The same study showed that drinking did, however, lower semen count and quality. And I want to remind you – this is an article  on improving testosterone levels, not general health as there are a lot of studies that show drinking leads to an assortment of health issues. This acute spike in Testosterone could be due to the effect alcohol has on libido, and also the energy influx in the liver?
There have been case reports of development of prostate cancer in patients during treatment with testosterone, including one case series of twenty patients (Gaylis et al 2005). It is not known whether this reflects an increase in incidence, as prostate cancer is very common and because the monitoring for cancer in patients treated with testosterone is greater. Randomized controlled trials of testosterone treatment have found a low incidence of prostate cancer and they do not provide evidence of a link between testosterone treatment and the development of prostate cancer (Rhoden and Morgentaler 2004). More large scale clinical trials of longer durations of testosterone replacement are required to confirm that testosterone treatment does not cause prostate cancer. Overall, it is not known whether testosterone treatment of aging males with hypogonadism increases the risk of prostate cancer, but monitoring for the condition is clearly vital. This should take the form of PSA blood test and rectal examination every three months for the first year of treatment and yearly thereafter (Nieschlag et al 2005). Age adjusted PSA reference ranges should be used to identify men who require further assessment. The concept of PSA velocity is also important and refers to the rate of increase in PSA per year. Patients with abnormal rectal examination suggestive of prostate cancer, PSA above the age specific reference range or a PSA velocity greater than 0.75 ng/ml/yr should be referred to a urologist for consideration of prostate biopsy.
For facts sake I am 51yr old male and I am fat. I do have a large and muscular fat, but I also have a good amount of at on top of that. My body shape is not the typical huge “beer belly” gut that is hard and dangerous, rather, I am fat all over proportionally, but still considered obese. The fat on my body and around my middle is quite soft compared to male friends who have those large and hard bellies. Still, my doctor and reading indicate that fat has an effect on T potentially lowering the overall level that my T would be if I lost a good amount of that fat.
I am now 65 & have had Low-T problems since I was about 60. I took topical Testosterone for a few years until insurance stopped covering it. Then I took injections at a Men's Health-Low-T Clinic. Then I was diagnosed with Prostate Cancer & was told to stop taking Testosterone. I underwent radiation treatment to cure the Prostate cancer, but since there is a theory that taking Testosterone can lead to Prostate cancer, I have chosen not to resume taking it. While I am glad to be free of the cancer, I have been feeling extremely fatigued & tired all the time to the point that doing much of anything like a little yard work would leave me exhausted for days.

Beast Sports Nutrition - Super Test has all four of our dream ingredients: magnesium, fenugreek, longjack, and zinc. These ingredients have all been demonstrated to help increase natural testosterone levels, with plenty of scientific research to support them (done on humans too, and not just rats). By combining all four ingredients, Super Test has the best chance of helping to increase your testosterone levels, and thereby helping you gain muscle or have a more active sex life.
The results of these studies indicate that testosterone treatment in older men with low testosterone may proffer some benefits. However, testosterone treatments may also entail risks. The exact trade-off is unknown. Larger and longer studies need to be performed to clarify the effects of testosterone on heart health, bone health, disability, and more.

As a nurse I am very concerned with following my labs as most of these places don’t actually follow my labs. I also happen to have the side effect of polycythemia and donate 2-3 times a year for this reason. At one point I asked my doctor who referred me to a urologist. At the time I was on 150mg IM with half a dose or 0.5mL twice weekly to avoid the “roller coaster”. Anyways, I went there so I could get some concrete answers as to why I was having low T, this doctor all but threw me out of his office stating that “they” are making me dependent on T. As a professional in the medical field I was highly offended, he didn’t even speak with me about anything at all, I had no chance to ask what was going on, if my dosing was correct or if there was anything else I needed to do. He kicked me out and said he wasn’t even charging for the visit. Absolutely applaud. So to those who have found a Dr. that actually listens and works with your individual issues, kuddos. To the rest of us I highly recommend that you research as much as possible before using out of state clinics.

