. Low testosterone levels can affect your sex drive and your mood. The good news is that exercise improves mood and stimulates brain chemicals to help you feel happier and more confident. Exercise also boosts energy and endurance, and helps you to sleep better. Fitness experts recommend 30 minutes of exercise every day.
Hi my names Graham. I’ve suffered with Gyno for most of my adult life. Even when I’ve lost a ton of weight , those two unhelpful bags of fat are still there. To save me 4 to 6 grand on liposuction or surgery, will an estrogen blocker and testosterone booster help. I’ve also heard of a cream called andractim that can help , but they are expensive. Any advice would be great . Thanks.
After 90 days, it seemed like the Andro Gel kind of stopped having it’s effect. Went back to see the doc, and my levels had dropped back to about 198 from high 200’s. Doc said it’s not unusual that the body gets used to it, and maybe I needed to adjust up. I switched to four pumps per day, and I felt immediate effects. Now…there is a period of ultra-horniness, and sometimes, you will feel some of the “roid rage” at some of these levels. It varies from person to person. Generally, if you are an ass, or high strung, this will amplify it. If you are pretty mellow, you may notice that every once in a while you’ll get angry at something that does matter, but again, it’s different person to person.
While testosterone stimulates a man’s sex drive, it also aids in achieving and maintaining an erection. Testosterone alone doesn’t cause an erection, but it stimulates receptors in the brain to produce nitric oxide. Nitric oxide is a molecule that helps trigger a series of chemical reactions necessary for an erection to occur. When testosterone levels are too low, a man may have difficulty achieving an erection prior to sex or having spontaneous erections (for example, during sleep).
TT may help you but it may have adverse (harmful) results. (See discussion of these side effects below.) The Federal Drug Administration (FDA) has said that testosterone drug labels should state that there is a risk for heart disease and stroke for some men using testosterone products. All men should be checked for heart disease and stroke before, and periodically while on, TT. The AUA however, on careful review of evidence-based peer review literature, has stated that there is no strong evidence that TT either increases or decreases the risk of cardiovascular events.
I have used Androgel for 7 years with Testosterone levels between 650 and 900. PSA remained just under 3.0. 2 pumps per day. A year ago I increased my pumps to 4 per day and within a few months my Testosterone was 1,100 BUT my PSA shot up to 5.2. Last April, I totally stopped Androgel and within 2 months my Testosterone was under 20 (really) and PSA was virtually zero. Libido also fell from “strong” to “zero”. After 5 months of no Androgel, I resumed it in September at 2 pumps per day and now my Testosterone has improved to almost 600 and my PSA is just under 3.0. Am having my 3 month check-up with my Urologist tomorrow.

Disclaimer: While we work to ensure that product information is correct, on occasion manufacturers may alter their ingredient lists. Actual product packaging and materials may contain more and/or different information than that shown on our Web site. We recommend that you do not solely rely on the information presented and that you always read labels, warnings, and directions before using or consuming a product. For additional information about a product, please contact the manufacturer. Content on this site is for reference purposes and is not intended to substitute for advice given by a physician, pharmacist, or other licensed health-care professional. You should not use this information as self-diagnosis or for treating a health problem or disease. Contact your health-care provider immediately if you suspect that you have a medical problem. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease or health condition. Amazon.com assumes no liability for inaccuracies or misstatements about products.
TestosteroneTestosterone BoostersTestosterone SupplementsTestosterone InjectionsTestosterone CypionateTestosterone EnanthateTestosterone PropionateTestosterone Topical GelTestosterone CreamsTestosterone For MenTestosterone vs HGHTestosterone HCG InjectionsTestosterone SalesTestosterone LevelsTestosterone PricingTestosterone PillsTestosterone ProgramsTestosterone TreatmentsTestosterone TherapyTestosterone MedicationsTestosterone ReplacementTestosterone ShotsTestosterone DoctorsTestosterone Treatment ClinicsTestosterone Online SalesTestosterone Orders OnlineTestosterone For ED & Low TTestosterone PrescriptionsErectile Dysfunction TherapyLibido & Men's Sexual Health

