Document, Document, Document your testosterone levels

[FuzzyKen]

One of the things that is so very important to us as we age is the availability of hormone replacement therapy as males. In a male as you age it is normal for your testosterone production and your ability to utilize what you make to fall to ever decreasing levels.

Those of you who are in your late teens and early 20's are the ones who will be most victimized later if you do not have regular documentation on this progression in aging.

I made a couple of monster errors myself on this one and it has cost me dearly based on current rules.

The first thing is to have you understand that you ARE with little doubt going to get an argument from your MD's on this one and they are going to sit like pious idiots with no understanding. Those dealing with HIV will have it better because their MD's bother to understand the endocrinological ramifications of the drugs they prescribe as a whole.

The problem with these standard MD's as individuals is that they themselves rarely understand the rules on male hormone replacement therapy. Because male HRT is relatively new and not taught to everyone unless they themselves sign up for continuing education classes beyond what is required of them, they do not have the new information.

Secondly, there are two distinct and separate tests and you need to have both of these in your records not just one.

The first and most common is called a "Serum Testosterone Test" and what this does is to document what you are producing between your testicles and the tiny amount that is produced in your liver. That is the standard test that everyone knows about. The second and actually more important test is "Free Floating Testosterone Test" and that second test shows what you are able to utilize.

You could for example have a very high testosterone level as you age showing normal on the serum test, but your "free-floating" can be in the cellar and this means that you are not able to utilize what you are producing.

Surprisingly the MD's most current on all of these different things are those treating advanced HIV infection. Most other MD's do not even know what is going on in this area and that is indeed sad.

Old research has indicated that increasing the DHT level in a man will cause prostatic enlargment. What is strange is that there is some new research coming out of the Scandanavian countries indicating that this research is flawed and that it is an imbalance created by the decrease in testosterone production and it's CORRECT conversion that is the culprit.

If the prostatic argument was absolutely true we should be seeing vastly increased numbers of men receiving HRT in HIV that would be growing prostate glands the size of basketballs. In case most of you have not noticed this is NOT happening. Also of note is that we are NOT seeing HIV patients in constant "roid-rage" and this is something else that is a mystery. The other mystery is that we are not seeing tons of new prostate cancer diagnoses in these men either which is very loudly pointing a finger at some groups stating; "Your research on male hormone administration is to say the least flawed look again."

You need to start having these two testosterone level tests performed when you are 25 and then at least every 5 years after that age.

In time, I see things changing on male HRT, and it will be the HIV patients who will have paved a road to better health and a longer and satisfying sex life for all of us.

The main thing here is Document! Document! Document! so that you qualify and that any interested regulatory agencies can medically see the decline in production and as a result they will not question your Doctors decision to replace or supplement your hormone production.

I did not know where else to post this, but it is so important especially to you fellows under age 30 to get this as part of your medical records that you carry through your lifetime.

Remember that as this evolves and replacement in males becomes more common, we will all owe the HIV patients for the research that they started and provided on this issue.

 

[QuiteOne]

I'm confused. Are you advocating this for all men, or just those with some form of disease that might affect their testosterone level? For most healthy men I would think that this is an "if it ain't broke, don't fix it" kind of thing.

 

[FuzzyKen]

What I advocate is documenting so that you have the ability to get this kind of replacement later if it in fact is needed.

If you have no documentation showing that your levels were at for example 600 on the serum when you were 25 you will be forced to wait until your levels drop to below 200 which is an established norm "cut-off" point for most MD's. If the MD could in your records show that you were at 600 he could easily and without question legally prescribe replacement for you IF YOU THE PATIENT wanted it before it reached the pits.

I do advocate male HRT. There are individuals who disagree with me and I openly respect their right to do so. The problem is that falling levels of testosterone in a male has numerous other problems associated with it. Depression, weight gain, muscle atrophy of advancing years, skeletal changes, erectile dysfunction, loss of sex drive, and more. If you feel good and are getting around and being active as you age the higher testosterone levels in that manner promote your exercise and this in turn promotes muscle mass retention and on and on and on as one example.

The main thing is for you to BE ABLE to make this decision and have the figures as part of your medical record that will under current rules allow you to have it if you want it in the future.

 

[B_Nick4444]

The rub is to get the insurance folks to pay for them ... I definitely agree that the levels of the various hormones should be measured and documented

just try to find a medical professional to go along, simply because of what the insurance companies will cover, and why

 

[FuzzyKen]

The problem with getting this testing paid for by insurance is partly the insurance companies and partly the MD's themselves. These tests can be paid for as part of a general "physical examination" IF your MD orders them on a routine basis. It is HIS documentation and reasoning that determines what the insurance will pay or deny.

I am going through this right now because the MD screwed up and did not order the two tests at the same time. IF he had there would have been no problem. I had to pay off a $135.00 charge for the second lab test. I am also under an HMO and these are definitely more dificult to deal with than are PPO's with regards to lab work.

Considering you are looking at about $250 for the tests every five years AND that lab prices vary widely you can in fact price around with the labs yourself and just have the MD write the order.