The content here is for information purposes only. By delivering the information contained herein is does not mean preventing, diagnosing, mitigating, treating or curing any type of medical condition or disease. When beginning any natural supplementation regiment or integrative treatment, the advice of professionally licensed healthcare providers is advisable to seek.

Testosterone was first used as a clinical drug as early as 1937, but with little understanding of its mechanisms. The hormone is now widely prescribed to men whose bodies naturally produce low levels. But the levels at which testosterone deficiency become medically relevant still aren’t well understood. Normal testosterone production varies widely in men, so it’s difficult to know what levels have medical significance. The hormone’s mechanisms of action are also unclear.


Testosterone boosters are used by many athletes worldwide to achieve a significant muscle mass increase within a short period of time.[1] However; one cannot be completely confident in terms of the quality and efficacy of such products because of several reasons, such as the possibility of bad storage conditions and originating from an unreliable source. Over the years, some consumers of testosterone boosters have complained of kidney and liver abnormalities that could be linked to their use of boosters.[10] Cases of erroneous product administration have occurred in the past as athletes may not follow the instructions on the label fully, which can lead to many side effects.[11] In the present case, a man was admitted to a hospital because of a severe abdominal pain. The pain was later found to be caused by liver injury. The diagnosis confirmed that the levels of the key hepatic enzymes were markedly elevated. The medical complications observed were found to have occurred following the consumption of two courses of a commercial testosterone booster. According to researchers based in the US, about 13% of the annual cases of acute liver failure are attributable to idiosyncratic drug- and/or supplement-induced liver injury.[12] Marked increase in the levels of ALT, AST, and gamma-glutamyl transferase was observed after consuming the first course of the commercial testosterone booster, and they started to decline after the 2nd and 3rd course. This abruptly increases the levels of liver enzymes after the first course may be attributed to the interruption effect of commercial testosterone booster on liver function as a result of the effects of its ingredients.
"I am only 10 weeks into taking your product and I have lost 12 pounds and three inches from my waist. Normally I scoff at radio or TV ads promising results like this. But in this case, my results have far exceeded my expectations. My energy level has increased and my appetite has decreased! All this without any extra exercise program. Thanks from a very satisfied customer!"
Osteoporosis refers to pathological loss of bone density and strength. It is an important condition due to its prevalence and association with bone fractures; most commonly of the hip, vertebra and forearm. Men are relatively protected from the development of osteoporosis by a higher peak bone mass compared with women (Campion and Maricic 2003). Furthermore, women lose bone at an accelerated rate immediately following the menopause. Nevertheless, men start to lose bone mass during early adult life and experience an increase in the rate of bone loss with age (Scopacasa et al 2002). Women of a given age have a higher prevalence of osteoporosis in comparison to men but the prevalence increases with age in both sexes. As a result, men have a lower incidence of osteoporotic fractures than women of a given age but the gap between the sexes narrows with advancing age (Chang et al 2004) and there is evidence that hip fractures in men are associated with greater mortality than in women (Campion and Maricic 2003).
Testosterone strengthens bones. You may have thought of osteoporosis as a health problem that only women have to worry about, but men can suffer from this bone-weakening disease too. And low testosterone levels may be to blame. Testosterone has been shown to play an important role in bone health. It increases bone density by stimulating bone mineralization as well as decreases bone resorption. Elderly men suffering from osteoporosis typically have sub-optimal testosterone levels. If you want to enjoy strong, healthy bones well into old age, take steps to improve your testosterone levels now.
Another effect that can limit treatment is polycythemia, which occurs due to various stimulatory effects of testosterone on erythropoiesis (Zitzmann and Nieschlag 2004). Polycythemia is known to produce increased rates of cerebral ischemia and there have been reports of stroke during testosterone induced polycythaemia (Krauss et al 1991). It is necessary to monitor hematocrit during testosterone treatment, and hematocrit greater than 50% should prompt either a reduction of dose if testosterone levels are high or high-normal, or cessation of treatment if levels are low-normal. On the other hand, late onset hypogonadism frequently results in anemia which will then normalize during physiological testosterone replacement.