In non-human primates, it may be that testosterone in puberty stimulates sexual arousal, which allows the primate to increasingly seek out sexual experiences with females and thus creates a sexual preference for females.[39] Some research has also indicated that if testosterone is eliminated in an adult male human or other adult male primate's system, its sexual motivation decreases, but there is no corresponding decrease in ability to engage in sexual activity (mounting, ejaculating, etc.).[39]
It may also become a treatment for anemia, bone density and strength problems. In a 2017 study published in the journal of the American Medical Association (JAMA), testosterone treatments corrected anemia in older men with low testosterone levels better than a placebo. Another 2017 study published in JAMA found that older men with low testosterone had increased bone strength and density after treatment when compared with a placebo. 
Bottom line: testosterone boosters aren’t right for a lot of people. We dive deep into ingredient research below, but typically, testosterone boosters contain at least one (and often three or more) different ingredients that each impact your circulatory system — both the heart and blood. If you’re taking any kind of blood-thinner medication, or you have a history of heart disease, these supplements can get really dangerous, really quickly. The simple fact of the matter is that hormones are tricky things to mess with, and a doctor should be your first port of call to help you safely achieve your goals — whether they’re related to fitness, weight, or libido.
Hello there Abraham. My doc and you know each other well. We reside in Richmond, VA. Doc told me to inject my weekly Cypionate into sub fat for longer absorption, with reference you shared this info him with him. I have been his TRT patient for 10 years now. He is the best. I wont mention names. Please point me to a study showing the results of testosterone absorption from fat.

Dr. Martin’s Extra Strength Testosterone Booster made our top spot for budget-friendly enhancers. This is a unique and powerful blend of natural herbs that will help you with your energy levels and raise your stamina. Men will also appreciate better results when it comes to building up lean muscle, and the supplement will give your libido a boost, too.


Always worry of side effects i.e. prostate cancer! Also feels like I am doping like a pro-cyclist (hate cheaters) Without it my muscles and joints stiffens so painfully, fuzzy and somewhat depressed, when pushing very hard while exercising the sensations become bizarre and again so incredibly painful — it feels so good after the injection if I had waited too long!
Xenoestrogen is a chemical that imitates estrogen in the human body. When men are exposed to too much of this estrogen-imitating chemical, T levels drop significantly. The problem is xenoestrogen is freaking everywhere — plastics, shampoos, gasoline, cows, toothpaste. You name it and chances are there are xenoestrogen in it. The ubiquitous nature of this chemical in our modern world is one reason some endocrinologists believe that testosterone levels are lower in men today than in decades past. It’s also a reason doctors say the number of boys born with hypospadias — a birth defect in which the opening of the urethra is on the underside of the penis and not at the tip — has doubled.  Note to expecting parents: make sure mom stays away from xenoestrogens during the pregnancy.
But can testosterone replacement therapy help with heart disease? Study results are mixed. Small studies in the early 2000s found that men with heart disease who underwent testosterone therapy saw only slight improvements. Some were able to increase their walking distance by 33 percent. Another study found that hormone therapy only widened healthy arteries but had no effect on angina pain.
Well, this is another area of confusion and great debate, but I don’t think it’s as confusing as it appears to be in the literature. When most doctors learned about testosterone in medical school, they learned about total testosterone, or all the testosterone in the body. But about half of the testosterone that’s circulating in the bloodstream is not available to the cells. It’s tightly bound to a carrier molecule called sex hormone–binding globulin, which we abbreviate as SHBG.
If you’re an older man with low testosterone and interested in taking testosterone, this decision should be carefully considered with your physician. Your physician will be able to better assess the balance of your conditions and whether hormone replacement could put you at potential risk. It's a bad idea for anybody to engage in hormone supplementation without the supervision of a physician. Just because hormones occur naturally in the body does not mean that they can be taken without negative effects.

Sleep apnea is another frequently listed contraindication to testosterone treatment. There have been a few reports of the development, or worsening, of sleep apnea during testosterone therapy (Matsumoto et al 1985) but sleep apnea is actually associated with lower serum testosterone levels (Luboshitzky et al 2002). The reduction in fat mass during treatment with testosterone could potentially be beneficial for sleep apnea, so many specialists will still consider patients for treatment with appropriate monitoring. It is wise to take a clinical history for sleep apnea during testosterone treatment in all men and perform sleep studies in those who develop symptoms.


