Male Hormones Lab Testing

HORMONE LAB TESTING

Why Profiles?

When patients have hormone-related symptoms, it is usually not a clear-cut case of one hormone level being abnormal or even one hormone system. In fact, because of the role that hormones play as chemical messengers to wake up the genome in specific target tissues throughout the body, it makes sense that all hormones work in concert with each other to maintain a state of balance.

This could be likened to the instruments in an orchestra playing together in harmony; when one instrument is off key or playing too loudly or softly, the overall harmony is affected. In a similar manner, the adrenal, thyroid, and sex hormones work in harmony, and when one or more of the hormones in any one system becomes unbalanced, this affects the harmony or balance of the whole system. Symptoms common to hormonal imbalances in the endocrine systems are seen as the body struggles to maintain balance, but does not succeed. Without an overall picture of which hormone systems are affected, it is often difficult to know the best clinical course of action for correcting the imbalance.

Hormone “Profiles” are multiple hormone tests bundled into one convenient kit. Usually priced lower than the sum of the individual tests, these provide a more economical method to assess a patient’s overall hormonal status, giving a better picture of the hormone imbalances that are causing symptoms. Instead of treating a secondary hormonal imbalance caused by an abnormality in only one of the hormonal systems (e.g., low libido caused by low testosterone), you can address the underlying issues that lie at the root of the problem, and therefore, better guide your patients towards overall wellness.

Estradiol is tested because too much, relative to testosterone levels, suppresses testosterone receptors in target tissues and eventually leads to feminizing effects in men, such as breast enlargement. In healthy young men, testosterone is at its highest level, and estradiol is very low. However, as men age, this shifts to a higher estradiol/testosterone ratio. Even if testosterone levels are normal, symptoms can indicate a functional testosterone deficiency because of the effects of higher than normal estradiol levels.

There are several mechanisms by which relative levels of estradiol and testosterone can change. Weight gain, whether or not this results from low testosterone, results in increased production of aromatase in fat cells, which converts testosterone to estradiol. Rising estradiol levels also cause the liver to produce more SHBG, which has a greater affinity for testosterone than estradiol. This acts to suppress further the amount of circulating free testosterone. Estradiol also decreases LH production by negative feedback on the pituitary gland, which in turn acts to decrease testicular testosterone production. High estradiol levels can be controlled by weight reduction to decrease the amount of aromatase-producing adipose tissue. There are nutritional and pharmaceutical approaches to aromatase inhibition.

Progesterone is present in men but at a much lower level than found in premenopausal women. Some men supplement with topical progesterone to help with sleep, to support adrenal cortisol production (progesterone is a cortisol precursor), and to counterbalance the effects of estrogens on the prostate. It has also been used as a mild antiandrogen in patients with BPH and to reduce male pattern baldness, because of its competition with testosterone and DHT for androgen receptors.

Salivary progesterone levels can, therefore, be useful to monitor supplementation.

Testosterone is the primary indicator of male hypogonadism and andropause. Many things can contribute to low testosterone levels, including high cortisol levels and high estrogen levels, as described above. The hypothalamic-pituitary-testicular axis controls testosterone production in the testes, and so dysfunctions of the hypothalamus or pituitary can affect levels, as well as the negative feedback effect of estradiol on LH levels to suppress testosterone production.

SHBG binds and transports both testosterone and estrogens in the bloodstream, and it, therefore, regulates the relative amounts of free and bound hormone and consequently their bioavailability to target tissues. SHBG is a protein produced by the liver in response to exposure to any type of estrogen. Testosterone binds about three times more tightly to SHBG than does estradiol, so this increase in SHBG as a result of estrogen exposure causes the relative proportion of bioavailable testosterone to estradiol to decrease even further, exacerbating the symptoms of testosterone deficiency.

Many factors, in addition to estrogen exposure, can affect SHBG levels19. Thyroid hormone increases SHBG production, whereas insulin, decreases SHBG levels. In young men, testosterone levels are usually high and SHBG low, making most of the testosterone bioavailable. However, as men age, gain weight, and their estrogen levels increase, SHBG also rises, decreasing bioavailable testosterone. Measuring SHBG in blood provides an indication of the overall exposure to estrogens, as well as the bioavailable (free) fraction of testosterone (calculated from the ratio of testosterone to SHBG).

PSA is a measure of prostate health and high levels can indicate the presence of BPH or advancing prostate cancer. As prostate cells start to become crowded, they produce PSA, which acts to suppress angiogenesis and therefore reduce the blood supply to the surrounding tissue to prevent it from further growth. High levels are therefore seen only as a result of growth that is fairly rapid. It is important to test PSA levels prior to starting testosterone therapy, as a sharp increase in PSA can indicate prostate problems.

Dehydroepiandrosterone (DHEA) is a precursor for the production of estrogens and testosterone and is therefore normally present in greater quantities than all the other steroid hormones. It is mostly found in the circulation in its conjugated form, DHEA sulfate (DHEA-S). Its production, which occurs in the adrenal glands, declines gradually with age. Like cortisol, it is involved with immune function and a balance between the two is essential. Low DHEA can result in reduced libido and general malaise.

Cortisol is an indicator of adrenal function and exposure to stressors. Under normal circumstances, adrenal cortisol production shows a diurnal variation and is highest early in the morning, soon after waking, falling to lower levels in the evening. Normal cortisol production shows a healthy ability to respond to stress. Low cortisol levels can indicate adrenal fatigue (a reduced ability to respond to stressors) and can leave the body more vulnerable to poor blood sugar regulation and immune system dysfunction. Chronically high cortisol is a consequence of high, constant exposure to stressors, and this has serious implications for long-term health, including an increased risk of cancer, osteoporosis, and possibly Alzheimer’s disease.

The Thyroid Profile (free T4, free T3, TSH, and TPO) can indicate the presence of an imbalance in thyroid function, which can cause a wide variety of symptoms, including feeling cold all the time, low stamina, fatigue (particularly in the evening), depression, low sex drive, weight gain, and high cholesterol.

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