Reduced libido and erectile dysfunction, loss of muscle mass and strength, increased fat mass, fatigue, low mood and poor concentration, reduced bone density. The difficulty is that all of these are non-specific: depression, disturbed sleep, sleep apnoea, iron deficiency, hypothyroidism and plain chronic sleep restriction look exactly the same. That is why the test is ordered when symptoms are present, not for everyone.
These rules alone prevent the commonest error: a diagnosis of "low testosterone" based on an evening sample after a working day.
Most circulating testosterone is protein-bound, chiefly to sex hormone binding globulin. The free fraction is the active one. In obesity, diabetes, liver disease and with age the binding protein changes, and total testosterone stops reflecting the real picture — then free testosterone and SHBG are assessed. The work-up also includes LH and FSH, to establish the level of the problem, and prolactin where indicated.
Replacement therapy treats confirmed deficiency; it is not a way to improve athletic performance or general wellbeing at normal levels. It is contraindicated in prostate and breast cancer and requires caution in severe heart failure, significant sleep apnoea and a high haematocrit. Separately: exogenous testosterone suppresses the body's own production and sperm production — men planning children are managed differently.
Weight loss, treating sleep apnoea, restoring sleep and physical activity frequently raise testosterone without any therapy at all. It is the unromantic but most reliable first step, particularly with excess weight — fat tissue actively converts testosterone into oestrogens.
At GMS a urologist-andrologist consultation is AED 600; the full male hormone profile (total and free PSA, total and free testosterone, SHBG, free androgen index) is AED 900 and free testosterone alone AED 250. Lab tests are taken in the same clinic.
This article is for information only and does not replace a consultation. If you have symptoms, see a doctor.
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