Testosterone may improve cognitive ability. Not only have studies shown that there is a link between testosterone levels and Alzheimer’s, they’ve also shown a link between T levels and overall cognitive ability, particularly in older men. One such study performed by Dutch researchers found a direct linear relationship between T levels and cognitive function, while other studies have found a linear relationship between memory loss and T levels. Because of these correlations, many researchers believe testosterone plays a role in preventing brain tissue decay in elderly men. The hormone’s connection to cognition explains why some of the symptoms of low T in men are memory loss, trouble concentrating, and “fogginess.”
The science backs up the soldier’s self discovery, in fact, exposure to radiation (whether it’s from an army radar or the cell phone in your pocket, or the wifi router in your house) has been shown to lower sperm quality, fertility and testosterone. This is true not only for military personnel (88, 89,90) but all males living in a modern world (91).
I am 45 years old and have been diagnosed with low testosterone levels. In 2014 my levels were 16.5 and in 2016 that dramatically reduced to a score of 10.4. My doctor prescribed me Testo gel which I rub on every morning and have done so for the last 6 weeks. I keep myself fit, gym twice a week and martial arts twice a week and found my energy levels were depleting and didn’t seem to recover quickly the next day. I started to feel exhausted and experienced low libido,lack of motivation and mental focus. I actually thought oh well this is what happens when you get older.

Testosterone may fight depression. If you’ve been battling the black dog of depression, it may be because of low testosterone levels. Researchers have found that men suffering from depression typically have deficient testosterone levels. While scientists haven’t been able to figure out whether it’s low testosterone that causes depression or if depression causes low T levels, preliminary research has shown that some men suffering depression report improvement in mood and other factors of depression after undergoing doctor-directed testosterone treatments.
Sprinting has been shown numerous times that it has positive effects on testosterone levels. One 2011 study (ref 84) looked at weightlifters who performed 4x35m sprints twice a week. In contrast to the control group (who continued lifting but did not sprint), it was found that “After the 4-week training program, total testosterone and the total testosterone/cortisol ratio increased significantly in the (sprinters) EXP group”.
Costs were, in my opinion, very high especially for Axiron. I began reading all the health issues with drugs of this type. I became concerned and stopped using them. I took several over the counter supplements without much success. But recently I purchased from Briland Brands on amazon PaleoTest. I restarted a workout regimen and now feel great both during the workout and after. I can absolutely tell the difference. And it is a fraction of the price of the prescription drugs I took.
What makes TestoFuel different from other testosterone boosters on the market is that the company is constantly researching and updating the ingredients. So, you know you are getting a product that has been formulated using the latest clinical studies. Unlike most other companies that formulate a product and update it every 3 – 5 years or never at all.
Overall there is evidence that testosterone treatment increases lean body mass and reduces obesity, particularly visceral obesity, in a variety of populations including aging men. With regard to muscle changes, some studies demonstrate improvements in maximal strength but the results are inconsistent and it has not been demonstrated that these changes lead to clinically important improvements in mobility, endurance or quality of life. Studies are needed to clarify this. Changes in abdominal obesity are particularly important as visceral fat is now recognised as predisposing the metabolic syndrome, diabetes and cardiovascular disease.
I’ve been on testosterone replacement for over 3 years and at first I did the shots and my mood swings were ridiculous, my skin broke out on my chest and shoulders, and my henatocrit went to 55%. I finally got fed up with doing shots every two weeks and switched to Gel and it’s been so much better. It actually increases my levels which is rare for most men. I do 12.5 mg, three pumps a day, and this keeps My level between 500 and 600. My hematocrit is 48.5 and no mood swings.

“About 2 weeks after starting Andro400, I noticed my belly fat disappearing. Now, after only one month, I've lost about ten pounds all in my mid section. What a miracle! I have more energy and don't have to hold my gut in any longer. I'm more relaxed and my libido has increased 5 fold! I'm 58 years old and beginning to feel like a teenager again! Your product has delivered exactly as advertised. I'm elated!”
I am still on T therapy. But here’s what pisses me off: No one tells you that you will be hooked on the drug virtually forever! Don’t ever stop it abruptly! I did and I had a major crash: physically and emotionally. I went into the darkest depression ever…and I was lacking in energy so much that I had to have 4 naps a day…just to get through the day. I was also robbed of any initiative to do anything.
^ Jump up to: a b Travison TG, Vesper HW, Orwoll E, Wu F, Kaufman JM, Wang Y, Lapauw B, Fiers T, Matsumoto AM, Bhasin S (April 2017). "Harmonized Reference Ranges for Circulating Testosterone Levels in Men of Four Cohort Studies in the United States and Europe". The Journal of Clinical Endocrinology and Metabolism. 102 (4): 1161–1173. doi:10.1210/jc.2016-2935. PMC 5460736. PMID 28324103.

