While comparing with
female menopause, in men, the fall in sex hormone production is much more
gradual, developing over decades rather than months or years. Mental and
physical changes can occur, but they are much more subtle in onset and can
easily be missed. Therefore, some
experts claim that the term “male menopause”, or andropause, is not strictly accurate
and does not reflect changes in men as a process. Instead, they prefer to talk
about “partial androgen deficiency of the ageing male” (PADAM).
How is androgen deficiency (PADAM) diagnosed?
No definitive tests
for PADAM exist yet. Low blood levels of testosterone alone are insufficient to
make the diagnosis, however they may lead to the raise awareness on the potential
health problems source. The combination of several different suggestive
symptoms and physical signs, together with low blood levels of testosterone,
should raise suspicion that PADAM is present.
There are a few
methods employed to determine if a man has indeed a low amount of testosterone
in his body. The first method is for the physician to take a complete medical
history of the patient. The doctor will be looking for signs and symptoms of
androgen deficiency. The patient will be asked questions about their sex life,
poor erections, less volume of semen, orgasmic quality, decreased energy, loss
of muscle strength, self-esteem problems, depression, tiredness, irritability,
insomnia, sweating, hair loss and abdominal weight gain. Other important symptoms
include a high LDL cholesterol number, osteoporosis, an increase in total body
fat and a reduction of red blood cells in the plasma. For many men, premature
aging is a form of hypogonadism. Although there are more symptoms than listed
here, the line of questioning will be the same in the doctor's office. From the
information provided here, it shows how important it is to verify the diagnosis
since so many of these symptoms can relate to other diseases.
After determining
that the symptoms seem to suggest low testosterone, you will be required to have
your testosterone measured using a Testosterone blood test. The two
relevant blood tests are the Total Testosterone and the Free
Testosterone tests. Most anti-aging doctors recommend taking the blood draw
in the morning, usually before 10:00 a.m. This is when the male's testosterone
level is at its highest point. Several blood tests should be performed over a
period of a week to determine the actual number when trying to diagnose
andropause. The levels of testosterone tend to fluctuate throughout the day.
Once results are confirmed, there are several options the person can consider
and discuss with their doctor regarding the testosterone delivery system will
work best for them.
The problem with measuring testosterone levels
It would be
comforting to think that a simple blood test could identify androgen
deficiency. Unfortunately, this is not the case. Widespread disagreement exists
over what is the normal range of testosterone levels and what, exactly, should
be measured in the blood to assess androgen deficiency.
The existing “normal”
range for total testosterone is based upon statistical analysis of pooled
samples from all men, including those who might have PADAM. So, the “normal”
testosterone levels are not necessarily the same, as the healthy levels.
Testosterone is
released into the bloodstream in pulses, and levels vary through the day
(diurnal variation). In general, the testicles release more testosterone in the
morning than later in the day. Blood samples should therefore be taken between
8am and 10am, as we mentioned earlier. Therefore, multiple separate, consistent
results are recommended to establish that there is a problem with testosterone
levels.
About 60-70 per cent
of the total testosterone is tightly bound to a protein, present in the blood,
called sex hormone binding globulin (SHBG). This protein-binding is a common
way in which hormones are transported in the bloodstream and it is effectively
a circulating store of testosterone. The testosterone only becomes active when
the link to SHBG is broken, and this is a process which occurs at a certain
rate all the time. Older men produce relatively more SHBG, as do heavy drinkers
and men with thyroid disorders, thus reducing the amount of “free”
testosterone.
Another 30-40 per
cent of the total testosterone is more loosely bound to another protein, called
albumen. Testosterone bound to albumen is also inactive, so free testosterone
probably accounts for only 1 to 2 per cent of the total.
Measurement of total
testosterone is therefore a poor measure of active testosterone. Free
testosterone levels are expensive to measure and are not widely available.
Free Androgen Index
(FAI = total testosterone/SHBG x100) is an alternative measure of androgen
state that is not as reliable as free testosterone, but is better than relying
solely on total testosterone.
How the Test Is Performed
Blood is typically
drawn from a vein, usually from the inside of the elbow or the back of the
hand. The site is cleaned with germ-killing medicine (antiseptic). The health
care provider wraps an elastic band around the upper arm to apply pressure to
the area and make the vein swell with blood.
Next, the health
care provider gently inserts a needle into the vein. The blood collects into an
airtight vial or tube attached to the needle. The elastic band is removed from
your arm. Once the blood has been collected, the needle is removed, and the
puncture site is covered to stop any bleeding.
Results
The normal values listed below are called a reference range and should be
used for the mere guidance. These ranges vary from lab to lab, and your lab may
have a different range for what’s normal. Your lab report should contain the
range your lab uses. Also, your doctor will evaluate your results based on your
health and other factors. This means that a value that falls outside the normal
values listed here may still be normal for you or your lab.
Several sources for the reference range were indeed different, when I
tried to compare them. There are the data from two sources:
- Source One:
·
Total Testosterone: 270-1070 ng/dL (9-38 nmol/L)
·
Free Testosterone: 50-210 ng/mL (174-729 pmol/L)
- Source Two:
·
Total Testosterone:
19-49
years old 249-836 ng/dL
50
years and older 193-740 ng/dL
·
Free Testosterone: 32-168 pg/mL
·
Free
Androgen Index: 30-150
Sources and Additional Information: