Testosterone: Common Questions | Testosterone Test: Total …

Recommended by Dr. Michael White, Published on May 4th, 2016
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1.If I have a low testosterone level, will taking supplemental testosterone help?

Maybe. Testosterone supplements, either with gels, patches or injections, can raise testosterone levels. They may help to relieve some symptoms and/or prevent muscle and bone loss that occurs with aging in men; however, this has not been definitively proven. There is concern that testosterone replacement therapy may exacerbate preexisting prostate cancer, but no evidence of causing cancer. There are label warnings that testosterone administration may result in possible increased risk of heart attack and stroke. Although men with may have low testosterone, in many cases testosterone administration does not improve the symptoms because there are other underlying conditions. Therefore, consult a healthcare practitioner for a medical evaluation and consultation to determine if this is the right therapy for you. Also read the Hormone Health Network's infographic: The Truth About Testosterone Therapy.

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Women's bodies also produce testosterone but in small amounts. It is needed for hormonal balance and to help women's bodies to function normally. If your body is producing too much testosterone, you may have more body hair than average, have abnormal or no menstrual periods, or be infertile. A testosterone test, in conjunction with measuring other hormone levels, can help your healthcare provider to understand what is causing your symptoms.

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The amount, color, and texture of hair is largely determined by genetics. Studies have shown a proportional relationship of testosterone levels to the amount of body hair. The hair growth response to testosterone differs in different parts of the body. Hence, in some men, for example, testosterone promotes hair growth in the abdomen and back while hair growth is suppressed in the scalp, leading to male pattern baldness. Genetics plays a major role in the expression of the 5-alpha reductase, which converts testosterone to the hair-altering compound dihydrotestosterone, leading to a family tendency towards balding. The drug finasteride (Propecia) inhibits the action of 5-alpha reductase and can reverse male pattern baldness in some men.

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Testosterone is present in the blood as "free" testosterone (less than 4%) or bound testosterone (~98%). The latter may be loosely bound to albumin (about one-third), the main protein in the fluid portion of the blood, or bound to a specific binding protein called sex hormone binding globulin or SHBG (about two-thirds). The percentages in the three fractions varies greatly. The binding between testosterone and albumin is not very strong and is easily reversed, so the term bioavailable testosterone (BAT) refers to the sum of free testosterone plus albumin-bound testosterone.

It is suggested that bioavailable testosterone represents the fraction of circulating testosterone that readily enters cells and better reflects the bioactivity of testosterone than does the simple measurement of serum total testosterone. Also, varying levels of SHBG can result in inaccurate measurements of bioavailable testosterone. Decreased SHBG levels can be seen in obesity, hypothyroidism, androgen use, and nephritic syndrome (a form of kidney disease). Increased levels are seen in cirrhosis, hyperthyroidism, and estrogen use. In these situations, measurement of free testosterone may be more useful.

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