Xenoestrogen is a chemical that imitates estrogen in the human body. When men are exposed to too much of this estrogen-imitating chemical, T levels drop significantly. The problem is xenoestrogen is freaking everywhere — plastics, shampoos, gasoline, cows, toothpaste. You name it and chances are there are xenoestrogen in it. The ubiquitous nature of this chemical in our modern world is one reason some endocrinologists believe that testosterone levels are lower in men today than in decades past. It’s also a reason doctors say the number of boys born with hypospadias — a birth defect in which the opening of the urethra is on the underside of the penis and not at the tip — has doubled.  Note to expecting parents: make sure mom stays away from xenoestrogens during the pregnancy.
Margaret, I’m on Trt, and my wife is 43 going through Peri- (early/pre) menopause. She started trying about a drop a day to see if her libido would improve, and it did, dramatically, and also her moods and patience. After about a month of feeling 30again, she started noticing lite facial hair developing, decreased breast size, and return of all previous symptoms. So she went off it. About a month later, she started St.JohnsWart, and everything improved tenfold. Now she feels 20 instead of just 30 on testosterone. She literally glows with smiles and energy, and has an extremely high libido. Maybe try that first. Good luck.

Natural testosterone boosters also help to increase the amount of free testosterone in the body. There are a couple of different ingredients they use that help with this. One of these ingredients is stinging nettle. Stinging nettle is actually able to bind to the globulin in place of testosterone, therefore leaving more free testosterone in the body that is unbound.


In accordance with sperm competition theory, testosterone levels are shown to increase as a response to previously neutral stimuli when conditioned to become sexual in male rats.[40] This reaction engages penile reflexes (such as erection and ejaculation) that aid in sperm competition when more than one male is present in mating encounters, allowing for more production of successful sperm and a higher chance of reproduction.
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
Fenugreek, in the form of a capsule, testofen, or Fenugreek tea could do the trick. The fact that fenugreek increases libido is not mythology; it is backed by a clinical study which showed the libido of men aged 25-52 increased by 25%[1] on average when taking fenugreek extract for six weeks.  According to Lee Myer, of www.peaktestosterone.com fame, fenugreek will help you achieve orgasm as well, so if this is an issue for you, fenugreek may be the answer.  It’s a frustrating problem to have.
If you take a statin (cholesterol lowering medication) and you follow the 30-Day Heart Tune-Up program, there is a good chance you’ll be able to work with your doctor and over time safely stop your statin medication. Statin medications lower cholesterol, and you need cholesterol to make testosterone. Ask your doctor what you can do with lifestyle changes to not need a statin medication. Improving your cholesterol profile is only part of the answer. Many of the risk calculators doctors use look at tobacco use, body weight, blood pressure, blood sugar, and cholesterol. Improve all your risk factors, and often you won’t qualify for a medication!
   The International Journal of Sports Physiology and Performance recently studied tennis players, rugby teams, and wrestlers to find a link between testosterone and competitive outcome. They found that the difference between winning and losing was reflected in testosterone levels! The athletes' own natural testosterone prior to the game was directly related to the outcome after the game -- the higher the testosterone, the more frequently the athlete won.6

For the 3rd year in a row, DAA Max claims the #1 spot in the Top 10. A product that stands out in all categories with a formula that has been shown in studies to increase free testosterone levels after just 12 days of consistent use. DAA Max’s feedback over the years has shown that this product is not only potent in terms of elevating testosterone and boosting one’s libido, but at its low price it just can’t be beaten.
The reliable measurement of serum free testosterone requires equilibrium dialysis. This is not appropriate for clinical use as it is very time consuming and therefore expensive. The amount of bioavailable testosterone can be measured as a percentage of the total testosterone after precipitation of the SHBG bound fraction using ammonium sulphate. The bioavailable testosterone is then calculated from the total testosterone level. This method has an excellent correlation with free testosterone (Tremblay and Dube 1974) but is not widely available for clinical use. In most clinical situations the available tests are total testosterone and SHBG which are both easily and reliably measured. Total testosterone is appropriate for the diagnosis of overt male hypogonadism where testosterone levels are very low and also in excluding hypogonadism in patients with normal/high-normal testosterone levels. With increasing age, a greater number of men have total testosterone levels just below the normal range or in the low-normal range. In these patients total testosterone can be an unreliable indicator of hypogonadal status. There are a number of formulae that calculate an estimated bioavailable or free testosterone level using the SHBG and total testosterone levels. Some of these have been shown to correlate well with laboratory measures and there is evidence that they more reliably indicate hypogonadism than total testosterone in cases of borderline biochemical hypogonadism (Vermeulen et al 1971; Morris et al 2004). It is important that such tests are validated for use in patient populations relevant to the patient under consideration.
×