Garlic is a very effective food that has been used for centuries in treating various physical ailments including heart problems and respiratory infections. What most people don’t know is that it is also a potent aphrodisiac and very effective in boosting sperm volume. It contains a compound called allicin which improves blood flow to the male sexual organs, increasing sperm production and semen volume.
There are two keys to incorporating fat in your diet: getting enough fat, and getting the right kinds of it. A study from 1984 (done, no doubt, with Big Brother watching) looked at 30 healthy men who switched from eating 40% fat (much of it saturated) to 25% fat (much of it unsaturated), with more protein and carbs to make up the difference in calories. After 6 weeks, their average serum testosterone, free testosterone, and 4-androstenedione (an important hormone for testosterone synthesis) all dropped significantly [6]. I think getting 40% of your calories from fat is too little – I recommend 50-70% of calories from fat, or even more in some cases.
Lean beef, chicken, fish, and eggs are some of your options. Tofu, nuts, and seeds have protein, too. Try to get about 5 to 6 ounces per day, although the ideal amount for you depends on your age, sex, and how active you are. When you don't eat enough of these foods, your body makes more of a substance that binds with testosterone, leaving you with less T available to do its job.
Testosterone was first used as a clinical drug as early as 1937, but with little understanding of its mechanisms. The hormone is now widely prescribed to men whose bodies naturally produce low levels. But the levels at which testosterone deficiency become medically relevant still aren’t well understood. Normal testosterone production varies widely in men, so it’s difficult to know what levels have medical significance. The hormone’s mechanisms of action are also unclear.
“I'm 55 years old and hitting the ball further than I've ever hit, and I'm not getting tired going 18 holes! And when I play softball I'm hitting the ball further. I work for the DWP in LA and it's a very physically demanding job. Andro400 really helps because we work 16 hour days a lot. I was turning down a lot of overtime, but when I started taking Andro400, it got me through the day. I really notice a difference – even my wife did. It really works!”
Your first step should be to see your doctor. If you think you have low testosterone, we cannot stress enough that you should proceed with caution and talk to a medical professional — taking a booster can definitely do more harm than good. Low testosterone can be a symptom of more serious problems, like a pituitary disorder or a side-effect of medication, and a booster can mask the root cause. A doctor will be able to evaluate your testosterone levels with a simple blood test, and if you both decide a booster is the way to go, give the ingredients of any supplement a once-over to make sure that they’re not at risk of making your personal health situation worse.
In the last few years, a lot of men and women have switched over to a pellet that goes under your skin. This is probably the best way to take testosterone now. The pellet is life-changing for both men and women (the dose for women is much lower than it is for men). Women, you won’t get bulky and grow a beard when you take testosterone to achieve normal levels, but you will probably lean out a little without losing your curves, and your energy and sex drive will be amazing. Female bodybuilders who experience weird scary side effects are taking anabolic steroids.
I am 50 yrs old. I tried to go the route my urologist provide of 50mgs of injectable test weekly. No man can live on that dose. For the past five years I have self administered injectable cyponate at the rate of 250 mgs to 750 mgs weekly. Non stop , no breaks. I have polycythemia from these injections. I give blood every 8 weeks to combat this. I have administered 10 X the recommended dose with no bad side effects. I get full blood work done yearly. Doctors are so scared they will get sued if something happens that they wont give you enough. Its a shame.
The steroid hormone known as dehydroepiandrosterone, DHEA, plays an important role in sexual behavior, mental health and muscle growth. Your body uses this hormone to make sex steroids. Thus, taking a DHEA supplement should increase your circulating testosterone. A 2018 paper in the International Journal of Sports Medicine explored this possibility in athletic women.

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.