I agree with you that getting this documentation is a pain in the rear, but without great documentation under current prescribing guidelines the doctor cannot prescrible HRT for a male unless he is a "risk taker" and these days few are.

I am going through this personally. My levels are about 20 points above the very bottom cut-off point. I exhibit many of the symptoms of diminished testosterone levels and I still because of the lack of documentation that was destroyed in a fire 20 years ago have no proof that the levels were ever higher and I am not yet able to receive the supplementation I need.

 

[ToBe]

The first thing is to have you understand that you ARE with little doubt going to get an argument from your MD's on this one and they are going to sit like pious idiots with no understanding. Those dealing with HIV will have it better because their MD's bother to understand the endocrinological ramifications of the drugs they prescribe as a whole.

The problem with these standard MD's as individuals is that they themselves rarely understand the rules on male hormone replacement therapy. Because male HRT is relatively new and not taught to everyone unless they themselves sign up for continuing education classes beyond what is required of them, they do not have the new information.

If a patient is suffering from hypogonadism, then testosterone replacement is quite reasonable. If levels are within the normal range, there is no evidence in the literature that raising them to higher levels will relieve symptoms.

Diagnosis of this condition is based on historical, examination, and lab test findings.

Secondly, there are two distinct and separate tests and you need to have both of these in your records not just one.

The first and most common is called a "Serum Testosterone Test" and what this does is to document what you are producing between your testicles and the tiny amount that is produced in your liver. That is the standard test that everyone knows about. The second and actually more important test is "Free Floating Testosterone Test" and that second test shows what you are able to utilize.

You could for example have a very high testosterone level as you age showing normal on the serum test, but your "free-floating" can be in the cellar and this means that you are not able to utilize what you are producing.

Usually, for screening purposes, a total testosterone level is all that is needed. However, one must keep in mind that testosterone levels do fluctuate throughout the day and in general over the course of time. For young men, levels are highest in the morning and usually fall by 25-35% in the evening. As we age, this diurnal variation becomes less profound. Nevertheless, it is recommended to have measurements done at 8 am. Then, if the level is found to be low, the test should be repeated 1 or 2 times to verify the results.

Free Testosterone testing has had its problems over time. There are few different assay types whose results are not comparable. There is an analog method which has been shown to be inaccurate and should not be used anymore. The equilibrium dialysis method is currently the preferred method, but not all laboratores perform it correctly. So, my recommendation is that the equilibrium dialysis method should be used at a laboratory that is proficient in endocrine testing.

The main reason for getting a free T is if one suspects that total T does not accurately reflect one's true bioavailable T. T in the body is either free, bound to SHBG (steroid hormone binding globulin), or weakly bound to albumin. That which is either free or weakly bound to albumin is considered bioavailable. There are a couple of cases where this applies:
*obesity: people tend to have lower total T levels, but normal Free T levels because less T is bound to SHBG. The degree of this phenomenon is proportional to the degree of obesity.
*old age: Slightly more T gets bound to SHBG
*Females with PCOS

Another test that I would recommend is a sperm count. As we know, the end result of having T in our bodies is sperm production. As long as your sperm count is normal, you have enough T in your body. Generally, men with hypogonadism have severe abnormalities in their sperm count.

Surprisingly the MD's most current on all of these different things are those treating advanced HIV infection. Most other MD's do not even know what is going on in this area and that is indeed sad.

Old research has indicated that increasing the DHT level in a man will cause prostatic enlargment. What is strange is that there is some new research coming out of the Scandanavian countries indicating that this research is flawed and that it is an imbalance created by the decrease in testosterone production and it's CORRECT conversion that is the culprit.

If the prostatic argument was absolutely true we should be seeing vastly increased numbers of men receiving HRT in HIV that would be growing prostate glands the size of basketballs. In case most of you have not noticed this is NOT happening. Also of note is that we are NOT seeing HIV patients in constant "roid-rage" and this is something else that is a mystery. The other mystery is that we are not seeing tons of new prostate cancer diagnoses in these men either which is very loudly pointing a finger at some groups stating; "Your research on male hormone administration is to say the least flawed look again."

The current theory is that testosterone and DHT are necessary but not sufficient on their own to cause prostatic enlagement. However, research in the past has shown that people who do not create DHT because of an enzyme deficiency has very small prostates throughout life. However, if you compare men with BPH (benign prostatic hypertrophy) versus men without BPH their blood T and DHT levels do not differ significantly.

Your HIV argument is flawed because the goal of T supplementation is to restore normal levels, whereas athletes abusing steroids achieve supranormal levels of androgens.

You need to start having these two testosterone level tests performed when you are 25 and then at least every 5 years after that age.

In time, I see things changing on male HRT, and it will be the HIV patients who will have paved a road to better health and a longer and satisfying sex life for all of us.

The main thing here is Document! Document! Document! so that you qualify and that any interested regulatory agencies can medically see the decline in production and as a result they will not question your Doctors decision to replace or supplement your hormone production.

Documenting a total testosterone level a couple of times throughout life is harmless and may be useful. The cost is usually about $50 for the test. I am skeptical that documenting Free T over time will yield much benefit, unless a person is obese, in which case the total T may appear low, but he may have sufficient Free T.