Treatment of hypogonadism depends on the cause and if you're concerned about fertility.
There is no perfect test for hypogonadism and diagnosis can be a judgement call on the part of the physician.
Several different types of testosterone measurements may be necessary to fully evaluate someone's testosterone status.
Total testosterone is the most common test used to diagnose hypogonadism, but it's not always the most accurate test.
Total testosterone is a measure of the total amount of testosterone in the blood.
Measured free testosterone
Dialyzable testosterone is testosterone that isn't bound to protein. This test is known as measuring free testosterone because it measures the most active component of testosterone.
The free testosterone level is determined based on the total testosterone and the percentage of testosterone that's removed using equilibrium dialysis.
Calculated free testosterone
Generally, total testosterone is the most reliable test. The free testosterone is calculated using the more accurate total testosterone level but also takes the proteins albumin and SHBG into consideration.
A simple calculation of free testosterone is called the free testosterone index.
Free testosterone index = total testosterone/SHBG x 100
A more complicated formula can be used to give the value for free testosterone based on total testosterone, albumin, and SHBG levels.
Bioavailable testosterone is calculated using a variety of measurements, including total and free testosterone as well as albumin and SHBG levels. Knowing how much testosterone is tightly bound and how much is bioavailable to the tissues is very important.
Measuring salivary testosterone isn't accurate enough and the normal range hasn't been clearly defined.
The goal for treatment of hypogonadism or testosterone deficiency is to bring testosterone levels into normal range.
Injecting testosterone can be difficult because it must be injected deep into the muscle. The testosterone forms a reservoir where contents are slowly released into the blood stream.
Testosterone skin patches are effective, but not a popular form of testosterone replacement therapy (TRT). Up to 30 percent of men experience rashes or skin irritation. The patches can also be inconvenient and can fall off during exercise.
A compounding pharmacy can prepare testosterone creams. The advantage of using a compounding pharmacy is the fact that a compounding pharmacist can create medication specific to the patients needs.
Androgel has become the most prescribed type of TRT. Androgel has the advantage over injections because Androgel supplies constant levels of testosterone to the blood.
Testim can be better than androgel at penetrating the skin. The main problem with Testim is it's particular odor. The gel can also feel sticky or tacky. Despite these inconveniences, Testim is commonly the TRT choice for men.
Striant is a tablet that's placed between the gum and cheek. It can be difficult to use, but when used right, men commonly reach normal levels of testosterone.
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