DAA (D-Aspartic Acid): When it comes to potent ingredients, D-Aspartic Acid is probably one the most potent ones currently available for boosting testosterone levels. This ingredient is used by sportsmen and bodybuilders alike to boost performance and gains, while it has also been shown to aid infertile men. DAA works with the brain, which stimulates the release of the luteinizing hormone that produces testosterone and also the secretion of growth hormone. Testosterone Synthesis also increases along with the other effects.
When looking for a solid natural testosterone booster, you’ll want one that has the ability to increase natural testosterone levels, increase muscular strength, improve performance and stamina, and help pack on lean muscle mass.  With a mix of key ingredients like D-AA, Tribulus, Fenugreek, and DIM, Evlution’s booster aims to take your training to the next level.  It can also help improve your sleep which is vital in allowing the body to recover from intense sessions in the gym.

More can be learned from a large, randomized, placebo-controlled trial of finasteride treatment in 18,800 men aged 55 or more. Finasteride is a 5α-reductase inhibitor which acts to prevent the metabolism of testosterone to dihydrotestosterone (DHT) – the most active androgen in the prostate. The trial showed a greater overall incidence of prostate cancer in the control group, but men treated with finasteride were more likely to have high grade tumors (Thompson et al 2003), suggesting that reduced androgen exposure of the prostate may delay the presentation of prostate cancer and/or promote advanced disease in some other way.
The participants were seen every 4 weeks. Blood was taken to measure hormone levels, and questionnaires were given to assess physical function, health status, vitality, and sexual function. Body fat and muscle measurements were also taken at the beginning and end of the 16 weeks. The study was funded in part by NIH’s National Institute on Aging (NIA) and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Results appeared in the September 12, 2013, issue of the New England Journal of Medicine.
Another recent development is the production of adhesive tablets which are applied twice daily to the buccal mucosa on the gum above the incisor teeth. The tablets gradually release testosterone into the systemic venous circulation and steady state physiological concentrations are achieved in most patients within two days (Ross et al 2004). Some patients do not like the feeling of the tablet in the mouth or find that there is an abnormal taste in the mouth, but local adverse effects are usually mild and transient (Wang, Swerdloff et al 2004).
Since then, multiple studies have found no link between high testosterone levels and increasing your chances of developing prostate cancer. However — and this is a BIG however — if you already have prostate cancer, increased levels of testosterone may exacerbate the problem. It’s best to wait until after you treat your prostate cancer before you begin any T-boosting regimens. Tread carefully and talk with your doctor.
Thanks for reaching out buddy. Sorry to hear about your situation. First off, what I’d suggest is to forget about creams, they are a waste of money unless you are trying to moisturize your body – which I guess you’re not. As for estrogen blockers, the same goes here – but testosterone boosters on the other hand, they work with your body instead of against it to give you everything your body is missing – it sounds like it’s the missing piece to your puzzle. Bear in mind Graham, you’ll need to pay close attention to your diet – aim to cut down on refined carbohydrates and simple sugars – these are terrible for testosterone production and weight gain. If you drink more water, eat a balanced diet, and exercise occasionally while supplementing with testofuel.com you’ll soon be back on track. All the best!
While I do have a pretty manly mustache, I’m not a doctor or a medical expert. I’m a guy with a law degree he’s never used who blogs about manliness. What I’m about to share shouldn’t be taken as a substitute for qualified medical expertise. It’s simply my experience and views on the subject. Before you make any changes in lifestyle or diet, talk to your doctor or healthcare provider. Be smart.

We start with plastic. A lot of plastic contains bisphenol A (BPA); BPA is a weak synthetic estrogen. Like many other chemicals used in making plastics, BPA is a hormone disruptor and can block or mimic hormones and how they act in the body (34). If you think you’re safe with BPA plastic, think again. Research shows that BPA free plastic has similar estrogen-like effects on the body.
Made many mistakes growing up. Late highschool, small group of guys tried Testosterone and obviously it worked great on all levels especially on the football field etc. College years we did it again and again but not anywhere near the levels of body builders we knew and saw at the gym. When it became harder to find, then….. poof it became “legal” in the form of Pro-hormones. Great right? Not so. It worked but it also worked on everything else in a negative way. Mainly liver toxicity that I noticed and just the general idea of not really knowing what was in it. When I was 38 I had a bad event with diverticulitis. I was hospitalized for 4 days and it was horrible. This is in an infection in a diverticula that forms in your intestines. It was so bad and fast that it spread with a rapid onset of epididymitis ( infection on the epididymis of your testical). After the hospital I went see my gastro who was a board member of a large anti aging group of doctors. We did bloodwork and My testosterone levels were lower than a woman! Like 110. He also explained to me that I had probably never fully recovered normal test levels from my last “get in shape” run with pro hormones 2 years before and it probably played a part in the weakening of my intestinal wall and immune system and after discussion I realized that I had exhibited all of the text book effects of low T to the letter. After spilling my guts to my doctor we decided upon the gel. It worked great but having kids around I was worried about it affecting them so we switched to in ejections taken every 2 weeks of cypionate 200mg and my wife helps me with that at home and I never stray from the regime . My levels are around 700 to 750 and basically PSA that is non existent. I am now 41 and feel great , go to Doctor twice a year for bloodwork and all is well. My doctor also tells me that in his opinion our environmental factors play a huge role in this, meaning hormones in meats, milks, public water etc. and because of that together with “Poor decision making (me in highschool, college etc) America is in the midst of an epidemic that is being under advertised and overlooked. I constantly read up on the latest info I can find and I liked reading this and your posts. Sometimes I feel guilty because I get comments on how I look and my energy levels and I wonder is this too good to be true? But if I am following a strict regiment and bloodwork reports good things…. Do I need to worry about anything else??? This is my story and I have never shared it with ANYONE other than my wife. Big move for me!! Last point……. This is a generalization but…….all women take hormones. It’s is universally accepted and part of a woman’s life without a doubt. Why is it Taboo to publicly discuss men and hormones? I guarantee if you are a man 35 and above and you did dumb things like me and or exhibit symptoms of low T, do yourself a huge favor and go see a doctor and get blood work done. More than likely you have it! I still hide all of this and I don’t want to shout it out because I feel embarrassed. WHY? Enough already!!!!
Changes in body composition are seen with aging. In general terms, aging males are prone to loss of muscle mass and a gain in fat mass, especially in the form of visceral or central fat. An epidemiological study of community dwelling men aged between 24 and 85 years has confirmed that total and free testosterone levels are inversely correlated with waist circumference and that testosterone levels are specifically related to this measure of central obesity rather than general obesity (Svartberg, von Muhlen, Sundsfjord et al 2004). Prospective studies show that testosterone levels predict future development of central obesity (Khaw and Barrett-Connor 1992; Tsai et al 2000). Reductions in free testosterone also correlate with age related declines in fat free mass (muscle mass) and muscle strength (Baumgartner et al 1999; Roy et al 2002). Studies in hypogonadal men confirm an increase in fat mass and decrease in fat free mass versus comparable eugonadal men (Katznelson et al 1998). Taken together, the epidemiological data suggest that a hypogonadal state promotes loss of muscle mass and a gain in fat mass, particularly visceral fat and therefore mimics the changes of ‘normal’ aging.
There are the testosterone deficiency signs, such as loss of sexual desire, erectile dysfunction, impaired fertility, chronic fatigue, etc. But it’s not always possible to understand which medical condition caused the decrease in testosterone levels. For example, if you always feel exhausted and have no sexual desire, it may provide evidence of depression.
Ok. So this product is meant to be taken continuously and without side-effects. But my question is, will there be replenishment from this product in aiding the body's natural ability to produce testosterone? In other words, will there ever be a time when I can say well I don't have to take this any more as my body is producing testosterone again on it's own and my muscle mass has been enhanced?
When you're under a lot of stress, your body releases high levels of the stress hormone cortisol. This hormone actually blocks the effects of testosterone,6 presumably because, from a biological standpoint, testosterone-associated behaviors (mating, competing, aggression) may have lowered your chances of survival in an emergency (hence, the "fight or flight" response is dominant, courtesy of cortisol).
I used to give a duration of 9 weeks between shots during early days when I commenced this form of medication. Which then, gradually made me reduce to 8 weeks, then 7 weeks since last year and now I had to intake this after 4th week which is the least duration I gave. I have started to find this pattern risky for the other health hazards due to over dosage.
One of the few testosterone boosters on the market to feature Eurycoma Longifolia, a patented ingredient that was developed at Massachusetts Institute of Technology (MIT) for the treatment of sexual dysfunction and male fertility, Tongkat Ali supports increased sex drive through multiple pathways, including boosting one’s free testosterone levels. Great as a standalone testosterone booster and a staple in many people’s post cycle after an anabolic cycle.
The effects of testosterone in humans and other vertebrates occur by way of multiple mechanisms: by activation of the androgen receptor (directly or as DHT), and by conversion to estradiol and activation of certain estrogen receptors.[113][114] Androgens such as testosterone have also been found to bind to and activate membrane androgen receptors.[115][116][117]
The mineral zinc is important for testosterone production, and supplementing your diet for as little as six weeks has been shown to cause a marked improvement in testosterone among men with low levels.1 Likewise, research has shown that restricting dietary sources of zinc leads to a significant decrease in testosterone, while zinc supplementation increases it2 -- and even protects men from exercised-induced reductions in testosterone levels.3
Testosterone decreases body fat. Testosterone plays an important role in regulating insulin, glucose, and fat metabolism. As our T levels decrease, our body’s ability to regulate insulin, glucose, and fat metabolism decreases, which in turn causes adipose tissue (i.e. fat) to begin accumulating. To add insult to injury, that increased adipose tissue may also contribute to further decreasing testosterone levels because it converts testosterone into estrogen.
Epidemiological data has associated low testosterone levels with atherogenic lipid parameters, including lower HDL cholesterol (Lichtenstein et al 1987; Haffner et al 1993; Van Pottelbergh et al 2003) and higher total cholesterol (Haffner et al 1993; Van Pottelbergh et al 2003), LDL cholesterol (Haffner et al 1993) and triglyceride levels (Lichtenstein et al 1987; Haffner et al 1993). Furthermore, these relationships are independent of other factors such as age, obesity and glucose levels (Haffner et al 1993; Van Pottelbergh et al 2003). Interventional trails of testosterone replacement have shown that treatment causes a decrease in total cholesterol. A recent meta-analysis of 17 randomized controlled trials confirmed this and found that the magnitude of changes was larger in trials of patients with lower baseline testosterone levels (Isidori et al 2005). The same meta-analysis found no significant overall change in LDL or HDL cholesterol levels but in trials with baseline testosterone levels greater than 10 nmol/l, there was a small reduction in HDL cholesterol with testosterone treatment.
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.
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!
Over time, the testicular “machinery” that makes testosterone gradually becomes less effective, and testosterone levels start to fall, by about 1% a year, beginning in the 40s. As men get into their 50s, 60s, and beyond, they may start to have signs and symptoms of low testosterone such as lower sex drive and sense of vitality, erectile dysfunction, decreased energy, reduced muscle mass and bone density, and anemia. Taken together, these signs and symptoms are often called hypogonadism (“hypo” meaning low functioning and “gonadism” referring to the testicles). Researchers estimate that the condition affects anywhere from two to six million men in the United States. Yet it is an underdiagnosed problem, with only about 5% of those affected receiving treatment.
I started with the shots. Wowee! the effect was like night and day. For two years I was like a teenager. But then I noticed some REALLY risky (Health) behavior ( and memory gaps) and bad decisions with long-term implications(i.e judgement). So I tried stopping TRT (four years on the pumps),within four months, mood swings like menopause: snarly with co workers (not good in nursing), grumpy with everyone, switch from jovial to downcast in an instant (I’m male). Had to go back on and do an 18 mth taper, coupled with exercise. No TRT, makes exercise SO hard to do. Muscles seem so much more aware of stiffness.

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.
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